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At least 19 recordsLinked to original sources
PubMed2002

Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings.

STUDY OBJECTIVE: To review all existing studies of genital anatomy in girls selected for nonabuse, clarify terminology used to describe hymenal morphology and nonspecific findings, and test consensus terminology in the reevaluation of hymenal morphology and nonspecific findings in 147 premenarchal girls selected for nonabuse. METHODS: Over six months, the authors identified and evaluated 147 premenarchal girls without history of sexual abuse who were referred for gynecological examination. Parents and patients were screened for possible abuse or significant past medical or behavioral history, and each girl was interviewed and then received a complete examination including a genital examination documented by colposcopy with both 35 mm camera and video capabilities. Using established terminology(1) each case was then independently reviewed and hymenal morphology and nonspecific findings documented. RESULTS: The study population consisted of 147 premenarchal girls; 76.9% were Hispanic, 12.3% African-American, and 10.3% Caucasian. Subjects had a mean age of 63 months (+/minus sign 38). Hymenal configurations included: annular (concentric) 53%, crescentic (posterior rim) 29.2%, sleeve-like (redundant) 14.9%, septate 2%, and other (imperforate, cribriform) < 1%. Nonspecific findings included peri-hymenal bands, 91.8%; longitudinal intravaginal ridges, 93.8%; hymenal tags, 3.4%; hymenal bumps/mounds, 34%; linea vestibularis, 19%; ventral hymenal cleft/notch at 12 o'clock in 79% of annular or redundant hymens; ventral cleft/notch not at 12 o'clock, 19%; failure of midline fusion, 0.6%; hymenal opening size > 4 mm, 30.6%; erythema, 48.9%; change in vascularity, 37.4%; labial adhesions, 15.6%; posterior hymenal notch/cleft (partial), 18.3%; posterior notch/cleft (complete), 0%; posterior hymenal concavity or angularity, 29.5%. In addition, each case was assessed for the presence of a thickened (45.5%) or irregular (51.7%) and narrowed (22.4%) hymenal edge. Each case was also reviewed for exposed intravaginal anatomy (93%). CONCLUSIONS: The authors concluded that improved techniques and photo documentation have provided examiners with a better understanding of hymenal morphology and that nonspecific genital findings are commonly found in a population of girls selected for nonabuse. A thorough understanding of normal studies and a consistent application of established terminology can prevent the misinterpretation of nonspecific or congenital findings as posttraumatic changes.

Adolescent↗
PubMed1986

Types of hymen in the newborn infant.

The incidence of various types of hymenal shape, its orifice and their interference with spontaneous vaginal discharge were investigated during the routine physical examination of 333 female infants within the first 24 h of life. A smooth hymen with a central orifice was observed in 53.5% of the female neonates, a folded hymen with a central orifice in 27.3%; folded hymen with eccentric orifice in 4.5%; an anterior opening of the hymen in 10.8%; posterior opening in 0.6%; hymenal band in 3%; almost imperforate hymen in 0.3% of the newborns. The presence of anterior opening, posterior opening, hymenal band or almost imperforate hymen may interfere with free vaginal discharge. A ruffled, irregular hymen and a hymenal band require a careful investigation for other genital malformations.

Female↗
PubMed2003

Treatment of imperforate hymen by application of Foley catheter.

OBJECTIVE: To treatment of patients with imperforate hymen without damaging the structure of hymen. MATERIALS AND METHODS: Foley catheter was applied to 15 patients with the history of pelvic pain and diagnosed as imperforate hymen in Department of Obstetric and Gynecology, Faculty of Medicine, Selcuk University, between 1 January 1996 and 25 December 2000. After performed oval-centralize closure on imperforate hymen membranes, Foley catheter was inserted through closure of hymen and then balloon of Foley catheter was insufflated 10 cm(3). Catheter was removed after 2 weeks. RESULTS: Mean age of patients was 14.3+/-2.6. After procedure, closure of hymen was open. Hymen was seen annular and intact. Following the patients, closing of the closure of hymen was not seen. After marriage of six patients, hymeneal bleeding and defloration was seen in all of them. Ceftriaxon (Rocephin, Roche, Istanbul) 1g was given to all patients only one dose as prophylactic antibiotheraphy. Any pelvic and vaginal infection were not seen due to this procedure during follow up. CONCLUSION: This new technique is less invasive than other methods and prevents many social problem by preventing destruction of the architecture of hymen and providing annular-intact hymeneal ring.

Adolescent↗
PubMed1992

Appearance of the hymen in prepubertal girls.

The recent increase in requests for genital examinations in girls who may have been sexually abused has necessitated detailed information not previously available on normal anatomy of the prepubertal girl. This study was undertaken to document the genital anatomy of 211 girls between the ages of 1 month and 7 years who presented for well child care or nongynecologic complaints and who had no history of sexual abuse. Each child's genitalia was examined and photographed, with findings reported reflecting those observed photographically. The study population consisted of 36% blacks, 33.6% white non-Hispanics, 29.9% Hispanics, and 0.5% Asians. Subjects had a mean age of 21 +/- 20.6 (SD) months. Extensive labial agglutination sufficient to obscure the hymen was noted in 5% (10/211) and partial agglutination in an additional 17% (35/211). A significant difference was noted in hymenal configuration by age, with a fimbriated hymen the most common type (46%) in infants aged 12 months or younger and a crescentic hymen the most common (51%) in girls older than 24 months (P less than or equal to .001). No significant difference was noted in hymen configuration by race. Hymenal bumps (mounds) were observed in 7%, hymenal tags in 3%, vestibular bands in 98%, longitudinal intravaginal ridges in 25%, and external ridges in 15% of subjects in whom the anatomy under study could be visualized. Hymenal notches (clefts) occurred superiorly and laterally on the hymenal rim but none were found inferiorly on the lower half of the hymen. A narrow rounded hymenal ring with a transection was observed in only 1 (0.5%) of 201 subjects and was not considered a normal finding.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed2003

Adolescent Foley catheter technique for visualizing hymenal injuries in adolescent sexual assault.

OBJECTIVES: To determine the usefulness of the Foley catheter balloon technique for visualizing injuries of the estrogenized hymen in adolescent sexual assault victims compared with supine labial traction. METHODS: A prospective clinical trial of 20 adolescent (age 13-16 years old) victims of sexual assault evaluated at a free-standing Nurse Examiner Clinic was conducted over a four-month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection, using supine labial traction, to photodocument hymenal abnormalities. Photographs of the hymen were obtained using the labial traction technique and then with the Foley technique. Three emergency physicians independently examined each pair of photographs with high interrater agreement for the presence of injury (kappa = 0.88). RESULTS: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14.8 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in three patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in nine additional cases (60%). The common injuries to the hymen included lacerations (30%), followed by ecchymosis and abrasions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. CONCLUSIONS: The Foley catheter balloon technique is a simple method allowing improved photodocumentation of hymenal trauma in adolescent sexual assault victims compared with supine labial traction.

Adolescent↗
PubMed2004

Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse.

OBJECTIVE: To compare the morphology of the hymen in adolescent girls who have and have not had sexual intercourse involving penile-vaginal penetration. SUBJECTS: Female patients aged 13 to 19 years, recruited from an urban adolescent medicine practice. METHODS: Subjects were interviewed in private after completing detailed questionnaires and then underwent a physical examination. External genital inspections were performed using a colposcope with an attached 35-mm camera to document the appearance of the hymen. The presence of notches or clefts was recorded during the examination, and photographs taken at x10 magnification were used to take measurements of the width of the posterior hymenal rim. RESULTS: Posterior hymenal notches and clefts were more common among girls admitting past intercourse (13/27 [48%]) than in girls who denied intercourse (2/58 [3%]; P =.001), but the mean width of the posterior hymenal rim was not significantly different between the 2 groups (2.5 mm vs 3.0 mm; P =.11). Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion. CONCLUSIONS: Deep notches or complete clefts in the posterior rim of the hymen were rare in girls who denied intercourse. Subjects who admitted past intercourse still had nondisrupted, intact hymens in 52% of cases.

Adolescent↗
PubMed2000

Dominant transmission of imperforate hymen.

OBJECTIVE: Imperforate hymen is an uncommon anomaly of the reproductive tract, occurring in approximately 0.1% of newborn females. The familial occurrence of imperforate hymen in a child, her mother, and her mother's monozygotic twin is reported. DESIGN: Case report. SETTING: Academic medical center. PATIENT(S): Three affected family members. MAIN OUTCOME MEASURE(S): Karyotype and pedigree analysis. RESULT(S): The proband, presenting with peritonitis, was evaluated at age 12 for imperforate hymen because this condition was diagnosed in her mother at age 14. At age 14, the mother's monozygotic twin was asymptomatic except for primary amenorrhea and was also demonstrated to have imperforate hymen. No other reproductive system abnormalities were known to be present in the remaining family members. Chromosomal structural analysis confirmed that the mother of the proband had no chromosomal abnormalities. CONCLUSION(S): The occurrence of imperforate hymen in two consecutive generations of a family is consistent with a dominant mode of transmission, either sex-linked or autosomal. Previously reported examples of siblings with imperforate hymen suggested a recessive mode of inheritance. Taken together, these cases suggest that imperforate hymen can be caused by mutations in several genes. This case highlights the importance of evaluating all family members of affected patients. Familial examples of other developmental anomalies of the female reproductive tract also suggest a multifactorial genetic etiology.

Adult↗
PubMed1987

A simulated "acquired" imperforate hymen following the genital trauma of sexual abuse.

Imperforate hymen, a condition in which the hymen has no aperture, usually occurs congenitally, secondary to failure of development of a lumen. A case of a documented simulated "acquired" imperforate hymen is presented in this article. The patient, a 5-year-old girl, was the victim of sexual abuse. Initial examination showed tears, scars, and distortion of the hymen, laceration of the perineal body, and loss of normal anal tone. Follow-up evaluations over the next year showed progressive healing. By 7 months after the injury, the hymen was replaced by a thick, opaque scar with no orifice. Patients with an apparent imperforate hymen require a sensitive interview and careful visual inspection of the genital and anal areas to delineate signs of injury. The finding of an apparent imperforate hymen on physical examination does not eliminate the possibility of antecedent vaginal penetration and sexual abuse.

Anus Diseases↗
PubMed2002

Use of hymenal measurements in the diagnosis of previous penetration.

OBJECTIVE: To determine the usefulness of measurements of the vaginal opening and amount of hymenal tissue present inferiorly and laterally in the diagnosis of vaginal penetration. METHODS: The transhymenal diameters and the amount of tissue present between the hymenal edge and vestibule inferiorly at 6 o'clock and laterally at 3 o'clock and 9 o'clock were measured from photographs of 189 prepubertal children with a validated history of digital or penile penetration and 197 children who denied previous sexual abuse. Statistical analyses were conducted to compare the mean values and hymenal symmetry between groups as well as to determine the sensitivity and specificity of various cutoff points. RESULTS: Comparison of the mean diameters demonstrated that children with a penetration history had a significantly larger transverse opening than nonabused children when examined in the knee-chest position (5.6 vs 4.6 mm). However, there was extensive overlap in measurements between the 2 groups. No significant differences were noted between groups in the size of the vertical diameter, the amount of tissue present inferiorly or laterally, or the symmetry of the hymen in either position. Children with previous penetration were more likely than nonabused children to have a horizontal opening measuring >6.5 mm in the knee-chest position, but the sensitivity and specificity of this test were low (29% and 86%, respectively). Higher values had better specificity but very low sensitivity. Less than 1.0 mm of hymenal tissue was detected at 6 o'clock only in those with a history of penetration (100% specificity), but the sensitivity was low (1%-2%). CONCLUSION: Most hymenal measurements lack adequate sensitivity or specificity to be used to confirm previous penetration. Less than 1.0 mm of hymenal tissue at 6 o'clock was detected only in victims of abuse, but the usefulness of this test is limited by the rarity of this finding.

Child↗
PubMed2002

The adolescent hymen.

The genital examination is not a routine part of health maintenance assessment in prepubertal and pubertal girls. However, evaluation of minors for suspected sexual abuse has been addressed extensively in the last two decades. In spite of this, normal anatomic variations and developmental changes are not fully investigated. This paper reviews current knowledge about the hymen, with a focus on puberty and adolescence. More is known about the external genitals of prepubertal children than of adolescent girls. No longitudinal studies have been performed among girls older than age 3. Tanner staging does not include detailed genital development. A variety of terms have been used to describe the configuration and/or distortion of the hymen: attenuation, clefts, tears and transections, bumps and notches. No studies have been published on the normal variations of the width of the hymenal rim, although an attenuated and/or narrow rim is categorized as consistent with penetrative sexual abuse according to an international consensus statement. Critiques of the literature on the hymen have been published by experts on forensic medicine, emphasizing the fact that the normal hymenal appearance in adolescents still is not well documented. Few studies on hymenal configuration in nonabused adolescent girls have been performed, including girls with and without experience of consensual vaginal intercourse and use of tampons. Longitudinal investigations are required for a better knowledge of female genital development during puberty, with a special focus on vulvar and hymenal anatomy.

Adolescent↗
PubMed1991

Appearance of the hymen in newborns.

This study was undertaken to evaluate the genital anatomy of female newborns. Hymenal configuration and the number and location of clefts, bumps, tags, and ridges were observed in 468 neonates; photographs for confirmation were obtained for 449 neonates (96%). Hymenal configurations observed included an annular hymen with a central or ventrally displaced orifice in 80% (372/468) of neonates, a fimbriated hymen in 19% (90/468), and a septated or cribriform hymen in 1% (6/468). Configurations significantly differed by race (P less than .001) but no difference was noted by gestational age or weight. Clefts, which occurred only on the ventral 180 degrees of the rim, were observed in 34% of neonates with an annular hymen. Fifty-six percent of neonates had a longitudinal intravaginal ridge, 87% had an external hymenal ridge, and 13% had a tag extending from the rim or a ridge. Periurethral ligaments were frequently observed. It is concluded that lateral and ventral clefts, intravaginal and external ridges, and periurethral bands are normal anatomical findings in the newborn.

Female↗
PubMed1993

Appearance of the hymen at birth and one year of age: a longitudinal study.

The increase in the number of prepubertal girls who require evaluation of possible sexual abuse creates a need for detailed information, not previously available from cross-sectional studies, on the influence of aging on the hymen's appearance. This study was undertaken to evaluate and document, using a longitudinal design, changes in the hymen's morphology in 62 girls without a history of sexual abuse between birth and their first birthday. Labial agglutination extensive enough to obscure the inferior half of the hymen was observed in 5 girls (8%) at 1 year of age. Thirty-three (58%) of the remaining 57 infants experienced a marked decrease in the amount of their hymenal tissue between birth and 1 year. Significantly more infants at 1 year of age had a crescentic configuration (0% vs 28%), and significantly fewer had an external ridge (82% vs 14%) as compared to the newborn period. An annular hymen with a central or ventrally displaced opening progressed to a crescentic hymen in 13 children by 1 year, 77% (10/13) of whom were observed to have a notch (cleft) at the 12 o'clock position on the earlier study. A superior notch appeared for the first time in 9 girls. Lateral notches resolved in 5 cases and persisted in 2. Inferior notches between the 4 and 8 o'clock positions were not observed at birth or 1 year. Hymenal tags resolved in 2 instances, persisted in the same location in 2, and appeared for the first time in 4 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1975

Position of rectal fistula in relation to the hymen in 46 girls with imperforate anus.

Forty-six records of infant girls with so-called imperforate anus have been reviewed to determine the position of the rectal opening in relation to the hymen. Eight of these children proved to have the cloacal deformity, in which the rectum enters high into a single tube and just behind the opening of a double or septate vagina, with the urethra entering anteriorly at the same level. No normal hymen was visible in these eight children. Seventeen patients had a normal-appearing hymen, and no rectal opening on the perineum. In each of these 17 children the rectal opening was found above the tissue flap overlying the posterior vestibule. In the remaining 21 patients, the hymen was visible and appeared normal, and there was a rectal opening somewhere on the perineum between the vestibule and the normal position for the external sphincters. These findings suggest that in the presence of a normal-appearing hymen, and in the absence of a normal anus, the rectal opening will be either in the posterior part of the vestibule or on the perineum. Where no hymen was visible, we have found in a limited experience that the rectal opening was high in the pelvis in some degree of the so-called cloacal deformity.

Anus, Imperforate↗
PubMed2001

The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse.

OBJECTIVE: To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old. METHODS: Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse. RESULTS: The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position. CONCLUSION: Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?"

Biomarkers↗
PubMed1997

Use of Foley catheter to examine estrogenized hymens for evidence of sexual abuse.

An examination technique for the collection of evidence to document physical findings of sexual abuse of children uses a Foley catheter in older girls with estrogenized hymens. The inflated balloon in the distal vaginal vault puts pressure on the hymen, effectively stretching it out and allowing for a more accurate view of the hymen edges. This report demonstrates the results in 2 of 17 adolescent girls who underwent the Foley catheter stretch technique. Patient 1 was a 13-year-old girl who gave a statement of repeated sexual abuse, including penile penetration by an adult male. Patient 2 was a 12-year-old girl who disclosed a single episode of sexual assault 1 year previously. After careful examination, a Foley catheter (14 Fr) was inserted through the hymen orifice and inflated using 40 ml of air. Gentle pulling toward the orifice resulted in stretching of the hymenal tissues over the balloon surface of the catheter. After photodocumentation of the anatomy of the hymen edges, the balloon was deflated and removed.

Adolescent↗
PubMed1995

Prenatal diagnosis of congenital imperforate hymen.

BACKGROUND: Congenital imperforate hymen is an external urogenital anomaly that has a small differential diagnosis. With careful antenatal sonographic evaluation of the female perineum, identification of a thin protruding membrane consistent with imperforate hymen can be made. CASE: We report a case in which an imperforate hymen was diagnosed in a fetus at 25 weeks' gestation. It appeared as a thin membrane that distended the vagina and spread the labia majora because of retained secretions. An associated renal abnormality was present, representing either a right multicystic dysplastic kidney or cystic dysplasia. CONCLUSION: Imperforate hymen and hydrocolpos can be diagnosed as early as the second trimester. Because of the additional renal anomaly in this case, it is suggested that the presence of prenatally diagnosed imperforate hymen warrants a careful survey of the remaining fetal anatomy to rule out associated abnormalities. The possibility of a familial occurrence should be considered, and the appropriate history should be obtained.

Abnormalities, Multiple↗
PubMed1998

Can tampon use cause hymen changes in girls who have not had sexual intercourse? A review of the literature.

Since tampon availability has become ubiquitous, several authors have opined about their effect on the virginal hymen, but only one paper has scientifically addressed the subject of tampon use and clefts in the hymens of never-sexually-active adolescent girls. It naturally has become an authority used by the courts. The Emans et al. (1994) study asserts that 'for physicians testifying in court about sexual assault cases, complete clefts in adolescents cannot be attributed to prior tampon use'. On closer inspection, however, it appears that the authors have interpreted their statistical finding using a strict scientific convention (chi 2, P = 0.06 as not having statistical significance) that may mislead in a clinical or legal situation. Indeed, there is a definite possibility that tampon use compared to not having used tampons in their never-sexually-active sample was associated with an increased percentage of complete hymenal clefts (14% vs. 6%; P = 0.06). Nevertheless, clefts were found in both the sexually active and the never-active groups: 20 of their 200 never-sexually-active subjects possessed complete hymenal clefts, as did only 84 of their 100 sexually active subjects. Caution should be used by all physicians asked to testify in courts regarding possible causes of a hymenal cleft.

Adolescent↗
PubMed2002

A longitudinal study of hymenal development from 3 to 9 years of age.

PURPOSE: To document hymenal characteristics associated with normal development in girls between 3 and 9 years of age. STUDY DESIGN: The hymens of 93 children without a history of sexual abuse were examined and photographed at 3 and 5 years of age; 80 children were reexamined at 7 and 61 at 9 years of age. Hymenal features recorded included periurethral and vestibular bands, notches, transections, longitudinal intravaginal ridges, external ridges, mounds, and tags. Transhymenal diameters were measured as well as the tissue at 3, 6, and 9 o'clock positions. Changes in hymenal measurements over time were analyzed using the general estimating equation approach to repeated measures. RESULTS: Crescentic configuration became more common as the children aged (P <.01). The number of mounds and intravaginal ridges observed per child as well as the size of the transhymenal diameter increased as the sample aged. The mean amount of tissue at the 6 o'clock position significantly changed over time (P <.01). However, no significant changes were observed in the number of tags, periurethral or vestibular bands, notches, external ridges, or amount of tissue present at the 3 or 9 o'clock position. CONCLUSIONS: Few changes occur in the morphologic features of the hymen between 3 and 9 years of age.

Anthropometry↗