Genital findings in prepubertal girls selected for nonabuse: a descriptive study.
This project was designed to collect normative data on the genital anatomy from a sample of nonabused prepubertal girls. A total of 114 girls between the ages of 10 months and 10 years were examined and photographed with a colposcope. After screening for the onset of puberty and the possibility of undetected abuse, 93 subjects remained. Examination techniques included a supine labial separation approach, a supine labial traction method, and a prone knee-chest position. Common genital finding included erythema of the vestibule (56%), periurethral bands (50.6%), labial adhesions (38.9%), lymphoid follicles on the fossa navicularis (33.7%), posterior fourchette midline avascular areas (25.6%), and urethral dilation with labial traction (14.9%). The hymenal orifice opened more frequently during the knee-chest (95.2%) and the labial traction (90.5%) methods than with the supine separation (79.3%) approach. Hymenal findings included mounds (33.8%), projections (33.3%), and "septal remnants"/midline hymenal tags (18.5%). Intravaginal findings of vaginal ridges (90.2%) and rugae (88.7%) were found primarily through the labial traction approach. The cervix was visualized without the use of speculum in 69% of the children during the knee-chest examination. Unusual findings included posterior fourchette friability (4.7%), anterior hymenal clefts (1.2%), and notches of the hymen (6%). One child had an imperforate hymen (1.2%) and 2 (2.5%) had hymenal septa. A vaginal discharge was detected in 2 (2.6%) and a foreign body in 1 (1.3%). Tables that include the vertical and horizontal hymenal orifice diameters by age group and by method are presented.
McCann
J
J
Department of Pediatrics, Valley Medical Center, University of California, San Francisco 93702.
Wells
R
R
Simon
M
M
Voris
J
J
D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000473:pathology; D002675:Child, Preschool; D003127:Colposcopy / Q000379:methods; D005260:Female; D005836:Genitalia, Female / Q000033:anatomy & histology*; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology; D007223:Infant; D011627:Puberty; D012016:Reference Values; D012727:Sex Characteristics; D009626:Terminology as Topic; D014621:Vagina / Q000033:anatomy & histology; D014844:Vulva / Q000033:anatomy & histology