Vaginal introital diameter in the evaluation of sexual abuse.
Physical objective markers to aid in the diagnosis of sexual abuse are few. We therefore studied 242 females, ages 1 through 12 years, to determine if the vaginal introital diameter is useful in evaluating a child for sexual abuse. The children were divided into three groups: Group I, history of sexual contact and/or Neisseria gonorrhoeae; Group II, no history of sexual contact but at risk; and Group III, nonabused. A vaginal introital transverse diameter of greater than 4 mm was more prevalent among children in Group I (94%) than in Group II, (5%); or in Group III (0%) (chi 2, p less than .001). Eighty-eight percent of children who complained of penile-vaginal penetration had a vaginal introital diameter greater than 4 mm as compared to 18% of children with no penetration (chi 2, p less than .001). Forty-six percent of children who complained of fondling with penetration had a vaginal introital diameter of greater than 4 mm as compared to 14% in those without a history of penetration (chi 2, p less than .008). Fifty-eight percent of children with more than one encounter had a vaginal introital diameter greater than 4 mm as compared to 29% in those with one encounter (chi 2, p less than .006). In a logarithmic regression analysis, the greatest proportion of children with a vaginal introital diameter greater than 4 mm was observed in the penile-vaginal contact group (chi 2, p less than .00003). The test is not very sensitive but highly specific. The sensitivity drops precipitously at greater than 5 mm without losing the specificity. A vaginal introital diameter of greater than 4 mm is highly associated with sexual contact in children less than 13 years of age.
White
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Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill.
Ingram
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Lyna
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D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000331:legislation & jurisprudence; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D007223:Infant; D010808:Physical Examination / Q000379:methods*; D012016:Reference Values; D012749:Sexually Transmitted Diseases / Q000175:diagnosis; D014481:United States; D014621:Vagina / Q000293:injuries*