title: Genital findings in prepubertal girls evaluated for sexual abuse. A different perspective on hymenal measurements.
abstract: OBJECTIVE
  To evaluate the usefulness of the horizontal transhymenal diameter as a screening parameter to differentiate between prepubertal girls with and without other definitive signs of sexual abuse.
  
  
  METHODS
  Case comparison study using transhymenal measurements as a diagnostic screening test referenced against prior publications of criterion standards.
  
  
  METHODS
  A primary care (family practice) clinic in association with an academic program in northern California.
  
  
  METHODS
  A consecutive, referred sample of 1058 prepubertal girls aged 6 months to 10 years who were examined as allegedly having been sexually molested between 1987 and 1994.
  
  
  RESULTS
  Girls with no definitive signs of genital trauma exhibited a mean transhymenal diameter of 2.3 mm and in general showed an increase of approximately 1 mm per year of age. Girls with definitive signs of genital trauma exhibited a mean transhymenal diameter of 9.0 mm and no significant variance with age. Correcting for age differences, the transhymenal diameter was highly significant as a differentiating factor (F = 1079, P < .001). When compared against the criterion standard, the transhymenal measurement is 99% specific and 79% sensitive as a screening tool.
  
  
  CONCLUSIONS
  Although not independently diagnostic of sexual molestation, the transhymenal diameter, when compared against the criterion standard for age, is a useful screening parameter for primary care physicians evaluating children of potential sexual abuse.
authors.affiliation: M.H.S. Family Practice Residency Program, Methodist Hospital of Sacramento, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Pugno
mesh_terms: D002140:California; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology / Q000293:injuries*; D007223:Infant; D011627:Puberty