title: A case-control study of anatomic changes resulting from sexual abuse.
abstract: OBJECTIVE
  Our goal was to identify vulvar and hymenal characteristics associated with sexual abuse among female children between the ages of 3 and 8 years.
  
  
  METHODS
  Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetration and 200 children who denied prior abuse. Bivariate analyses were conducted by chi(2), the Fisher exact test, and the Student t test to assess differences in vulvar and hymenal features between groups.
  
  
  RESULTS
  Vaginal discharge was observed more frequently in abused children (P =.01). No difference was noted in the percentage of abused versus nonabused children with labial agglutination, increased vascularity, linea vestibularis, friability, a perineal depression, or a hymenal bump, tag, longitudinal intravaginal ridge, external ridge, band, or superficial notch. Furthermore, the mean number of each of these features per child did not differ between groups. A hymenal transection, perforation, or deep notch was observed in 4 children, all of whom were abused.
  
  
  CONCLUSIONS
  The genital examination of the abused child rarely differs from that of the nonabused child. Thus legal experts should focus on the child's history as the primary evidence of abuse.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston 77555-0587, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Berenson
authors.forename: M R
authors.initials: MR
authors.lastname: Chacko
authors.forename: C M
authors.initials: CM
authors.lastname: Wiemann
authors.forename: C O
authors.initials: CO
authors.lastname: Mishaw
authors.forename: W N
authors.initials: WN
authors.lastname: Friedrich
authors.forename: J J
authors.initials: JJ
authors.lastname: Grady
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology* / Q000473:pathology; D015994:Incidence; D012016:Reference Values; D012742:Sex Offenses; D019522:Vaginal Discharge / Q000453:epidemiology; D014844:Vulva / Q000033:anatomy & histology*