title: Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and nonspecific findings.
abstract: 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.
authors.affiliation: LAC+USC Violence Intervention Program, Department of Pediatrics, University of Southern California, Keck School of Medicine, California, Los Angeles 90033, USA. aheger@aol.com
authors.forename: Astrid H
authors.initials: AH
authors.lastname: Heger
authors.forename: Lynne
authors.initials: L
authors.lastname: Ticson
authors.forename: Lisa
authors.initials: L
authors.lastname: Guerra
authors.forename: Julie
authors.initials: J
authors.lastname: Lister
authors.forename: Toni
authors.initials: T
authors.lastname: Zaragoza
authors.forename: Gina
authors.initials: G
authors.lastname: McConnell
authors.forename: Mary
authors.initials: M
authors.lastname: Morahan
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D005260:Female; D005836:Genitalia, Female / Q000033:anatomy & histology; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology* / Q000473:pathology