Adolescent Foley catheter technique for visualizing hymenal injuries in adolescent sexual assault.
OBJECTIVE
To determine the usefulness of the Foley catheter balloon technique for visualizing injuries of the estrogenized hymen in adolescent sexual assault victims compared with supine labial traction.


METHODS
A prospective clinical trial of 20 adolescent (age 13-16 years old) victims of sexual assault evaluated at a free-standing Nurse Examiner Clinic was conducted over a four-month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection, using supine labial traction, to photodocument hymenal abnormalities. Photographs of the hymen were obtained using the labial traction technique and then with the Foley technique. Three emergency physicians independently examined each pair of photographs with high interrater agreement for the presence of injury (kappa = 0.88).


RESULTS
Twenty adolescent sexual assault victims volunteered for the study; mean age was 14.8 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in three patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in nine additional cases (60%). The common injuries to the hymen included lacerations (30%), followed by ecchymosis and abrasions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon.


CONCLUSIONS
The Foley catheter balloon technique is a simple method allowing improved photodocumentation of hymenal trauma in adolescent sexual assault victims compared with supine labial traction.
Jones
Jeffrey S
JS
Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus 49503, USA. jeffjones44@attbi.com
Dunnuck
Chris
C
Rossman
Linda
L
Wynn
Barbara N
BN
Genco
Michael
M
D000293:Adolescent; D002404:Catheterization / Q000379:methods; D004630:Emergencies; D005260:Female; D006801:Humans; D006924:Hymen / Q000293:injuries*; D010865:Pilot Projects; D011446:Prospective Studies; D012742:Sex Offenses; D016896:Treatment Outcome; D014754:Violence