title: Changes in genital anatomy and microbiology in girls between age 6 and age 12 years: a longitudinal study.
abstract: OBJECTIVE
  To study changes in genital anatomy and occurrence of human papillomavirus and Gardnerella vaginalis in girls resulting from growth and development.
  
  
  METHODS
  At age 11-12 years, an invitation was sent to 180 girls to attend a follow-up examination. All girls had previously participated in a study exploring anogenital anatomy and microbiology in children selected for non-abuse at age 5 and 6. The genital area was examined with a colposcope and microbiological samples for Gardnerella vaginalis (GV) and human papillomavirus (HPV) were collected. GV was identified by conventional criteria and HPV by a PCR method.
  
  
  RESULTS
  Thirty-one girls were examined twice, at mean age 5.7 and 12.0 years. At first examination all were pre-pubertal. At second examination 21 girls were B2/P2 or above. Significantly more girls had developed a structure called a fossa groove. A thick and redundant hymen with a tendency of folding outward was more common at the second examination. Two girls had GV and one girl had HPV-16 identified. Another girl was classified to have a deep notch and a probable transection in her hymen, and this girl reported a painful insertion of a tampon. All girls denied sexual activity.
  
  
  CONCLUSIONS
  The main genital finding in girls entering puberty is the hymen becoming thick and redundant with a tendency of folding out. In the study findings associated with sexual activity were discovered in two girls, and the possibility of alternative explanations is discussed.
authors: Resource Centre about Violence, Traumatic Stress and Suicide Prevention, St. Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway. arne.k.myhre@ntnu.no
authors: Arne K
authors: AK
authors: Myhre
authors: Kirsti
authors: K
authors: Myklestad
authors: Joyce A
authors: JA
authors: Adams
mesh_terms: D052685:Alphapapillomavirus / Q000302:isolation & purification; D001003:Anal Canal / Q000382:microbiology; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis; D002657:Child Development; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology* / Q000254:growth & development; D008137:Longitudinal Studies; D011627:Puberty / Q000502:physiology; D012016:Reference Values; D014621:Vagina / Q000033:anatomy & histology / Q000382:microbiology*