title: Sexual assault in prepubertal girls: 'It is normal to be normal' - or is it? Evidence of vaginal penetration in prepubertal girls.
abstract: Study objective The purpose of this study is to evaluate the long-term effects of penile vaginal penetration in prepubertal girls. The specific emphasis is on whether there would be visible identifiable medical evidence of penetration on examinations done months or years after the event.  Literature review The medical literature regarding this subject was reviewed specifically for defendable evidence supporting a statement that there would be no findings as well as those that suggested that there would be visible evidence of trauma. Specific definitions of sexual assault, visible anatomic change from trauma, and sexual penetration are established for clarity. The effect of the lack of estrogen on the genital tissue of prepubertal girls is reviewed in relationship to the potential effects of trauma. The average diameters of the hymenal opening in this age group and the diameter of the erect male penis were reviewed.  Conclusion The result of the study both from review of the medical literature and an understanding of the anatomy and histology of the unestrogenized genitalia of the prepubertal girl makes it clear that if there has been forceful penile penetration of the hymen there will be both a history of pain and bleeding and healed evidence of this forceful penetration.
authors.affiliation: California Forensic Medical Training Center, Sacramento, CA, USA. Tnh1@earthlink.net
authors.forename: Theodore N
authors.initials: TN
authors.lastname: Hariton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005836:Genitalia, Female / Q000293:injuries; D058869:Gynecological Examination; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology / Q000293:injuries*; D007223:Infant; D008297:Male; D010413:Penis / Q000033:anatomy & histology; D011902:Rape; D014945:Wound Healing