Hymenal morphology in children and adolescents following penile-vaginal penetration

Abstract

The hymenal injuries in adolescents due to penile penetration is more common and more severe than in adults because of the lack of sexual and child birth experience. In a case of rape which has occurred within few days, the medical professional can identify the injuries on genitalia which are supportive of vaginal penetration. But if the child presents at a later stage there may not be any injury or scar to prove sexual abuse. The paper reviews the contribution of the different examination techniques in identifying the hymenal injuries, different features of an intact hymen, injuries and healing process, which can be expected if the hymen has been penetrated on adolescent children. The appearance of the normal hymen, hymenal injuries healing process of adolescents are not well documented except deep lacerations and transection through the posterior hymen which leaves evidence of previous injury. Most of the publications conclude with stressing the importance of recording the detailed statement given by the child as medico legal diagnosis of alleged non-acute cases of sexual abuse. Therefore obtaining a detailed history of the incident which is the standard duty of care in managing a victim of sexual abuse is as important as recording and interpretation of the hymenal injuries to help the law to make a judicial judgment. The words like no evidence of penetration, normal hymen and intact hymen should be used with caution.