ABSTRACT
A 6-year-old girl had been referred to the children’s advocacy centre for a complete medical evaluation for suspected sexual abuse. She disclosed that her mother’s boyfriend put his ‘private parts’ into her private parts. The last time the mother’s boyfriend was at their home was 4 months ago. She was initially seen by her paediatrician who described her hymen as ‘not normal’. Examination reveals the finding seen (Image 6a). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig6a.jpg"/>
What are the genital finding?
Would this finding be consistent with her disclosure of sexual abuse?
12Erythema and urethral dilation are seen. Examination as shown in the photo revealed otherwise normal labia majora, labia minora, clitoral hood and urethra. A persistent septal remnant was suspected at 6 o’clock. To further assess this, the labia were gently separated, revealing that the suspected septum was a hymenal tag (Image 6b). In prepubertal girls, the hymen is sensitive to touch, thus different exam techniques are used to confirm findings. Labial separation and labial traction may be used in the supine position. Examination in the prone knee-chest position may be done as well. In menarchal females, the estrogenized hymenal tissues are less sensitive and a Q-tip or swab may be used to demonstrate the septum to confirm the findings. In the presence of a septum, it is important to differentiate the finding from a vaginal duplication, which will require additional intervention.
A hymenal tag is considered a normal finding and may be present in normal female newborns. 1 , 2 Tags are commonly located in the superior and inferior positions and tend to resolve spontaneously. New hymenal tags may appear postnatally as a result of extension of an intravaginal or external hymenal ridge. This examination is consistent with the child’s disclosure of sexual abuse. This may be due to either the sexual abuse not causing any injuries or the initial injury healing at the point of examination especially in this child where sexual abuse last occurred 4 months prior to her examination.
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