Imperforate Hymen: Clinical Pearls and Implications of Management.

Imperforate hymen is a common condition that with classic appearance and presentation in puberty. This may be diagnosed in a neonate when mucocolpos is noted. There are many great pretenders of this condition, but the hallmarks include a bulging hymen with blue hue at puberty. If this is not seen on external genital exam, the provider should proceed with magnetic resonance imaging to better assess the reproductive tract anatomy before engaging in surgery. For providers uncomfortable in managing conditions often confused with an imperforate hymen, referral to a Pediatric and Adolescent Gynecologist or specialist comfortable managing these conditions, is recommended.

The little tissue that couldn't - dispelling myths about the Hymen's role in determining sexual history and assault.

Conclusions about women's and girls' sexual history are made in some settings based on assumptions about the hymen, a small membranous tissue with no known biological function, which typically occupies a portion of the external vaginal opening in females. Clinicians, however, continue to refer to changes in the hymen to assess for a history of consensual or nonconsensual sexual intercourse. We reviewed published evidence to dispel commonly held myths about the hymen and its morphology, function, and use as evidence in cases of sexual violence.An examination of the hymen is not an accurate or reliable test of a previous history of sexual activity, including sexual assault. Clinicians tasked with performing forensic sexual assault examinations should avoid descriptions such as "intact hymen" or "broken hymen" in all cases, and describe specific findings using international standards and terminology of morphological features.We call on clinicians to consider the low predictive value of a hymen examination and to: 1) avoid relying solely on the status of the hymen in sexual assault examinations and reporting; 2) help raise awareness of this issue among their peers and counterparts in law enforcement and the judicial system; and 3) promote fact-based discussions about the limitations of hymenal examinations as part of clinical education for all specialties that address the sexual or reproductive health of women and girls.

Appearance of external genital organs and types of hymen in Turkish female foetal cadavers.

The present study's purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.

Sexual assault in prepubertal girls: 'It is normal to be normal' - or is it? Evidence of vaginal penetration in prepubertal girls.

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.

The prepubertal hymen.

Not so long ago, some doctors believed that they could determine, on the basis of examination of a girl's genitals, whether or not the girl had engaged in sexual intercourse. Even today, 'virginity checks' are conducted by doctors in some countries. Some Australian doctors still believe that it should be possible to determine, on the basis of examination findings, whether a child has been sexually abused. This article sets out to describe some of the common variations in hymenal anatomy in order to dispel myths and misperceptions surrounding genital examination findings in young girls.

[From virginity certificates to hymenoplasty surgery in France]. / Des « certificats de virginité ¼ aux hyménoplasties en France.

"In the Republic, it is not allowed to deliver virginity certificates, prior to marriage; in the French Republic, the laws of religion cannot prevail over the laws of the Republic" said President Emmanuel Macron in February 2020. Nevertheless, what about the religious status of these certificates? Why focusing only on virginity certificates without mentioning the concomitant practice of hymen rehabilitation? There is a whole range of revirginization surgical practices, such as nymphoplasty or vaginoplasty, among which hymenoplasty figures only incidentally?

TITLE: Des « certificats de virginité ¼ aux hyménoplasties en France. ABSTRACT: « Dans la République, on ne peut pas exiger des certificats de virginité pour se marier ; dans la République, on ne doit jamais accepter que les lois de la religion puissent être supérieures aux lois de la République ¼, telle est la déclaration en février 2020 du président Emmanuel Macron. Mais quel est donc le statut de ces certificats de virginité, est-il véritablement religieux ? Pourquoi se focaliser sur les « certificats de virginité ¼ sans jamais évoquer la pratique concomitante de la réfection d'hymen ? N'existe-t-il pas une diversité de pratiques chirurgicales participant du processus de revirginisation telle que la nymphoplastie ou la vaginoplastie ; l'hyménoplastie ne serait-elle que la pointe émergée de l'iceberg ?

[Expert evaluation of unusual anatomical structure of the genital organs and hymen in sexually assaulted victims].

The paper reports examples of expert examination of women with anomalous anatomical organization of external genitalia and hymen who have experienced sexual assault. Expert interpretation of these findings and their forensic medical implications is offered.

Definition of apical descent in women with and without previous hysterectomy: A retrospective analysis.

BACKGROUND: While normal pelvic organ support has been defined for women with intact uterus, this is not the case for post- hysterectomy vault descent. A recent systematic review found that definitions of apical prolapse are highly variable. OBJECTIVES: To investigate the relationship between prolapse symptoms and apical POP-Q measurements and establish cutoffs for 'significant apical descent using receiver-operator characteristics (ROC) statistics. STUDY DESIGN: Retrospective analysis of patients seen at a tertiary urogynecological unit. Evaluation included a standardized interview and clinical assessment using the Pelvic Organ Prolapse Quantification (POP-Q) system. ROC curves were prepared for the relationship between prolapse symptoms and POP-Q measure "C". RESULTS: The records of 3010 women were available for analysis. Prolapse symptoms were reported by 52.3% (n = 1573), with a mean bother of 5.9 (SD 3.0, range 0-10). POP-Q point "C" was associated with symptoms of prolapse (p <0.0001) and prolapse bother (p <0.0001) on both univariate and multivariate analysis. ROC curves for women with and without uterus were similar, although the relationship between apical descent and symptoms of prolapse was stronger for women with uterus (AUC 0.728 versus 0.678). After controlling for multi-compartment prolapse, the models improved, resulting in AUCs of 0.782 and 0.720. For prediction of prolapse symptoms, cutoffs were set at C = -5 (sensitivity 0.73, specificity 0.67 with uterus in situ, sensitivity 0.59, specificity, 0.73 after hysterectomy). CONCLUSION: A cut- off for 'significant central compartment descent' of 5 cm above the hymen on Valsalva seems valid regardless of previous hysterectomy.

Diagnosis and Management of Hymenal Variants: ACOG Committee Opinion, Number 780.

At puberty, a patient with an imperforate hymen typically presents with a vaginal bulge of thin hymenal tissue with a dark or bluish hue caused by the hematocolpos behind it. Other findings that may be present include an abdominal mass, urinary retention, dysuria, constipation, and dyschezia. On evaluation, the goal is to differentiate an imperforate hymen from other obstructing anatomic etiologies, such as labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Surgical intervention is necessary only in symptomatic prepubertal patients. After confirmation of the diagnosis, surgical intervention usually is deferred until pubertal estrogenization has occurred because the imperforate hymen may open spontaneously at puberty. It is important to complete an abdominal and a perineal examination. If the physical examination reveals a bulging hymen and ultrasonography reveals hematocolpos, further imaging is not required. However, if the diagnosis is not certain or there is a concern for a distal vaginal atresia, cervical atresia, an obstructed uterine horn, or transverse or longitudinal vaginal septum, magnetic resonance imaging is recommended. The ideal time for surgical intervention on hymenal tissue is before the onset of pain and after onset of pubertal development, when the vaginal tissue is estrogenized. Surgical management of clinically significant hymenal variations involves excision of the hymenal tissue and rarely is associated with long-term sequelae. If there is concern that the patient has a distal vaginal atresia or a transverse vaginal septum, the patient should be referred to a center with expertise in the management of these conditions.

Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan.

OBJECTIVE: The purpose of this study was to report the distribution of pelvic support among a population-based sample of middle-aged community-dwelling women, as defined by pelvic organ prolapse quantification (POP-Q) and study factors that might influence POP-Q measurements. STUDY DESIGN: We conducted a secondary analysis of a population-based study of community-dwelling, African American and white women aged 35-64 years from southeastern Michigan. Three hundred ninety-four women consented to physical examination using the POP-Q. Statistical analysis included descriptive statistics and multivariable regression. Estimates were weighted to reflect probability and nonresponse characteristics of the sample to increase generalizability of the findings. RESULTS: The following values were the mean values for POP-Q points: Aa and Ba = -1.2 cm, C = -6.5 cm (intact uterus), C = -6.9 cm (hysterectomy), and Ap and Bp = -1.8 cm. The POP-Q stages were organized in the following manner: stage 0, 8.8%; stage I, 21.4%; stage II, 67.7%; stage III, 2.1%. Increasing vaginal parity was associated with increasing descent of the anterior, apical, and posterior vaginal wall (P < .001). CONCLUSION: In this population-based study of women from southeastern Michigan, 90% of the women had anterior and posterior vaginal wall support that was above or extended to the hymen. Increasing vaginal parity was associated with increasing descent of the anterior, posterior, and vaginal apex.

The anatomy of the distal vagina: towards unity.

INTRODUCTION: Factual presentations of sexual anatomy are required for educational purposes, for clinical and more general communication about sexual matters. To date, unambiguous, accurate and objective images with appropriate labeling to enhance specificity in communication have been lacking. AIM: The aim of this presentation is to provide a comprehensive overview of anatomy of the distal vagina. We aim to simplify the anatomy to reduce the confusion of historical descriptions. In doing so, we aim to avoid sacrificing any of the specific detail. This would aid communication between clinicians, researchers, and the nonclinician regarding this anatomy. OUTCOME MEASURES AND METHODS: This article reviews the historical and current anatomical literature. Systematic dissection and photography, histological study, and magnetic resonance imaging have been used as the basis for this presentation. Digital technology has been used to label, color, and highlight photography to provide clarity and permit diagramatization of photography. No distortion has otherwise been used in presenting images from cadavers or anatomical research. RESULTS: The anatomy of the distal vagina and surrounding structures is shown and described in detailed. The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit though the responses are not uniform. CONCLUSIONS: Significant progress has been made in the field of female sexual anatomy and its pictorial representation. This may facilitate further progress in the related fields of female sexual health and education.

Comparison of examination methods used in the evaluation of prepubertal and pubertal female genitalia: a descriptive study.

OBJECTIVE: To compare the effectiveness of three different examination methods in their ability to help the examiner detect both acute and non-acute genital injuries in prepubertal and pubertal girls suspected of having been sexually abused. METHODS: Forty-six prepubertal and 74 pubertal girls, whose ages ranged from 4 months to 18 years, were evaluated to determine the relative effectiveness of three different examination methods. RESULTS: All the girls had sustained a recent genital injury from various causes. The mean time between an injury and the first examination was 24h for the prepubertal girls and 27h for the pubertal girls. The three "multimethod" examination approaches used were the supine labial separation method; the supine labial traction technique; and the prone knee-chest position. The supine labial separation method was useful in identifying an injury on the external portion of the genitalia in both groups of girls. Injuries within the vestibule, on the hymenal surface, or in the fossa navicularis required greater separation of the labia. This was accomplished through the use of either the supine labial traction technique or the prone knee-chest position. The prone knee-chest position was the most successful method for identifying hymenal lacerations in both groups of girls. Of the 10 hymenal lacerations detected in the prepubertal girls 20% were identified during the use of the supine labial separation method, 60% with the supine labial traction technique, and 100% with the prone knee-chest position approach. Of the 49 hymenal lacerations detected in the pubertal girls 24% were identified with the supine labial separation method, 65% with the supine labial traction technique, and 90% with the prone knee-chest position approach. The data from this study has shown that the results of a medical examination will vary by the method employed. CONCLUSIONS: While no single technique detected all the injuries, the use of the multimethod examination approach did prove to be a valuable adjunct in the evaluation of both the prepubertal and the pubertal girl's genitalia, particularly in the identification of a hymenal laceration. PRACTICE IMPLICATIONS: This approach uses three different examination methods: the supine labial separation method, the supine labial traction technique, and the prone knee-chest position. According to the results of this study, without the combined use of these three methods a significant number of injuries, particularly hymenal lacerations, could be missed in both the child and the adolescent.

Impact of mechanical force on posterior hymen - Implications for sexual abuse injury interpretations.

BACKGROUND: Residual anogenital findings following sexual abuse are rare. There is a need for further understanding of the interpretation of hymenal findings. OBJECTIVES: This study evaluates which is more significant with respect to posterior hymenal tissue morphology - previous consensual penile vaginal penetrations or vaginal delivery. DESIGN: A post hoc study comparing nulliparous and parous hymen in heterosexually active female volunteers, with the focus on healed hymenal defects. Adult posterior hymen configuration was evaluated using labial separation or traction. When needed, the hymenal status was evaluated using a swab. A colposcopy with photography was used for documentation. Experts reviewed all taken photographs and recorded the posterior hymenal defects. Photographs were analyzed to determine the level of agreement. PARTICIPANTS: Eighty-seven adult female volunteers were recruited to participate in the study by a personal invitation to a gynecological examination to document anogenital findings. The examination was performed following consensual vaginal intercourse. Age ranged from 20 to 53 (median 26.6years). RESULTS: Single site posterior hymenal transections were significantly more likely in the nulliparous volunteers, compared to the parous volunteers (22/51, 43.1% vs. 4/36, 11.1%, p<0.001). A deep notch, which extends nearly to the base of the hymen was detected in one (2.0%) sexually active nulliparous volunteer, and surprisingly two (3.9%) volunteers had a single, more superficial hymenal notch, that is not considered a sign of previous vaginal penetration. The width of the ridge of the posterior vaginal wall in the vestibule was measured from the anterior part of the navicular fossa to the base of the hymen. The mean width of the ridge of the posterior vaginal wall was 3.1mm (SD2.2, range 0-8) in the photos of 41 nulliparous volunteers. The prevalence of 'double leaf hymen' was 2/87 (2.3%). The inter-rater reliability with a Kappa score of 0.69 indicated strong agreement. CONCLUSION: The myth "hymen is present only in virgins" has now been invalidated. The absence of posterior hymen increases delivery by delivery in adult female volunteers. The space between the anterior part of the navicular fossa and the base of hymen, 'the ridge of the posterior vaginal wall' in the vestibule was evaluated for the first time among studies evaluating hymenal status. Careful assessment of the ridge of the posterior vaginal wall is needed to avoid misinterpretations when evaluating the depth of a hymenal defect.

Is the hymen a suitable cut-off point for clinically relevant pelvic organ prolapse?

OBJECTIVES: The primary objective was to evaluate the ability of different anatomic cut-off points, as established in specialist urogynecology populations, to identify clinically relevant prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care. STUDY DESIGN: Cross-sectional study among 890 women (≥55 years) screened for pelvic floor symptoms. MAIN OUTCOME MEASURES: The Pelvic Floor Distress Inventory 20 was used to measure symptoms, and the Pelvic Organ Prolapse Quantification (POP-Q) system was used to assess prolapse. Areas under the curves, sensitivity, and specificity were calculated for the hymen as a cut-off point for symptomatic prolapse of the anterior and posterior vaginal wall. For the apical compartment, a cut-off point of -5cm relative to the hymen was used. RESULTS: Vaginal bulging was the only symptom reported more often with increasing POP-Q stages. Areas under the curves (95% confidence intervals) to discriminate between women with and without vaginal bulging symptoms were 0.66 (0.61-0.72), 0.56 (0.50-0.63), and 0.61 (0.55-0.66) for the anterior (Ba), posterior (Bp) and apical (C) compartment, respectively. When the hymen was used as the cut-off point, Ba had a sensitivity of 38.1% and a specificity of 82.4%, and Bp had a sensitivity of 13.3% and a specificity of 96.5%. For C, the cut-off point of -5cm relative to the hymen had a sensitivity of 37.9% and a specificity of 73.1%. CONCLUSIONS: The anatomic cut-off points for clinically relevant prolapse established in the specialist urogynecology population cannot adequately identify symptomatic prolapse in a population of postmenopausal women with pelvic floor symptoms recruited from primary care.

Himen: un epónimo y mito de larga data en terminologia anatomica / Hymen: a long-standing eponym and myth in terminologia anatomica

RESUMEN: En Terminología Anatómica el término himen es identificado con el número 3530. Es un pequeño tejido membranoso que normalmente ocupa una parte de la abertura vaginal externa en la mujer. La pertinencia del término himen ha sido poco abordada en la literatura del campo terminológico anatómico, por tanto, el objetivo del presente trabajo fue analizar este término, verificar su etimología y funcionalidad, y determinar cómo este ha sido considerado en algunos aspectos de orden cultural, clínico y jurídico. El término himen proviene del latín hymen que es préstamo del griego hymḗn ὑμήν que significa membrana. Con el valor general de cualquier membrana fue usado en Grecia desde el siglo V a.C., sin embargo, a través de un fenómeno de especialización latina, a partir de los siglos I y II d.C., el término fue usado con su significado actual. Su origen proviene del nombre del dios griego del matrimonio llamado Himeneo, lo que vincula el término a un epónimo y mito a la vez. Pese a lo anterior, creemos que su conservación en Terminología Anatómica se podría deber a su larga data de uso, aun cuando podrían existir mejores opciones para denominar esta estructura. El himen no presenta una función biológica conocida, sin embargo, ha tenido gran valoración a nivel cultural, clínico y jurídico, en el que el examen físico ha determinado conclusiones sobre la historia sexual de mujeres y niñas aun cuando las evidencias demuestran que no es una prueba precisa o confiable de la actividad sexual.

SUMMARY: In Terminologia Anatomica the term hymen is identified with the number 3530. It is a small membranous tissue that normally occupies a part of the external vaginal opening in women. The relevance of the term hymen has been scarcely addressed in the literature of the anatomical terminology field. Therefore, the objective of this work was to analyze this term, verify its etymology and functionality, and determine how it has been considered in certain cultural clinical and legal aspects. The term hymen comes from the Latin hymen, borrowed from the Greek hymḗn ὑμήν , which means membrane. With the general value of any membrane, it was used in Greece from the 5th century BC, however, through a phenomenon of Latin specialization, from the 1st and 2nd centuries AD, the term was used applying its current meaning. Its origin comes from the name of the Greek god of marriage called Hymenaeus, which links the term to an eponym and a myth at the same time. Despite the above, we believe that its conservation in Terminologia Anatomica could be due to its long history, even though there may be better options to name this structure. The hymen does not have a known biological function, however, it has been highly valued at a cultural, clinical and legal level, in which the physical examination has determined conclusions about the sexual history of women and girls even when the evidence shows that it is not an accurate or reliable proof of sexual activity.

[Sexual abuse of prepubertal children]. / Seksuelle overgrep mot prepubertale barn.

BACKGROUND: During the last 15 years, a considerable change has taken place regarding the understanding of anatomical and microbiological anogenital findings in children. At the end of the 1980s, abnormal findings were described in more than 50 % of allegedly abused children. Today such findings are described in 5 %. An important consequence of this change is that absence of abnormal findings should never be used to exclude abuse, not even abuse with anogenital penetration. The main reason for this change is increased knowledge about normal variation and healing after injury, as well as an improvement in standardisation of terminology. MATERIAL AND METHODS: This paper is based on relevant literature published on this topic. RESULTS AND CONCLUSIONS: During this period, several findings have been reclassified from abnormal to normal or non-specific. Examples of such findings are anal dilatation, large and gaping hymenal opening and narrow hymenal brim. Some of the previously reported cases of anogenital scarring are probably mis-classified normal structures. Research-based international classification scales are now established in order to aid the physician in diagnosing sexual abuse, and these are revised on a regular basis. It is currently common to classify medical findings into three main categories; normal/unspecific findings, indeterminate findings and diagnostic findings.

Statement on virginity testing.

Virginity testing (virginity examination) is a gynecological examination that is intended to correlate the status and appearance of the hymen with previous sexual contact to determine whether a female has had or is habituated to sexual intercourse. Virginity examinations are practiced in many countries, often forcibly, including in detention places; on women who allege rape or are accused of prostitution; and as part of public or social policies to control sexuality. The Independent Forensic Expert Group (IFEG) - thirty-five preeminent independent forensic experts from eighteen countries specialized in evaluating and documenting the physical and psychological effects of torture and ill-treatment - released a statement on the practice in December 2014. In its statement, the IFEG outlines the physical and psychological effects of forcibly conducting virginity examinations on females based on its collective experience. The Group assesses whether, based on the effects, forcibly conducted virginity examinations constitute cruel, inhuman, or degrading treatment or torture. Finally, the IFEG addresses the medical interpretation, relevance, and ethical implications of such examinations. The IFEG concludes that virginity examinations are medically unreliable and have no clinical or scientific value. These examinations are inherently discriminatory and, in almost all instances, when conducted forcibly, result in significant physical and mental pain and suffering, thereby constituting cruel, inhuman and degrading treatment or torture. When virginity examinations are forcibly conducted and involve vaginal penetration, the examination should be considered as sexual assault and rape. Involvement of health professionals in these examinations violates the basic standards and ethics of the professions.

Appearance of the hymen in newborns.

This study was undertaken to evaluate the genital anatomy of female newborns. Hymenal configuration and the number and location of clefts, bumps, tags, and ridges were observed in 468 neonates; photographs for confirmation were obtained for 449 neonates (96%). Hymenal configurations observed included an annular hymen with a central or ventrally displaced orifice in 80% (372/468) of neonates, a fimbriated hymen in 19% (90/468), and a septated or cribriform hymen in 1% (6/468). Configurations significantly differed by race (P less than .001) but no difference was noted by gestational age or weight. Clefts, which occurred only on the ventral 180 degrees of the rim, were observed in 34% of neonates with an annular hymen. Fifty-six percent of neonates had a longitudinal intravaginal ridge, 87% had an external hymenal ridge, and 13% had a tag extending from the rim or a ridge. Periurethral ligaments were frequently observed. It is concluded that lateral and ventral clefts, intravaginal and external ridges, and periurethral bands are normal anatomical findings in the newborn.

Appearance of the hymen in prepubertal girls.

The recent increase in requests for genital examinations in girls who may have been sexually abused has necessitated detailed information not previously available on normal anatomy of the prepubertal girl. This study was undertaken to document the genital anatomy of 211 girls between the ages of 1 month and 7 years who presented for well child care or nongynecologic complaints and who had no history of sexual abuse. Each child's genitalia was examined and photographed, with findings reported reflecting those observed photographically. The study population consisted of 36% blacks, 33.6% white non-Hispanics, 29.9% Hispanics, and 0.5% Asians. Subjects had a mean age of 21 +/- 20.6 (SD) months. Extensive labial agglutination sufficient to obscure the hymen was noted in 5% (10/211) and partial agglutination in an additional 17% (35/211). A significant difference was noted in hymenal configuration by age, with a fimbriated hymen the most common type (46%) in infants aged 12 months or younger and a crescentic hymen the most common (51%) in girls older than 24 months (P less than or equal to .001). No significant difference was noted in hymen configuration by race. Hymenal bumps (mounds) were observed in 7%, hymenal tags in 3%, vestibular bands in 98%, longitudinal intravaginal ridges in 25%, and external ridges in 15% of subjects in whom the anatomy under study could be visualized. Hymenal notches (clefts) occurred superiorly and laterally on the hymenal rim but none were found inferiorly on the lower half of the hymen. A narrow rounded hymenal ring with a transection was observed in only 1 (0.5%) of 201 subjects and was not considered a normal finding.(ABSTRACT TRUNCATED AT 250 WORDS)

A longitudinal study of hymenal morphology in the first 3 years of life.

OBJECTIVE: To document the effects of aging on hymenal morphology during the first 3 years of life in a cohort of nonabused girls. METHODS: Using a longitudinal design, we examined and photographed the external genitalia of 134 girls at 2 months or less and near 3 years of age; 42 of these girls were also examined near 1 year of age. The prevalence of each hymenal characteristic was calculated at each time, and differences were analyzed using the z statistic and McNemar change tests. Measurements of transhymenal diameters and the inferior rims were compared using a paired t-test. RESULTS: Hymenal configuration in 65% (87 of 134) of the subjects changed between birth and 3 years, usually from annular or fimbriated to crescentic. External ridges observed at birth usually resolved by 3 years, whereas intravaginal ridges were observed more often in 3-year-olds (P = .00). Analysis by race showed that the prevalence of both superior and lateral notches decreased in whites, whereas the prevalence of intravaginal ridges changed only in blacks (P = .00). Sixty-eight percent (15 of 22) of the tags present at birth were not observed at 3 years, while nine tags formed during this period. Changes observed between 1 and 3 years included increases in the mean horizontal (P = .00) and vertical (P = .02) transhymenal diameters and in the prevalence of the crescentic configuration (P = .04). CONCLUSIONS: Changes in hymenal morphology, which may vary by race, occur in the first 3 years of life. Alterations are more pronounced in the first year than in years 2 and 3. Physicians should understand the effects of aging on the hymen's appearance to differentiate normal development from post-traumatic or infectious changes.