Genital findings in adolescent girls referred for suspected sexual abuse
J. A. Adams and S. Knudson
Division of Adolescent Medicine, University of California, San Diego, USA.
BACKGROUND: Sexual abuse is a common problem affecting adolescent girls,
but the frequency of medical findings in this population has not been
specifically described. OBJECTIVE: To describe the frequency of specific
genital findings in a group of pubertal girls who had experienced probable
or definite sexual abuse. DESIGN: Patient series, medical chart and
photograph review. SETTING: Specialty referral clinic for abused children.
PATIENTS AND SELECTION: Referred sample of female patients, examined
between January 1, 1987, and June 30, 1994, with Tanner genital stages 3,
4, or 5, who reported a history of penile-vaginal penetration, had
colposcopic photographs taken, and were determined, by means of a
previously described classification system, to have experienced probable or
definite abuse. INTERVENTIONS: None. MAIN RESULTS: The study included 204
girls, aged 9 to 17 years (mean, 13 years); race or ethnicity was Mexican
American in 57%, white in 34%, and other in 9%. Abnormal genital findings
were documented in 32% of patients overall but were more common when the
girls had reported bleeding at the time of the assault (50% vs 26%; P =
.004, chi 2 analysis), or when the examination occurred within 72 hours of
the last episode of abuse (69% vs 26%; P < .001, chi 2 analysis).
Transections of the hymen were unusual (8%), but notches in the hymen were
more common (25%). CONCLUSIONS: Normal or nonspecific results of genital
examinations are commonly found in adolescents who have been sexually
abused, unless the abuse was very recent. Further studies are needed to
document the healing of genital injuries in victims of acute assault and
the frequency of hymenal findings in nonabused, non-sexually active
adolescents.
