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Joyce A. Adams, MD; Ann S. Botash, MD; Nancy Kellogg, MD

Arch Pediatr Adolesc Med. 2004;158:280-285.

Objective  To compare the morphology of the hymen in adolescent girls who have and have not had sexual intercourse involving penile-vaginal penetration.

Subjects  Female patients aged 13 to 19 years, recruited from an urban adolescent medicine practice.

Methods  Subjects were interviewed in private after completing detailed questionnaires and then underwent a physical examination. External genital inspections were performed using a colposcope with an attached 35-mm camera to document the appearance of the hymen. The presence of notches or clefts was recorded during the examination, and photographs taken at x10 magnification were used to take measurements of the width of the posterior hymenal rim.

Results  Posterior hymenal notches and clefts were more common among girls admitting past intercourse (13/27 [48%]) than in girls who denied intercourse (2/58 [3%]; P = .001), but the mean width of the posterior hymenal rim was not significantly different between the 2 groups (2.5 mm vs 3.0 mm; P = .11). Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion.

Conclusions  Deep notches or complete clefts in the posterior rim of the hymen were rare in girls who denied intercourse. Subjects who admitted past intercourse still had nondisrupted, intact hymens in 52% of cases.

From the University of California, San Diego (Dr Adams); Upstate Medical University, Syracuse, NY (Dr Botash); and the University of Texas Health Science Center, San Antonio (Dr Kellogg).

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