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Genital Findings in Prepubertal Girls Evaluated for Sexual Abuse
A Different Perspective on Hymenal Measurements
Perry A. Pugno, MD, MPH
Arch Fam Med. 1999;8:403-406.
Objective To evaluate the usefulness of the horizontal transhymenal diameter as a screening parameter to differentiate between prepubertal girls with and without other definitive signs of sexual abuse.
Design Case comparison study using transhymenal measurements as a diagnostic screening test referenced against prior publications of criterion standards.
Setting A primary care (family practice) clinic in association with an academic program in northern California.
Patients A consecutive, referred sample of 1058 prepubertal girls aged 6 months to 10 years who were examined as allegedly having been sexually molested between 1987 and 1994.
Results Girls with no definitive signs of genital trauma exhibited a mean transhymenal diameter of 2.3 mm and in general showed an increase of approximately 1 mm per year of age. Girls with definitive signs of genital trauma exhibited a mean transhymenal diameter of 9.0 mm and no significant variance with age. Correcting for age differences, the transhymenal diameter was highly significant as a differentiating factor (F=1079, P<.001). When compared against the criterion standard, the transhymenal measurement is 99% specific and 79% sensitive as a screening tool.
Conclusion Although not independently diagnostic of sexual molestation, the transhymenal diameter, when compared against the criterion standard for age, is a useful screening parameter for primary care physicians evaluating children of potential sexual abuse.
From the M.H.S. Family Practice Residency Program, Methodist Hospital of Sacramento, Mercy Healthcare, and Department of Family and Community Medicine, University of California at Davis Medical Center, Sacramento.
RELATED ARTICLE
The Archives of Family Medicine Continuing Medical Education Program
Arch Fam Med. 1999;8(5):383-385.
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