Source:Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse.
Arch Pediatr Adolesc Med

Eighty-five adolescent girls age 13–19 years were recruited from an academic adolescent ambulatory clinic in San Diego, Calif, for participation in a study by researchers from the University of California, San Diego, Upstate Medical University, Syracuse, NY, and the University of Texas, San Antonio. The purpose of the study was to correlate morphology of the hymen with sexual activity. Participants completed a detailed questionnaire that included questions about sexual history and tampon use. Exclusionary criteria included prior pregnancy, abortion, forced sexual intercourse, anorexia nervosa, or anxiety disorder. Subjects underwent unblinded colposcopic examination by 1 of the authors. Photographs taken during examination were reviewed by 2 separate investigators blinded to sexual history. All examiners and reviewers had conducted at least 1,000 sexual abuse evaluations. Photographs were evaluated for the presence of deep notches (>50% of hymenal diameter) or complete clefts in the posterior hymen. The examiner also measured width of the posterior hymen.

Fifty-eight girls denied prior sexual intercourse and 27 girls gave a history of 1 or more episodes of penile-vaginal intercourse. Fifty-two of 58 girls with no history of sexual intercourse gave a history of tampon usage, and 25 of these (48%) reported difficulty and pain on first usage. Sixty-seven examinations yielded photographs adequate for review by the 2 blinded reviewers—of this group, 45 denied sexual intercourse and 22 admitted prior sexual intercourse. Both outside reviewers agreed with the examiner on the absence of deep notches or clefts in 37 of 45 patients (82%), the presence of deep notches or clefts in 18 of 20 patients (90%), and were unable to determine whether deep notches or clefts were present in 2 patients. The Cohen |statistic for agreement between evaluators ranged from 0.71 to 0.85 (P<.001).

Mean posterior hymenal width did not differ significantly between girls with and without a history of prior sexual intercourse (2.5 mm versus 3.0 mm), using a t-test for comparison of means. However, using X2 analysis, participants with a prior history of sexual intercourse were significantly more likely to have a posterior hymenal diameter <1.0 mm than participants who denied sexual intercourse (22% versus 3%, P<.01). Girls with a past history of sexual intercourse were much more likely to have deep notches or complete clefts in the posterior hymen than those without such history (40% versus 3%). The 2 subjects with deep notches or clefts in the posterior hymen, but no history of sexual intercourse, reported difficulty and severe pain on first usage of tampon. A majority (52%) of girls with a history of sexual intercourse had a nondisrupted hymen that had neither deep notch nor a complete cleft in the posterior or lateral margins. The authors conclude: “The absence of notches does not rule out previous penile-vaginal penetration in an adolescent.”

This study convincingly dispels a...

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