Hymenal injury is considered to be nearly pathognomonic of child sexual abuse. Accidental injury of the hymen is felt to be a rare event. Child abuse experts often cite cases of picket-fence or bedpost impalements as the exception, and dismiss the likelihood of accidental injury to the hymen. Despite this sentiment, accidental injuries of the anogenital region, including the hymen, have been described in the literature. The following case documents such an accidental injury, and follows the injuries from the acute stage through initial healing.

A 7-year-old white girl presented to the emergency department with the chief complaint of vaginal bleeding after a fall in the bathtub. The physician who examined her noted vaginal blood with no clear source and consulted a staff pediatrician experienced in evaluating child abuse.

The patient was a comfortable, articulate child who readily agreed to being interviewed alone. She gave a history of “bowling” in...

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