A number of readers were concerned about the following points raised by Dr Berkowitz in her article in the December 1992 issue of Pediatrics in Review (1992;13:443-452).

Several photographs were thought to be normal (Figures 9, 10, and 12) rather than documenting sexual abuse. The readers were concerned that if these particular photographs are used to diagnose sexual abuse, overdiagnosis of such a devastating psychosocial problem could have serious and long-lasting consequences. Another reader also noted, "there does not seem to be any consensus among experts...as to which terms to use (notched, cleft, transection, concave hymenal variations, V- or U- shaped indentations) for genital anal findings.

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