HYMENAL FINDINGS IN ADOLESCENT WOMEN - IMPACT OF TAMPON USE AND CONSENSUAL SEXUAL-ACTIVITY

We undertook a prospective study of 300 postmenarcheat female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, s ports participation, prior gynecologic examination, and consensual sex ual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 su bjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse . Sexually active subjects (81%) were significantly more likely than t ampon users and pad users to have ''complete clefts'' in the lower hym en between the 2 o'clock and 10 o'clock positions (p <0.001); tampon u sers were not significantly different from pad users (11% vs 5%). In s ubjects who were not sexually active,the presence of these complete cl efts was not related to participation in sports or to prior pelvic exa mination. Although median hymenal opening diameter differed in the thr ee groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for grou p 3; p <0.0001), the ranges of measurements were wide. Tampon users we re significantly more likely than pad users to have mothers and friend s, but not sisters, who had a favorable attitude toward tampon use. Th e best predictors of tampon use in a multivariate model were a favorab le maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (C I), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy com pared with 56% of examinations in tampon users and 81% in sexually act ive young women (p <0.001). The best predictors of ease of speculum ex amination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide usef ul data for physicians who testify in sexual assault cases and gives n ew information on the predictors of tampon use and ease of gynecologic examination in young women.