WHAT IS AN INTACT HYMEN - A CRITIQUE OF THE LITERATURE

The purpose of this study was to establish medicolegal guidelines base d upon medical findings which support or refute allegations of sexual penetration, taking into account non-sexual explanations for positive physical findings. A review of the literature was undertaken to examin e what has been determined about the range of usual findings which can be expected if the hymen has been penetrated. While a large body of l iterature is available on the topic, some findings are ambiguous, and further research is required to advance and clarify our knowledge base in these areas. In only a minority of non-acute cases can definitive statements be made as to whether an alleged molestation has occurred. A non-scarred hymen that will not admit a finger is 'intact'; a hymena l opening accommodating two fingers or a vaginal speculum, with eviden ce of a deficit or scarring at the lower pole, indicates past sexual o r, possibly, non-sexual penetration. Other findings are not definitive and, at best, can estimate only relative probability of occurrence of penetration. Findings within the normal range should be presented as 'neither confirm nor deny abuse', not 'consistent with abuse'. Often, it is impossible to establish whether a hymen is 'intact' in regard to past sexual intercourse.