A case-control study of anatomic changes resulting from sexual abuse

OBJECTIVE: Our goal was to identify vulvar and hymenal characteristics asso ciated with sexual abuse among female children between the ages of 3 and 8 years. STUDY DESIGN: Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetrati on and 200 children who denied prior abuse, Bivariate analyses were conduct ed by chi(2), the Fisher exact test, and the Student t test to assess diffe rences in vulvar and hymenal features between groups. RESULTS: Vaginal discharge was observed more frequently in abused children (P=.01). No difference was noted in the percentage of abused Versus nonabus ed children with labial agglutination, increased vascularity, linea vestibu laris, friability, a perineal depression, or a hymenal bump, tag, longitudi nal intravaginal ridge. external ridge, band, or superficial notch. Further more, the mean number of each of these features per child did not differ be tween groups. A hymenal transection, perforation, or deep notch was observe d in 4 children, all of whom were abused. CONCLUSION: The genital examination of the abused child rarely differs from that of the nonabused child. Thus legal experts should focus on the child' s history as the primary evidence of abuse.