Comparison of examination methods used in the evaluation of prepubertal and pubertal female genitalia: a descriptive study.

OBJECTIVE

To compare the effectiveness of three different examination methods in their ability to help the examiner detect both acute and non-acute genital injuries in prepubertal and pubertal girls suspected of having been sexually abused.

METHODS

Forty-six prepubertal and 74 pubertal girls, whose ages ranged from 4 months to 18 years, were evaluated to determine the relative effectiveness of three different examination methods.

RESULTS

All the girls had sustained a recent genital injury from various causes. The mean time between an injury and the first examination was 24h for the prepubertal girls and 27h for the pubertal girls. The three "multimethod" examination approaches used were the supine labial separation method; the supine labial traction technique; and the prone knee-chest position. The supine labial separation method was useful in identifying an injury on the external portion of the genitalia in both groups of girls. Injuries within the vestibule, on the hymenal surface, or in the fossa navicularis required greater separation of the labia. This was accomplished through the use of either the supine labial traction technique or the prone knee-chest position. The prone knee-chest position was the most successful method for identifying hymenal lacerations in both groups of girls. Of the 10 hymenal lacerations detected in the prepubertal girls 20% were identified during the use of the supine labial separation method, 60% with the supine labial traction technique, and 100% with the prone knee-chest position approach. Of the 49 hymenal lacerations detected in the pubertal girls 24% were identified with the supine labial separation method, 65% with the supine labial traction technique, and 90% with the prone knee-chest position approach. The data from this study has shown that the results of a medical examination will vary by the method employed.

CONCLUSIONS

While no single technique detected all the injuries, the use of the multimethod examination approach did prove to be a valuable adjunct in the evaluation of both the prepubertal and the pubertal girl's genitalia, particularly in the identification of a hymenal laceration.

PRACTICE IMPLICATIONS

This approach uses three different examination methods: the supine labial separation method, the supine labial traction technique, and the prone knee-chest position. According to the results of this study, without the combined use of these three methods a significant number of injuries, particularly hymenal lacerations, could be missed in both the child and the adolescent.