Emans S J, Woods E R, Allred E N, Grace E
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA 02115.
J Pediatr. 1994 Jul;125(1):153-60. doi: 10.1016/s0022-3476(94)70144-x.
We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual 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 subjects 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 tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 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 compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination 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 useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women.
我们对300名初潮后女性受试者（中位年龄18.0岁）进行了一项前瞻性研究，以调查：（1）使用卫生棉条、参与体育运动、既往妇科检查以及双方自愿的性行为与处女膜解剖结构之间的关系；（2）未发生性行为的女孩选择卫生棉条的相关因素；（3）与妇科检查难易程度相关的因素。样本包括：第1组100名受试者，她们否认有过性行为，月经期间仅使用卫生巾；第2组100名受试者，她们否认有过性行为且使用过卫生棉条；第3组100名受试者，她们有过性行为史。有性行为的受试者（81%）在处女膜下部2点至10点位置出现“完全裂伤 ”的可能性显著高于使用卫生棉条者和使用卫生巾者（p<0.001）；使用卫生棉条者与使用卫生巾者之间无显著差异（分别为11%和5%）。在未发生性行为的受试者中，这些完全裂伤的出现与参与体育运动或既往盆腔检查无关。尽管三组处女膜开口直径中位数有所不同（第1组为1.2 cm，第2组为1.5 cm，第3组为2.5 cm；p<0.0001），但测量范围较宽。使用卫生棉条者的母亲和朋友（而非姐妹）对使用卫生棉条持支持态度的可能性显著高于使用卫生巾者。多变量模型中，使用卫生棉条的最佳预测因素是母亲的支持态度（优势比[OR]为5.3；95%置信区间[CI]为2.4, 12.1）以及朋友使用卫生棉条（OR为7.9；95%CI为3.5, 18.1）。使用卫生巾者中只有26%的阴道窥器检查被评为容易，而使用卫生棉条者中这一比例为56%，有性行为的年轻女性中为81%（p<0.001）。阴道窥器检查容易程度的最佳预测因素是性行为（OR为15.9；95%CI为1.9, 135.3）和使用卫生棉条（OR为3.6；95%CI为1.0, 12.7）。这个大样本应为在性侵犯案件中提供证词的医生提供有用数据，并为年轻女性使用卫生棉条的预测因素以及妇科检查的难易程度提供新信息。
