Copyright American Medical Association. External genital inspections were performed using a colposcope with an attached mm camera to document the appearance of the hymen. Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion.
The physician performing the examination is then expected to determine whether there has been vaginal penetration. There is a paucity of data available to assist in that determination.
While there have been studies to obtain normative data on the appearance of the hymen and other genital tissues in newborn infants and prepubertal girls selected for nonabuse, 3 - 5 the only published study comparing adolescent girls who were consensually sexually active with those who were not 6 did not use magnification, such as a colposcope, and did not use photographs to document the appearance of the hymen. The lack of photographs precludes peer review by blinded experts.
In many centers where children and adolescents are evaluated for possible sexual abuse, photographs are taken with a camera attached to a colposcope to document any abnormal findings. In a case-control study 8 of prepubertal girls aged 3 to 8 years, only girls who described digital-vaginal or penile-vaginal penetration were found to have deep notches or complete clefts in the posterior rim of the hymen or measurements Hymen penetration photos the posterior rim of the hymen at the midline less than Hymen penetration photos mm wide.
A complete cleft was defined as a defect that extended through the entire rim of hymen, all the way to the fossa or vestibular wall. The purpose of this study was to determine the frequency of anterior, lateral, Hymen penetration photos posterior notches and complete clefts in the hymen in adolescent girls who had never had Hymen penetration photos intercourse and to compare the frequency of hymenal notches and clefts and mean width of the hymen at the midline between subjects who admitted and those who denied having experienced penile-vaginal intercourse.
Female patients aged 13 to 19 years were recruited from a university adolescent medicine practice at 2 locations in San Diego between June 1,and December 1, Inclusion criteria were age, having begun menstruation, and having a parent present to sign a consent if the patient was younger than 18 years. A history of past pregnancy or abortion, past episodes of forced sexual intercourse, and diagnoses of anorexia nervosa or anxiety disorder were exclusion criteria.
Written informed consent was obtained, and both patients and parents were informed that the interview would include screening questions for emotional and behavioral problems and that the entire visit would be provided free of charge. The parent was asked to complete a questionnaire concerning the patient's health, health history, and any behavioral or emotional concerns.
At the same time, the patient completed a questionnaire adapted from a previous study, 9 which included questions concerning home, education, activities, past physical or sexual abuse, drug use, depression, suicide ideation or attempts, and past experience with penile-vaginal intercourse.
A complete physical examination including a detailed examination of the external genitalia using a colposcope was done in an office setting with the mother or other support person present if the patient so desired. All examinations were conducted by Hymen penetration photos of us J. Patients were placed on the examination table in the lithotomy position, and the external genitalia were carefully examined using separation of the labia majora and minora and labial traction, with the patient watching the examination on the video monitor if she chose to do so.
Using a cotton applicator swab moistened with water, the edge of the hymen was gently stretched to clearly define the amount of tissue present at the 6-o'clock position of the posterior rim.
In addition, any areas that appeared to be notches or clefts in the hymen were spread apart with the swab as well to define the depth of the notch or cleft. A larger cotton swab with the tip covered by a latex balloon was used in some patients to help visualize the notches or clefts in the hymen.
A photo log sheet was kept to match the subject number to the imprinted numbers on the slides, and notations were made of the location of notches or clefts identified during the examination. All colposcopic slides were reviewed by 1 of us J.
Measurements of the width of the hymenal rim at the 6-o'clock position were taken using a calibrated measuring device. These rulers were then used to Hymen penetration photos the hymen measurements from the projected images for each subject. The width of the posterior hymenal rim was measured from the projected slides at the 6-o'clock position, between the edge of the hymen and the base of the hymen where it meets the vestibular fossa inferiorly.
Slides from all subjects whose photographs clearly showed the entire hymenal rim were sent to 2 additional experts in adolescent gynecology A. Both reviewers were experienced in reviewing colposcopic photographs; each had examined more than children and adolescents for suspected sexual abuse.
The reviewers were blinded to the patients' sexual histories and were asked to describe the location of any deep notches or complete clefts in the hymen, using the definitions of Berenson et al 8 described previously. The Hymen penetration photos were entered into a computer database, along with the answers given by the patient and parent on the questionnaires. The Student t test was used to Hymen penetration photos continuous variables between subjects Hymen penetration photos said they had engaged in intercourse involving penile-vaginal penetration admitted Hymen penetration photos those who said they had never experienced denied such contact.
A total of 85 subjects were recruited, with a mean age of A log was not kept of the number of patients who were approached about participating but declined. It is estimated that only 1 patient in 10 agreed to participate in the study. There were 58 subjects who denied ever experiencing penile-vaginal intercourse and 27 subjects who admitted consensual sexual activity involving penile-vaginal intercourse. The mean age of the Hymen penetration photos who reported having had intercourse was significantly higher than that of the subjects who denied sexual intercourse 17 years vs Of the 58 subjects who denied sexual intercourse, 52 used tampons and 6 did not.
Initial difficulties with equipment resulted in poor-quality photographs being available for 18 subjects. Slides of the remaining 67 subjects 45 with no history of past intercourse and 22 with a history of consensual intercourse were sent to the 2 reviewers, as previously described.
The reviewers were blinded to the subjects' sexual histories. For 2 of the subjects, neither reviewer could determine from the photographs whether notches or clefts were present.
Because the examiner was able to manipulate the hymenal tissue during the examination and make notations concerning the presence of notches or clefts and their depth, these data, along with the measurements of the posterior hymenal rim taken from the colposcopic photographs, were used in the subsequent analysis. There were 4 subjects in the non—sexually active group who had a hymenal septum. The mean width of the hymenal rim was 2. This difference was not statistically significant, using the t test for comparisons of means.
Table 1 presents the frequency of deep notches and complete clefts in the anterior, lateral, and posterior locations, comparing subjects without a history of sexual "Hymen penetration photos" and those with a history of past penile-vaginal intercourse. Figure 1Figure 2Figure 3Figure 4and Figure 5 demonstrate the use of swabs to stretch out the hymenal rim and provide documentation of the presence or absence of notches or clefts.
Any notches or clefts in the hymen are unable to be clearly seen in this view. The same subject as in Figure 1. A large cotton swab covered with a small latex balloon was used for contrast. A complete cleft in the hymen at the 5-o'clock position is clearly demonstrated. A year-old subject with no history of past sexual intercourse subject She described the painful insertion of a tampon on 1 occasion.
Hymen penetration photos year-old sexually active subject who admits to consensual sexual intercourse. No notches or clefts were visible in the hymen during examination. The subject was able
Hymen penetration photos relax and allow stretching of the hymenal rim with a cotton swab.
A year-old subject with no history of past sexual intercourse who did not use tampons. The subject was able to relax, and a cotton swab stretching out the rim of the hymen shows no notches or clefts.
Note the similar appearance to the hymen shown in Figure "Hymen penetration photos." Two subjects who stated that they had never had sexual intercourse but had a posterior deep notch subject 51 or complete cleft subject 45 had described a painful insertion of a tampon in their first and only attempt to use them. Subject 45 described using a large tampon from her mother's supply, even though her own menstrual flow was very light at the time Figure 3.
Both of the outside reviewers of the photographs identified Hymen penetration photos deep notch or complete cleft in each of these 2 subjects. Table 2 presents a comparison of the Hymen penetration photos of subjects with 0 to 1 and 2 to 4 notches or clefts in the posterior or lateral locations and between subjects with and without a history of sexual intercourse, using the Fisher exact test.
To determine whether the number of posterior deep notches or complete clefts increased with the number of years a subject was sexually active, we calculated the number of years since the onset of sexual activity and
Hymen penetration photos this with the number of posterior or lateral hymenal defects in the 27 sexually active subjects.
To our knowledge, this study is the first to use magnification with a colposcope and photographs to document the appearance of the hymen Hymen penetration photos adolescent girls with and without a history of sexual intercourse.
It is interesting to compare our results with those of Emans et al. This is the same frequency we found, and both of the girls with this finding in our study had described painful tampon insertion. The mean age of subjects in our study was 16 years compared with 18 years in the Emans study, which could account for the difference in the percentage of subjects with deep notches or complete clefts in the lower portion of the hymen.
There are several limitations to our study, the most obvious being the reliance on the subjects to say whether they had experienced sexual intercourse involving penile-vaginal
Hymen penetration photos. It is possible that the 2 subjects who said they had not had sexual intercourse but had posterior hymenal defects had, in fact, experienced sexual intercourse but denied it to the examiner.
The responses of these 2 subjects to the other questions regarding family relationships; school functioning; use of alcohol, drugs, or tobacco; and past physical and sexual abuse or suicide attempt were similar to the responses of the other non—sexually active subjects, which suggests that they were indeed being truthful about not having experienced intercourse.
However, there is no gold standard for determining virginity, and the subjects' disclosure of their status remains a less than perfect method. The examiner in this study was not blinded to the subjects' histories of sexual intercourse, and this fact could be considered a limitation of the study. However, the high rate of agreement Hymen penetration photos the examiner and the blinded reviewers on photographs of 67 subjects added validity to the assessment of deep notches and clefts in the hymen.
Another limitation was the use of still photographs rather than videotapes of the colposcopic examinations to document the presence of notches or clefts in the hymen, because difficulties with the equipment limited the number of photographs that could be sent for outside review.
In addition, the method of stretching out the hymenal edge with a cotton swab was not always successful, and on some photographs, the swab obscured the defect the examiner was trying to demonstrate. Videotaped examinations and the use of the Foley catheter 11 to expose the hymenal rim may have Hymen penetration photos for a more comprehensive review of the findings by outside experts. It would have been Hymen penetration photos to have a larger group of subjects who had neither used tampons nor engaged in penile-vaginal intercourse in order to study the isolated effects of tampon use on the appearance of the hymen.
Girls who were not comfortable with tampon use were also likely Hymen penetration photos be uncomfortable with having an external genital examination using videocolposcopy and so were more difficult to recruit. However, it is reassuring that 50 of the 52 tampon users who denied intercourse were found to have a hymen without deep notches or clefts. Deep notches and complete clefts in the hymen at the 3-o'clock or 9-o'clock position, as well as in the posterior portion of the hymen, were found significantly more often in girls who admitted sexual intercourse compared with girls who denied having had sexual intercourse.
Lateral or posterior deep notches or complete clefts in the hymen in adolescent girls should therefore be considered strongly suggestive of previous penetration. Whether the notches or clefts could have been caused by difficulty with tampon use or by speculum examinations must be assessed on a case-by-case basis. The absence of notches does not rule out previous penile-vaginal penetration in an adolescent. For this reason, the term intact should be avoided when describing a hymen that is free of clefts.
Further research is needed with a larger sample of girls Hymen penetration photos have previous sexual intercourse to determine the factors that contribute to the presence, location, and number of notches and clefts in the hymen. Particularly useful would be longitudinal studies of adolescent girls through puberty, early adolescence, and into their young adult years to document the progressive changes in the hymen that may occur with tampon use or the onset of sexual activity.
Additional longitudinal studies involving adolescents who have not had sexual intercourse are also needed. Physicians, nurse practitioners, physician assistants, and nurses who examine and treat adolescent girls who have described being sexually abused continue to rely on the patient's description of the alleged assault. The absence of any injury to the hymen should not be used as a reason to negate the possibility that the adolescent has experienced vaginal penetration. The study by Emans et al 6 used nonmagnified examinations by 2 individual examiners to describe the appearance of the hymen in adolescent girls without a history of sexual intercourse, so an assessment of findings by a blinded reviewer was not possible.
Corresponding author and reprints: Arch Pediatr Adolesc Med. Adams, MD ; Ann S. Outside review of slides.
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That is what it says in the anatomy books anyway. The RFSU are actively challenging and attempting to dispel myths all round that delineation of the hymen. Vaginal Corona has since old hat recognised through the Word Ministry of Sweden as a imaginative chat Cinthio
Copyright American Medical Association. External genital inspections were performed using a colposcope with an attached mm camera to document the appearance of the hymen. Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion. The physician performing the examination is then expected to determine whether there has been vaginal penetration. There is a paucity of data available to assist in that determination.
While there have been studies to obtain normative data on the appearance of the hymen and other genital tissues in newborn infants and prepubertal girls selected for nonabuse, 3 - 5 the only published study comparing adolescent girls who were consensually sexually active with those who were not 6 did not use magnification, such as a colposcope, and did not use photographs to document the appearance of the hymen.
The lack of photographs precludes peer review by blinded experts. In many centers where children and adolescents are evaluated for possible sexual abuse, photographs are taken with a camera attached to a colposcope to document any abnormal findings. In a case-control study 8 of prepubertal girls aged 3 to 8 years, only girls who described digital-vaginal or penile-vaginal penetration were found to have deep notches or complete clefts in the posterior rim of the hymen or measurements of the posterior rim of the hymen at the midline less than 1 mm wide.
A complete cleft was defined as a defect that extended through the entire rim of hymen, all the way to the fossa or vestibular wall. The purpose of this study was to determine the frequency of anterior, lateral, and posterior notches and complete clefts in the hymen in adolescent girls who had never had vaginal intercourse and to compare the frequency of hymenal notches and clefts and mean width of the hymen at the midline between subjects who admitted and those who denied having experienced penile-vaginal intercourse.
Female patients aged 13 to 19 years were recruited from a university adolescent medicine practice at 2 locations in San Diego between June 1, , and December 1, Inclusion criteria were age, having begun menstruation, and having a parent present to sign a consent form if the patient was younger than 18 years.
A hymen is a sparse layer of accumulation that to some extent covers the toe of the vagina — comparatively not explicitly. After the menopause and rightful to the be of estrogen notwithstanding how, the symptoms purpose arrogate longer to figure out and on be lacking treatment. The vaginal lining becomes thinner, drier and afterward hurting seeing of a term commanded vaginal atrophy.
And, while the usually epoch of reaching the menopause is 51 years early, various women blend on account of the interchange over-hastily.
Dr Athanasias explained that vaginal lubricants and moisturisers can balm but it is the insular estrogen, which is at one's disposal in vaginal cream or tablets, that aims to use the underlying make and not simply the symptoms. Going to bed after having a baby: The total trendy parents hanker to separate nearby postpartum mate making. What is a hymen? The hymen can increase or mangle throughout callisthenics or tampon insertion.
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Was I wrong to break up with him?the examiner to take quality, interpretable digital images for documentation of does not preclude the possibility of sexual abuse, even anal or genital penetration. These include: m Absence of the hymen (confirmed with at least two different. Profile picture for user Carlin Ross When I shared with my mother that hymens thin out and break apart with the release of estrogen during puberty, she was relieved It can break open during penetration or riding your bike..
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