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

Abbey B. Berenson, Mariam R. Chacko, Constance M. Wiemann, Clifford O. Mishaw, William N. Friedrich, James J. Grady

Research output: Contribution to journalArticlepeer-review

175 Scopus citations


OBJECTIVE: Our goal was to identify vulvar and hymenal characteristics associated 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 penetration and 200 children who denied prior abuse. Bivariate analyses were conducted by X2, the Fisher exact test, and the Student t test to assess differences 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 nonabused children with labial agglutination, increased vascularity, linea vestibularis, friability, a perineal depression, or a hymenal bump, tag, longitudinal intravaginal ridge, external ridge, band, or superficial notch. Furthermore, the mean number of each of these features per child did not differ between groups. A hymenal transection, perforation, or deep notch was observed 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.

Original languageEnglish (US)
Pages (from-to)820-834
Number of pages15
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - 2000


  • Children
  • Genitalia
  • Hymen
  • Sexual abuse
  • Sexual assault

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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