Hymen Trauma

Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.


Hymenal trauma is occasionally found after sexual abuse and more rarely after accidental injuries. Recognition of specific patterns related to abuse is important. Findings of confirmed sexual abuse are primarily acute injuries to the genitalia, anus, or oral cavity; genital scarring; sexually transmitted infections (STIs); and hymenal transection or evidence of deep notches. The significance of notches or clefts in the hymen depends on the location and severity of the defect. Posterior or inferior hymenal tears that extend to the vaginal floor provide conclusive evidence of penetrating or blunt force trauma. Furthermore, studies report that only girls with confirmation of abuse had evidence of deep notches extending through more than 50% of the posterior hymenal rim. Categories of sexual abuse can be divided into signs suggestive of abuse versus those specific for abuse. However, because positive findings occur infrequently, one cannot overemphasize that the history from the child still remains the single most important diagnostic feature in deciding whether a child has been sexually abused.

Look For

Findings highly specific for abuse include acute laceration of the hymen (partial or complete) and hymenal ecchymosis.

Associated findings increasing the likelihood of sexual abuse include perianal lacerations extending into the anal sphincter, purulent or malodorous vaginal discharge, and immediate anal dilatation of 20 mm or greater in a knee-chest position with no constipation, no stool in the vault, and no underlying neurological disorder.

In comparison, accidental injuries, such a straddle injuries, are typically unilateral and superficial and involve the anterior portion of the genitalia, particularly the labia minora or urethra and not the hymen. Picket-fence-type injuries may produce hymenal trauma.

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