The hymen morphology in normal newborn Saudi girls

Medico-legal study of the hymen

BACKGROUND

The study of hymen morphology and injuries is critical in forensic medicine, particularly in Iraq and other Asian countries. Problems with the hymen can have serious social consequences.

AIM OF THE STUDY

The aim of this study is to shed light on various hymen's variants, as well as the possible causes of their injuries and their medicolegal significance.

METHOD

This study was carried out at Baghdad's medico-legal directorate (M.L.D.) from January 1st to March 31st, 2017. There were 127 cases in total. They ranged in age from two to sixty. The morphology of the hymens, their injuries, and other relevant details were documented using a specific questionnaire.

RESULTS

Compared to other varied examinations undertaken, such as infertility, impotence, and others, the examination of the hymen made up (5.1%) of all examinations conducted in the Medico-Legal Directorate (M.L.D.) clinic in Baghdad. The majority of the women tested were over the age of 14. The annular hymen was the most common variant (57.3%). The elastic hymens percentage was 14.6% while the Imperforated variant had the lowest prevalence (0.8%). The majority of the properties of the examined hymens were smooth free edge, medium consistency, and medium sized hymen opening. The majority of the cases involved female children (prepubertal girls) who were accidently injured, followed by sexual assaults and wedding night doubts. The majority of hymen tears (40.2%) were old. Multiple tears (47.5%) outnumbered single tears (37.3%). Fresh tears were only observed in adult girls.

CONCLUSION

The annular variant of the smooth free edge, average consistency, and average hole size is the most common hymens. The elastic hymens were a main reason for the referral of cases for medical examination due to wedding night doubts. In more than half of the cases, the hymens were smooth with no transection or deep notches.

Appearance of external genital organs and types of hymen in Turkish female foetal cadavers

The present study's purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.

Genital findings in prepubertal girls: what can be concluded from an examination?

INTRODUCTION

Interpretation of genital findings is a key component of the medical examination for suspected child sexual abuse. This study seeks to review the extent of evidence-based research on genital findings in prepubertal girls.

METHODS

Literature review on normal genital anatomy in non-abused girls, case control studies comparing abused and non-abused girls, and observations of healing where the mechanism of injury is documented.

RESULTS

A prolific literature exists on children examined for suspected abuse. By comparison there is a very little literature on children screened for non-abuse. Primary data on normal genital anatomy in girls after the neonatal period was found in 10 papers of non-abused girls and 6 case-control studies. The screening methods used to ensure that only non-abused children were assigned to non-abused groups were of variable standards. The evidence base on prepubertal girls selected for non-abuse using robust methodology is very small. The evidence base on healing of documented genital injury is contained in two case series, and a small number of case reports. Almost the entire evidence base on prepubertal genital anatomy in girls is derived from the USA.

CONCLUSIONS

Knowledge of the American studies and the limited extent of the total evidence base are essential to interpretation. A posterior rim of hymen measuring at least 1mm is always present unless there has been trauma. There is such a wide range of normal hymen orifice size, that measurements are generally unhelpful. Genital injuries generally heal rapidly and most heal without residua. Hymen healing does not leave scarring, but scarring or vascular changes may occur to surrounding tissues. Except for deep lacerations hymen injury leaves no evidence of trauma. A full thickness transection through the posterior hymen is reliable evidence of trauma and does not heal without surgical repair.