Author(s): McCann J, Wells R, Simon M, Voris J
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Abstract This project was designed to collect normative data on the genital anatomy from a sample of nonabused prepubertal girls. A total of 114 girls between the ages of 10 months and 10 years were examined and photographed with a colposcope. After screening for the onset of puberty and the possibility of undetected abuse, 93 subjects remained. Examination techniques included a supine labial separation approach, a supine labial traction method, and a prone knee-chest position. Common genital finding included erythema of the vestibule (56\%), periurethral bands (50.6\%), labial adhesions (38.9\%), lymphoid follicles on the fossa navicularis (33.7\%), posterior fourchette midline avascular areas (25.6\%), and urethral dilation with labial traction (14.9\%). The hymenal orifice opened more frequently during the knee-chest (95.2\%) and the labial traction (90.5\%) methods than with the supine separation (79.3\%) approach. Hymenal findings included mounds (33.8\%), projections (33.3\%), and "septal remnants"/midline hymenal tags (18.5\%). Intravaginal findings of vaginal ridges (90.2\%) and rugae (88.7\%) were found primarily through the labial traction approach. The cervix was visualized without the use of speculum in 69\% of the children during the knee-chest examination. Unusual findings included posterior fourchette friability (4.7\%), anterior hymenal clefts (1.2\%), and notches of the hymen (6\%). One child had an imperforate hymen (1.2\%) and 2 (2.5\%) had hymenal septa. A vaginal discharge was detected in 2 (2.6\%) and a foreign body in 1 (1.3\%). Tables that include the vertical and horizontal hymenal orifice diameters by age group and by method are presented.
This article was published in Pediatrics
and referenced in Primary Healthcare: Open Access