Case 9

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A 9-year-old girl is brought for examination due to a concern by her primary care provider regarding her examination findings. The girl lives with her mother and mother’s boyfriend and two younger half-siblings. She does well in school and has no genital complaints or behavioral problems.

image of hymen, description below

Accessible Version

A photo of the hymen of a pre-pubertal female in the knee-chest position. The hymen is thin edged and is a smooth crescentic shape with the anterior edge not visible behind the overlying clitoral hood. Vaginal walls are visible through the opening of the hymen.

Which of the following is a true statement regarding the examination of this crescent-shaped hymen?

A. The hymen edge is less than 1 mm in size at the posterior margin and the finding is suspicious for sexual abuse.

B. The hymen edge may be rolled under and should be further evaluated with another examination technique.

C. The examination reveals a healed transection and is clear evidence of past penetrating trauma.

D. The width of the hymenal opening is larger than normal and is suspicious for sexual abuse.