Hymen pre puberty girls-

Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Volume 40, No. Not so long ago, some doctors believed that they could determine, on the basis of examination of a girl's genitals, whether or not the girl had engaged in sexual intercourse. Even today, 'virginity checks' are conducted by doctors in some countries. Some Australian doctors still believe that it should be possible to determine, on the basis of examination findings, whether a child has been sexually abused.

Choose a single article, issue, or full-access subscription. The child's history as obtained by the physician may be admitted as evidence in court trials; therefore, complete documentation of questions and answers is critical. Frog-leg position with patient on caretaker's lap. The prepubertal hymen pdf KB. Wood's lamp utility in the identification of semen. Downloads Help with downloads. Back Issues Older back issues Indices Order back isues. Another method of puerty visualization of the pubertal hymen requires the use ;re a Foley catheter.

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The vaginal mucosa appears red, thin Hymen pre puberty girls folded. Suspect a foreign body if there are WBCs in the urine but a negative urine culture. As everyone develops at different rates, there's no right or wrong age for a girl to start. From puberty onwards, depending on estrogen and activity levels, the hymenal tissue may be thicker, and the opening is often fimbriated or erratically shaped. More often, the diagnosis is made during the teen years. A torn hymen Hymen pre puberty girls be surgically restored in a procedure called hymenorrhaphy. Contemporaty Pediatrics. By using this site, you agree to the Terms of Use and Privacy Policy. Just create a psychological picture in your brain that you still married the virgin lady you had wanted to, show some love to each other then the gap will definitely be closed! Some years later after we were married I went to a HS reunion with her she did not want me to attend her reunion and was standing at a drink table Huskvarna riding mower engines or 4 men started talking about herunknowing that I was her husband…One of the guys commented that he bet every boy in the senior class had screwed her…. The hymen has no nerve innervation. History of Psychiatry. Your were deceived into marrying her.

Related Editorial.

  • The hymen is a piece of skin covering the vaginal opening in females.
  • The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening.
  • Genital bleeding is a common complaint in the pediatric population.
  • Hymens can come in different shapes.
  • Gynecological Examination of a Prepubertal Child A full gynecological examination of the child mainly includes inspection of external genitalia and in some cases rectal examination.
  • Back to Sexual health.

Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Volume 40, No. Not so long ago, some doctors believed that they could determine, on the basis of examination of a girl's genitals, whether or not the girl had engaged in sexual intercourse. Even today, 'virginity checks' are conducted by doctors in some countries.

Some Australian doctors still believe that it should be possible to determine, on the basis of examination findings, whether a child has been sexually abused. This article sets out to describe some of the common variations in hymenal anatomy in order to dispel myths and misperceptions surrounding genital examination findings in young girls.

Most general practitioners would immediately refer any prepubertal child who they suspected may be the victim of sexual abuse to a specialist centre for assessment and support. Given the consequences for doctors and patients when mistakes occur in the medicolegal arena and the potential risk of secondary trauma, this cautious approach seems wise.

However, there are several other presentations in young girls that would appropriately prompt the GP to conduct a genital examination. For example, in the absence of an allegation or suspicion of sexual abuse, symptoms of genital itch, redness, pain or discharge would usually warrant examination.

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The prepubertal hymen Volume 40, No. Article Download article Download Citations. Anne Smith Not so long ago, some doctors believed that they could determine, on the basis of examination of a girl's genitals, whether or not the girl had engaged in sexual intercourse. Downloads Help with downloads. The prepubertal hymen pdf KB. Opening or saving files Files on the website can be opened or downloaded and saved to your computer or device. MP3 Most web browsers will play the MP3 audio within the browser.

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In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases. Different types of hymens. The best way now is to forgive her and live with it. Take Care…. The hymen may stretch on its own or even rupture, during growth and development and be non-existent once a female reaches full-maturity. Unlike precocious puberty, other features of puberty are not present along with the premature bleeding. What can make the hymen break?

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Some girls may notice blood spots in their underwear from this happening. This is the situation where the hymen does completely cover the opening to the vagina. This condition usually goes undiagnosed until a girl enters puberty and her first period and the blood cannot flow out.

When this happens, the hymen almost completely closes off the vaginal opening. Menstrual blood is able to flow out, but a virginal female may not be able to use tampons. This is when one hymen is split into two openings over the vagina. This condition also does not stop menstrual blood flow, but can block the use of tampons in virginal females.

If a female does not choose to use tampons then these conditions usually do not cause issue prior to losing her virginity, but can cause issues during the first sexual intercourse. They are easily remedied with minor surgery. Hymen surgery can be done for a few reasons, either to repair a broken hymen or removing extra hymen tissue that blocks the vaginal opening.

This is essentially a cosmetic surgery performed to repair a broken hymen for personal reasons. The hymen is surgically reclosed to cause bleeding upon sexual intercourse. Some people may choose to do this for personal reasons or out of necessity due to spiritual beliefs. It can also be performed after cases of rape. This is the surgical procedure used to open a hymen that is imperforate, Microperforate or Septate.

Usually an anatomically correct hymen can be stretched and broken during first intercourse or tampon use without too much trauma. The concern is that there is an artery that runs along the side of the hymen and can cause major bleeding.

Having a Hymenectomy can decrease the risk of bleeding and allow fluids to leave the vagina easier. Keep in mind that the hymen can only be completely ruptured by sexual intercourse or use of tampons.

Some women may choose to attempt stretching it to make first intercourse more pleasurable. Here are a few tips to help stretch the hymen:. The problem now is, when am with her, i begin to get erection but before all the fore plays which i believe would have got me in the mood, my manhood would rather lie low and refuse to wake.

What could be the problem, please? I dont wanna lose her. Reply via my email please…. Just email me. Good luck. Has she been helping with the foreplay? If the female performs foreplay with you by stroking and manipulating your penis, that may help to get it up. Good sex is not a one-way street, both partners need to work at it. Maybe try self pleasure see if that helps. My wife was not a virgin when I met her. It always bothered me that someone else her old boyfriend was able to have her virginity and not me.

Sometimes I feel that I should have never married her. I know I have traditional ideals and mentality, but that is just how I feel. Time has not changed this we are together 43 years. It bothers me every day. I asked her to get vaginal sugery to rebuild her hymen and become a virgin do to speak. She refused. Iam not going through that pain.

The procedure would never change the fact that some other guy deflowered her and used her , it would validate her devotion to me letting me know that although she cannot be a virgin again or correct her mistake of not waiting for her husband to give her Virginity to I as a man would feel that she subjected herself physically and emotionally to the painful surgery of satisfying and the hurt I go through with the thought that some other guy had her virginity.

She just does not realize the emptiness and pain I feel. Responses from men as well are welcomed. I have a microperforate hymen, can you explain the type of surgery I would need before I could have sex. I am 25 and getting married. My hymen also seems to be thick. The hymen has no nerve innervation. In newborn babies, still under the influence of the mother's hormones , the hymen is thick, pale pink, and redundant folds in on itself and may protrude.

For the first two to four years of life, the infant produces hormones that continue this effect. The hymen can stretch or tear as a result of various behaviors, by tampon or menstrual cup use, pelvic examinations with a speculum , regular physical activity, sexual intercourse, [1] insertion of multiple fingers or items into the vagina, and activities such as gymnastics doing 'the splits' , or horseback riding.

In forensic medicine, it is recommended by health authorities that a physician who must swab near this area of a prepubescent girl avoid the hymen and swab the outer vulval vestibule instead. Normal variations of the hymen range from thin and stretchy to thick and somewhat rigid; or it may also be completely absent. In either case, surgical intervention may be needed to allow menstrual fluid to pass or intercourse to take place at all.

Prepubescent girls' hymenal openings come in many shapes, depending on hormonal and activity level, the most common being crescentic posterior rim : no tissue at the 12 o'clock position; crescent-shaped band of tissue from 1—2 to 10—11 o'clock, at its widest around 6 o'clock. From puberty onwards, depending on estrogen and activity levels, the hymenal tissue may be thicker, and the opening is often fimbriated or erratically shaped.

In adolescents, the hymenal opening can naturally extend and variation in shape and appearance increases. Variations of the female reproductive tract can result from agenesis or hypoplasia, canalization defects, lateral fusion and failure of resorption, resulting in various complications. Historically, it was believed that first sexual intercourse was necessarily traumatic to the hymen and always resulted in the hymen being "broken" or torn, causing bleeding.

However, research on women in Western populations has found that bleeding during first consensual intercourse does not always happen or is less common than not bleeding. In several studies of adolescent female rape victims, where patients were examined at a hospital following sexual assault, half or fewer of virgin victims had any injury to the hymen. In a study of adolescents who had previously had consensual sex, approximately half showed evidence of trauma to the hymen.

Trauma to the hymen is hypothesized to occur as a result of various other behaviors, such as tampon or menstrual cup use, pelvic examinations with a speculum , masturbation, gymnastics, or horseback riding, although the true prevalence of trauma as a result of these activities is unclear. The hymen is often attributed important cultural significance in certain communities because of its association with a woman's virginity.

In the 16th and 17th centuries, medical researchers mistakenly saw the presence or absence of the hymen as founding evidence of physical diseases such as "womb-fury", i. If not cured, womb-fury would, according to doctors practicing at the time, result in death. Due to similar reproductive system development, many mammals have hymens, including chimpanzees, elephants, manatees, whales, horses and llamas.

From Wikipedia, the free encyclopedia. This article is about the vaginal membrane. For the village, see Himen, Iran. For other uses, see Hymen disambiguation. External genital organs of female.

The labia minora have been drawn apart. Arrows point to carunculae myrtiformes "remnants" of the hymen in a post-pubertal individual.

Main article: Virginity test. Jean, eds. New York: Oxford University Press. Paige Clinical protocols in pediatric and adolescent gynecology. Virgin: The Untouched History. Bloomsbury USA. American Family Physician. University of California, Santa Barbara. Retrieved February 9, The hymen oftentimes, though not always, rips or tears the first time a female engages in penetrative intercourse, which may cause some temporary bleeding and slight discomfort.

We agree with Rogers and Stark that so called rupture and bleeding of the hymen is not to be routinely expected after first sexual intercourse. Simpson's Forensic Medicine 11th ed. London: Arnold. Possible explanations for the lack of genital trauma include In Mann, Gurdeep S. Imaging of Gynecological Disorders in Infants and Children.

Medical Radiology. Jean; Muram, David Oxford University Press. Retrieved February 2, Different normal variants in hymenal configuration are described, varying from the common annular, to crescentic, to navicular "boatlike" with an anteriorly displaced hymenal orifice.

Hymenal variations are rarely clinically significant before menarche. In the case of a navicular configuration, urinary complaints e. Sometimes, a cribriform fenestrated , septate, or navicular configuration to the hymen can be associated with retention of vaginal secretions and prolongation of the common condition of a mixed bacterial vulvovaginitis.

Blueprints Obstetrics and Gynecology. BMJ Case Reports. Encyclopedia of Jewish Medical Ethics. Occasionally, the hymen is harder than normal or it is complete and sealed without there being This condition is called imperforate hymen and, at times McGraw-Hill Professional. Imperforate hymen represents a persistent portion of the urogenital membrane It is one of the most common obstructive lesions of the female genital tract.

Related Editorial. Child victims of sexual abuse may present with physical findings that can include anogenital problems, enuresis or encopresis. Behavioral changes may involve sexual acting out, aggression, depression, eating disturbances and regression. Because the examination findings of most child victims of sexual abuse are within normal limits or are nonspecific, the child's statements are extremely important.

The child's history as obtained by the physician may be admitted as evidence in court trials; therefore, complete documentation of questions and answers is critical. A careful history should be obtained and a thorough physical examination should be performed with documentation of all findings. When examining the child's genitalia, it is important that the physician be familiar with normal variants, nonspecific changes and diagnostic signs of sexual abuse.

Judicious use of laboratory tests, along with appropriate therapy, should be individually tailored. Forensic evidence collection is indicated in certain cases. Referral for psychologic services is important because victims of abuse are more likely to have depression, anxiety disorders, behavioral problems and post-traumatic stress disorder.

It is estimated that by the age of 18, 12 to 25 percent of girls and 8 to 10 percent of boys have been victims of sexual abuse. Because the diagnosis of sexual abuse often has significant psychologic, social and legal ramifications, evaluating children who allegedly have been sexually abused can be anxiety provoking for physicians, as well as for patients and their families.

It is important that the physician be knowledgeable about the basic evaluation of children for sexual abuse and cognizant of the resources available in the community. Sexual abuse is defined as any sexual activity that a child cannot comprehend or give consent to, or that violates the law. In sexual play, the developmental level of the participants should be similar, and the activity should occur without coercion. Perpetrators may be relatives or nonrelatives and are most frequently male. Concern about possible sexual abuse should be raised when children exhibit behavioral changes or have anogenital or other medical problems.

Behavioral changes include sexual acting out, aggression, problems in school, regression e. Sexual acting-out behavior is the most specific indicator of possible sexual abuse.

Children may present with somatic complaints such as recurrent abdominal pain or frequent headaches resulting from the psychologic stress.

Even in legally confirmed cases of sexual abuse, most children do not have physical findings diagnostic of sexual abuse. Therefore, the child's disclosure is often the most important piece of information in determining the likelihood of abuse.

Investigative interviewing should be performed by the appropriate agencies and, if possible, by forensic interviewers. In addition, physicians should ask questions relevant to medical diagnosis and treatment. The medical interview may be admissible in court as an exception to hearsay; thus, careful documentation of questions and responses is critical. Questions and answers should be recorded verbatim. The physician should maintain a gentle and calm demeanor and be considerate of the apprehensive child.

It is helpful to explain the examination beforehand to the patient and caretaker. A complete physical examination, including careful documentation of any lacerations, ecchymoses or petechiae, is critical.

Physical examination of the oral cavity includes inspection of the hard and soft palate for bruising or petechiae, and inspection of the frenulum for any lacerations that can result from forced oral penetration. If the sexual assault has occurred within 72 hours of the physical examination, forensic evidence collection should be conducted. Rape evidence collection kits are available in the emergency department of most hospitals.

Evaluation of acute sexual assault may be conducted in an emergency department setting or, if available, at a children's advocacy center. In nonacute cases, the office of the family physician has the benefit of being a familiar location for the patient.

Magnification and illumination are essential when examining the genitalia. An otoscope or, if available, a colposcope can be used. Demonstration of the instruments before use can be helpful in alleviating a child's fears about the examination. Colposcopy allows enhanced illumination and magnification as well as photographic documentation. If photographic documentation is unavailable, diagrams can be used to illustrate abnormalities.

Examination of the genitalia of the prepubertal girl is best performed with the child in the frog-leg, frog-leg while sitting on caretaker's lap or prone knee-chest position Figures 1a , 1b and 1c. In the frog-leg position, the child is supine with the knees apart.

If the child is anxious, the examination may be performed while the child is sitting on the caretaker's lap. In the knee-chest position, the child is prone, with knees, chest and head in contact with the table, and the back is in lordosis. It is necessary to perform an examination in the prone knee-chest position to confirm or exclude abnormalities of the posterior aspect of the hymen. Because the examination position can influence findings, it is important to document the position in which the child was examined.

The labia majora are gently retracted between the thumb and forefinger with force applied downward and outward Figure 2. When performing the anogenital examination, it is important to be familiar with pre-pubertal anatomy and normal variants.

The most common hymenal configurations are crescentic, annular, cuff-like, septate Figures 3a , 3b , 3c and 3d and fimbriated. Top An year-old girl examined in the supine frog-leg position.

Bottom The same child examined in the prone knee-chest position. Note that the irregularities resolve in the knee-chest position. Locations of abnormalities should be described as on a clock face with the urethra in the o'clock position and the anus at the 6-o'clock position.

In prepubertal girls, use of the speculum is reserved for unexplained bleeding and may require an examination with sedation. In pubertal girls, estrogen causes the hymenal tissue to become thicker and more compliant; therefore, detection of trauma can be more challenging Figure 4. The use of a moistened cotton swab to gently move the hymen may be helpful in viewing all aspects of a fimbriated or redundant hymen.

Another method of improving visualization of the pubertal hymen requires the use of a Foley catheter. The catheter is inserted into the vagina, the balloon is inflated and, with mild retraction, the hymen is stretched Figure 5. Left Annular hymen in a prepubertal girl. Right Annular hymen in a pubertal girl. A Foley catheter is inserted, the balloon is inflated and slight retraction is given. This method allows better visualization of the redundant areas of the hymen.

A genital examination of boys may be performed with the patient in the sitting, supine or standing position. The physician should examine the penis, testicles and perineum for bite marks, abrasions, bruising or suction ecchymoses.

Evaluation of the anus may be performed with the patient in the supine, lateral recumbent or prone position with gentle retraction of the gluteal folds.

Results of a physical examination will be within normal limits in 80 percent of child victims of sexual abuse. Many forms of sexual abuse do not cause physical injury.

Although the lay public and law enforcement representatives may be fixated on vaginal penetration, sexual abuse may be nonpenetrating contact and may involve fondling, oral-genital, genital or anal contact, as well as genital-genital contact without penetration. Mucosal tissue is elastic and may be stretched without injury, and damage to these mucosal surfaces heals quickly. Finally, many victims of sexual abuse do not seek medical care for weeks or months after the abuse, and superficial abrasions and fissures can heal within 24 to 48 hours.

Most patients have normal and nonspecific findings on examination. These findings include the following: 1 hymenal tags, bumps or mounds, 2 labial adhesions, 3 clefts or notches in the anterior half between the 9- and 3-o'clock position of the hymen, 4 vaginal discharge, 5 erythema of the genitalia or anus, 6 perianal skin tags, 7 anal fissures and 8 anal dilatation with stool in the ampulla.

Physical findings that are concerning but not diagnostic of sexual abuse include the following: 1 notches or clefts in the posterior half of the hymen extending nearly to the vaginal floor, confirmed in all positions, 2 condylomata acuminata in a child older than two years who gives no history of sexual contact, 3 immediate, marked anal dilatation and 4 anal scarring.

Physical findings that are diagnostic of penetrating trauma include: 1 acute laceration or ecchymosis of the hymen, 2 absence of hymenal tissue in the posterior half, 3 healed hymenal transection or complete cleft Figure 6 , 4 deep anal laceration and 5 pregnancy without a history of consensual intercourse Table 1.

Left Healed transections are present at the 4- and 7-o'clock positions, and a notch is present at the 6-o'clock position. Right The hymen is absent as a result of chronic sexual abuse in this pubertal girl. Physical findings that are concerning for sexual abuse. Notches or clefts in the posterior half of the hymen extending nearly to the vaginal floor, confirmed in all positions.

Condylomata acuminata in a child older than two years who gives no history of sexual contact. Physical findings that are diagnostic of penetrating trauma. Sexual abuse.

Pediatr Rev ;—50, and Adams JA. Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Child Maltreatment In press. Evidence collection should be performed if sexual contact occurred within 72 hours of the physical examination.

Forensic evidence includes blood, semen, sperm, hair or skin fragments that could link the assault to an individual person, as well as debris e. Rape evidence collection kits are available and include detailed instructions for the handling of clothes and undergarments, and specimen collection. A history should include obtaining information about the assault, including the use of a condom or lubricants, and whether the victim has eaten, washed, voided, defecated, bathed or douched since the contact.

The history should also note if the victim is menstruating or not. Use of a Wood's lamp may be useful in the detection of semen. Areas that fluoresce should be sampled with a moistened cotton swab, and the specimen sent for laboratory analysis.

Although many other substances fluoresce, the collection of semen can be vitally important in a legal case. Because these specimens are used only for forensic evidence, additional specimens are necessary if cultures are to be obtained.

The decision to obtain cultures and to perform serologic testing should be based on the likelihood of oral, genital or anal penetration and the presence of symptoms.

Prepubertal females are more likely to be symptomatic if they have Chlamydia or gonorrhea. Pubertal females may be asymptomatic but remain infected. Local prevalence of STDs and risk factors of the child and the alleged perpetrator of abuse should also be taken into consideration. Risk factors for the child or adolescent include other history of sexual contact, multiple sexual partners, intravenous drug use and exchange of sex for food, shelter or money.

Risk factors for the alleged perpetrator include a history of multiple sexual partners, intravenous drug use and STDs. Asymptomatic children who disclose only fondling have a very low incidence of STDs.