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Table 1 Summary of included studies reporting on medical utility

From: Virginity testing: a systematic review

Author, Year Study design and population Results Quality of evidence
Berenson et al. 2000 [22] Case-control study at two centers in United States (n = 392)
Examiner(s): 1–2 physicians
Age of examinees: 3–8 years
Group 1: controls (n = 200)
Group 2: females with history of penetration (n = 192)
2.5% of Group 2 had physical findings that differed from those found in Group 1
Only one hymenal feature difference was found between the two groups; a septate hymen was observed more often in Group 2 than Group 1 (4% vs 1%; P = .03)
II-2
Good
Kellog et al. 2004 [23] Retrospective case review at one center in United States (n = 36)
Examiner(s): 1 physician, 2 nurses
Age of examinees: 12.3–17.8 years
Study group: pregnant adolescents
22 participants (64%) had normal or nonspecific examination findings; 8 (22%) had inconclusive findings; 4 (8%) had suggestive findings; 2 (6%) had findings of definite evidence of penetrating trauma II-2
Poor
Heger et al. 2002 [24] 5 year prospective study at one center in the United States (n = 2384)
Examiner(s): 2 physicians
Age of examinees: 3 months-14 years
Study group: females who reported vaginal penetration (n = 957)
Abnormal examinations were reported in only 6% of females who reported vaginal penetration II-2
Fair
Adams et al. 1994 [25] Retrospective case review at one center in the United States (n = 236)
Examiner(s): 1 staff of child abuse program
Age of examinees: 8 months-17 years and 11 months
Study group: girls who reported vaginal penetration/contact (n = 213)
Normal genital exam found in 59 cases (28%), non-specific exam in 104 cases (49%), and suspicious exam in 20 cases (9%)
Size of hymenal opening of study group was 7.7 ± 2.6 mm and compared to published data on non-abused children of the same age 6.9 ± 2.2 mm
II-2
Fair
Berenson et al. 2002 [26] Case-control study at two centers in the United States (n = 386)
Examiner(s): 1–2 physicians
Age of examinees: 3–8 years
Group 1: controls (n = 197)
Group 2: prepubertal females with history of penile or digital penetration (n = 189)
Group 2 had larger mean transverse hymen diameter than Group 1 when examined in the knee chest position but not supine position Hymenal orifice also increased with age
No significant differences found between groups in size of vertical diameter, amount of tissue present inferiorly or laterally, or symmetry of hymen in either position
II-2
Good
Heppenstall-Heger et al. 2003 [27] Prospective 10-year study at one center in United States (n = 94)
Examiner(s): three pediatricians and three nurse practitioners
Age of examinees: mean age 69.56 months (age range not specified)
Study group: 75 female children with history of vaginal penetration or trauma
Hymenal injuries were found in 37 (49.3%) of 75 girls with history of vaginal penetration or trauma
15 girls (20%) persisted with significant genital findings (i.e., a transection of the hymen)
In 80%, there was no hymenal irregularity
II-2
Fair
McCann et al. 2007 [28] Retrospective case review at multiple centers in the United States (n = 239)
Examiner(s): 1 physician and 2 nurses
Age of examinees: 4 months-18 years
Group 1: 113 prepubertal girls with history of vaginal penetration
Group 2: 126 pubertal adolescents with history of vaginal penetration
The hymenal injuries in Group 1 and Group 2 all healed rapidly and frequently left little or no evidence of the previous trauma II-2
Fair
Underhill et al. 1978 [29] Case study at one center in the United States (n = 28)
Examiner(s): 1–2 physicians
Age of examinees: 15–48 years
Study group: self-declared virgin females
Examination confirmed virginity in 58%, was inconclusive in 11% and unconfirmed in 31% of cases II-3
Poor
Frank et al. 1999 [30] Survey at one center in Turkey (n = 118)
Examiner(s): forensic physicians
Age of examinees: not specified
Study group: forensic physicians
66% of respondents reported that their findings from at least one virginity examination contradicted a recent virginity examination of the same patient III
Fair
Dubow et al. 2005 [31] Survey at one center in United States (n = 137)
Examiner(s): pediatric chief residents
Age of examinees: Not specified
Study group: pediatric chief residents
64% correctly identified prepubertal hymen III
Fair