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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