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 |