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Lacerations
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A laceration is defined as an acute tear through the full thickness of the skin or other tissues. When acute, a laceration may be associated with bleeding and /or bruising of the edges of the wound. A laceration to the hymen may involve the tearing of the full width of the hymen or only the partial width.
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Though laceration of the hymen may indicate vaginal penetration, in one study of 205 prepubertal girls with confirmed history of vaginal penetration, only 33% had reported hymenal lacerations. [42, 48] Even though it is not common, a laceration of the hymen of any depth is highly suggestive of child sexual abuse. (68)
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Lacerations of the hymen have also been described, though rarely, following accidents. These injuries can mimic those seen in child sexual abuse. [47]
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In pubertal girls, evidence from five studies show that hymenal lacerations are seen in 3% to 19% of those who allege sexual abuse including penile penetration. [47]
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Hymenal Transections
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A transection is a defect in the posterior hymen rim that extends to or through the base of the hymen. A transection is not an acute injury, but it can be considered a sign of a healed injury.
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Hymenal transections are very rarely seen in prepubertal girls who have not been sexually abused. However, a demonstrated transection, based on multiple studies, is commonly viewed as “a clear but uncommon indicator of past trauma” [42].
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A transection below the 3 to 9 o’clock location is the only non-acute hymen finding that is considered clear evidence of past injury (68). When hymenal transection are found, previous or past penetrative injury should be strongly suspected. (21, 68)
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Bumps and Munds
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A bump or a mund is a solid, localized, rounded, thickened area of tissue on the edge of the hymen.
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Bumps and mounds are considered a normal variant. They have been frequently observed in both abused and non-abused prepubertal girls. Several investigators found bumps in the anterior half of the hymen and in the posterior half of the hymen with similar frequency in abused and non-abused prepubertal girls. [42].
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Clefts and Notches
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Cleft and notches are indentations in the hymenal membrane.
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Clefts and notches in the anterior hymen have been described in newborn and in prepubertal sexually abused and non-abused girls.
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Clefts and notches can be part of the normal hymenal morphology in a fimbriated hymen. Superficial notches are defined as a notch inferior to 50% of the width of the hymenal membrane.
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Superficial notches (inferior to 50%) have been reported in both prepubertal girls with a history of vaginal penetration and prepubertal girls selected for non-abuse.
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Deep clefts or notches in the posterior half of a non-fimbriated hymen have only been reported in prepubertal girls with a history of vaginal penetration.
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In pubertal girls, posterior deep notches or complete clefts (transections) have been reported more often in girls with a history of forced (nonconsensual) vaginal penetration or consensual sexual intercourse than in girls denying sexual intercourse (33% vs 7%) [49]
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The finding of hymenal clefts increased with age. [48]
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Scars
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Hymenal lacerations can heal completely without scarring. They may also heal to leave a notch or a full transection. [47]
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