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The hymen is not necessarily torn after sexual intercourse

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7155.414 (Published 08 August 1998) Cite this as: BMJ 1998;317:414

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Little is known about the adolescent hymen

Rogers and Stark, forensic physicians, emphasise the need for
education about the nature of the postpubertal hymen1. As forensic
paediatricians we concur. Ten of the women described by Longmans et al
had been sexually abused2. The normal appearance of the prepubertal hymen
and its appearance following sexual abuse has been well described, the
appearance of the adolescent hymen is not well documented. The study by
Emans et al3 is an important exception4.

In 1997 we surveyed 121 District General Hospital consultants
including 68 paediatricians, 54 obstetricians and gynaecologists and 4 GUM
consultants. We wished to establish the frequency with which they
examined the adolescent hymen and the confidence they felt with regard to
the clinical findings.

91/121 examined adolescent genitalia less than 5 times per year. On
genital examination only 28/75 routinely assessed the hymen. There was
uncertainty regarding the significance of findings. 43% did not know if a
complete cleft might be an expected finding in adolescent girls who were
not sexually active and 40.5% did not know if it might be expected in
sexually active girls. One respondent thought that complete absence of
the hymen might be a
common finding in girls not sexually active and 8 respondents that it
might be a common finding in sexually active adolescent girls.(Frequency
of congenital absence of the hymen <0.03%, Jenny 19875) Asked if they
thought
that frequent sexual activity resulted in on-going loss or damage to the
hymen, 19 thought it did, 44 that they did not know and 3 said that it did
not.

In our experience of examination of over one thousand adolescents who
have suffered sexual abuse and/or have been sexually active, the most
common appearance of the hymen is of indeterminate disruption to the free
edge. Complete clefting or significant gaps in hymenal tissue is unusual.
We hypothesise that in the prepubertal girl, because of the relatively
size of the structures, penetration occurs through the hymenal tissue
causing tearing but that in the adolescent and adult woman, consensual
penetration occurs into the orifice which stretches and yields resulting
in spreading and indeterminate disruption. 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.

Emma Curtis, Senior Registrar
Camille San Lazaro, Senior Lecturer, Paediatric Forensic Medicine
Lindisfarne Centre, Royal Victoria Infirmary, Newcastle upon Tyne, NE1
4LP

1.Rogers DJ, Stark M. The hymen is not necessarily torn after sexual
intercourse.BMJ 1998;317:414

2.Longmans A,Verhoeff A,Bol Rapp R,Creighton F,van Lent M.Should
doctors reconstruct the vaginal introitus of adolescent girls to mimic the
virginal state? Who wants the procedure and why.BMJ 1998;316:459-60

3.Emans SJ,Woods ER,Alfred EN,Grace E. Hymenal findings in adolescent
women:Impact of tampon use and consensual sexual activity. J Pediatr
1994;125:153-60

4.Goodyear-Smith FA,Laidlaw TM. Can tampon use cause hymen changes
in girls who have not had sexual intercourse? A review of the literature.
Forensic Science International 1998;94:147-53

5.Jenny C,Kuhns MLD,Arakawa F. Hymens in Newborn Female Infants.
Paediatrics 1987;80(3):399-400

AUTHORS

Emma Curtis, Senior Registrar
Camille San Lazaro, Senior Lecturer, Paediatric Forensic Medicine
Lindisfarne Centre,
Royal Victoria Infirmary,
Newcastle upon Tyne, NE1 4LP
Tel. No. 0191 2195196 ext. 24753
Fax. No. 0191 2303541

Competing interests: No competing interests

10 September 1998
Emma Curtis