A Pregnant Adolescence with an Intact Hymen
Article content
Abstract
Child sexual abuse is a public health problem due to both the act itself and its consequences, one of the most serious of which is adolescent pregnancy. Unfortunately, it is difficult to provide evidence of such sexual crimes by forensic gynecologic examinations based on only the visual inspection of genitalia. Moreover, anatomic variations of genitalia can make it quite difficult for a physician to make a diagnosis of rape. A 14-year-old pregnant girl presented at our hospital with the allegation of sexual abuse. Although her pregnancy was obvious due to shape of her abdomen, her hymen was determined to be intact after examination. She was examined in the gynecology department to check on the pregnancy and investigate her health status. Ultrasound imagining revealed that she was 4 months and 3 days pregnant. The goal of this presentation is to draw physicians’ attention to the anatomic variations of the hymen. Our findings indicate that it is not always easy to make a diagnosis of sexual intercourse; the practitioner must take a multidisciplinary approach and develop his/her genital examination knowledge and skills.
Keywords
Adolescence pregnancy, Child sexual abuse, Child Maltreatment, Forensic Medicine, Forensic Science, Intact Hymen, Clinical forensic medicine
Downloads
References
Guidelines for Medico-legal Care for Victims of Sexual Violence: https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap7.pdf Accesssed 11 May 2021.
Turkish Juvenile Protection Code 3: https://www.mevzuat.gov.tr/mevzuatmetin/1. 5.5395.pdf. Accesssed 18 October 2022.
Turkish Penal Code 103-5: https://www.mevzuat.gov.tr/MevzuatMetin/1.5.5237.pdf Accesssed 10 May 2021.
Merritt, D. F. Vulvar and genital trauma in pediatric and adolescent gynecology. Current Opinion in Obstetrics and Gynecology. 2004;16(5):371-381.
Pokorny, S. F., Murphy, J. G., & Preminger, M. K. Circumferential hymen elasticity. A marker of physiologic maturity. The Journal of Reproductive Medicine. 1998;43(11):943-948.
Eg, M. B., Hansen, L. A., Sabroe, S., & Charles, A. V. Hymenal lesions and legal outcome in sexually abused girls with a history of vaginal penetration. Forensic Science International. 2015;252: 163-167.
Adams, J. A., Botash, A. S., & Kellogg, N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Archives of pediatrics & adolescent medicine. 2004;158(3):280-285.
Joki-Erkkilä, M., & Suikki, E. Impact of mechanical force on posterior hymen—Implications for sexual abuse injury interpretations. Forensic science international. 2018;292: 204-211.
Dhall, A. Adolescence: myths and misconceptions. Health for the millions. 1995;21(3):35-38.
Kellogg, N. D., Menard, S. W., & Santos, A. Genital anatomy in pregnant adolescents:“normal” does not mean “nothing happened”. Pediatrics. 2004;113(1):67-69.
Mishori, R., Ferdowsian, H., Naimer, K., Volpellier, M., & McHale, T. The little tissue that couldn’t–dispelling myths about the Hymen’s role in determining sexual history and assault. Reproductive health. 2019;16(1):1-9.
Wolf, B. Pregnancy after ejaculatio ante portas in a patient with an anatomical obstruction to intercourse. Zentralblatt fur Gynakologie. 1988;110(22):1457-1459.
Goodyear-Smith, F. A., & Laidlaw, T. M. What is an ‘intact’hymen? A critique of the literature. Medicine, Science and the Law, 1998;38(4):289-300.
Herman-Giddens, M. E., & Frothingham, T. E. Prepubertal female genitalia: examination for evidence of sexual abuse. Pediatrics. 1987; 80(2):203-208.
Bussen, S., Rehn, M., Haller, A., Weichert, K., & Dietl, J. Kindergynäkologische Aspekte des sexuellen Missbrauchs. Zentralblatt für Gynäkologie. 2001;123(10): 562-567.
Lillibridge, C., & Kappes, B. Quantitative observations of hymens in prepubescent females selected for non-abuse. Alaska medicine. 1993;35(2):160-167.
Herring, A. H., Attard, S. M., Gordon-Larsen, P., Joyner, W. H., & Halpern, C. T. Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey. BMJ. 2013;347.
Article details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
You must read and accept the copyright terms and conditions(click here for copyright terms).