The adolescent hymen

The genital examination is not a routine part of health maintenance assessment in prepubertal and pubertal girls. However, evaluation of minors for suspected sexual abuse has been addressed extensively in the last two decades. In spite of this, normal anatomic variations and developmental changes are not fully investigated. This paper reviews current knowledge about the hymen, with a focus on puberty and adolescence. More is known about the external genitals of prepubertal children than of adolescent girls. No longitudinal studies have been performed among girls older than age 3. Tanner staging does not include detailed genital development. A variety of terms have been used to describe the configuration and/or distortion of the hymen: attenuation, clefts, tears and transections, bumps and notches. No studies have been published on the normal variations of the width of the hymenal rim, although an attenuated and/or narrow rim is categorized as consistent with penetrative sexual abuse according to an international consensus statement. Critiques of the literature on the hymen have been published by experts on forensic medicine, emphasizing the fact that the normal hymenal appearance in adolescents still is not well documented. Few studies on hymenal configuration in nonabused adolescent girls have been performed, including girls with and without experience of consensual vaginal intercourse and use of tampons. Longitudinal investigations are required for a better knowledge of female genital development during puberty, with a special focus on vulvar and hymenal anatomy.