Comparison of genital examination techniques in prepubertal girls

The results of three separate methods used to examine prepubertal girls are compared and a technique for measuring hymenal orifice diameters from colposcopic photographs is presented. A total of 172 girls who were examined by three techniques during their evaluation in a clinic for suspected child sexual abuse victims were studied. Their ages ranged from 10 months to 11 years with a mean of 5 years, 8 months. The examination techniques used were the supine position with labial separation, the supine position with labial traction, and the knee-chest position. The knee-chest position (98%) and the supine traction method (96%) proved to be superior to the supine separation technique (86%) in opening the vaginal introitus. The largest vertical transhymenal diameters were produced in the knee-chest position, whereas the greatest transverse horizontal spans were generated by the supine traction procedure. Other soft tissue changes were noted but not quantified. A multimethod approach to the examination of the sexually abused child is recommended to take advantage of the strengths of each technique.