Moderate specificity for abuse |
Acute lacerations or extensive bruising of the labia,
peri-hymenal tissues, scrotum, or perineum (may be from unwitnessed
accidental trauma) |
Scar of posterior fourchette (the assessment of scars
is difficult unless there was documentation of acute injury at the same
site) |
Fresh laceration of the posterior fourchette, not
involving the hymen (must be differentiated from dehisced labial
adhesion or failure of midline fusion; may be caused by accidental
injury) |
Perianal scar not in the midline (the assessment of
scars is difficult unless there was documentation of acute injury at
the same site; may be due to other medical conditions such as Crohn's
disease, or previous medical procedures) |
High specificity for
abuse |
Acute laceration of the hymen (partial or complete) |
Ecchymosis (bruising) of the hymen |
Perianal lacerations extending deep to the external
anal sphincter (not to be confused with partial failure of midline
fusion) |
Hymenal transection (healed) (ie, an area where there
is no hymenal tissue remaining between the vaginal wall and the fossa
or vestibular wall [also called a complete cleft]. The finding should
be confirmed using additional examination techniques such as a swab,
prone knee-chest position, Foley catheter, water to float the edge of
the hymen) |
Absence of hymenal tissue (wide areas in the
posterior/inferior half of the hymenal rim with an absence of hymenal
tissue, extending to the base of the hymen, which is confirmed using
additional positioning or other methods) |