Table 2

Anogenital signs and suspected sexual abuse

ClassificationPhysical sign
Normal vulvovaginal featuresPeriurethral bands or ligaments
Longitudinal intravaginal ridges
Hymenal tags (in the newborn)
Smooth and non-scarred hymenal bumps
Smooth clefts in the anterior hymenal rim (3–9 o’clock)
Septate hymen
Fourchette: midline avascular area
Non-specific vulvovaginal featuresErythema, vascular congestion
Friability of perineal skin
Vaginal discharge (unless sexually transmitted infection)
Fusion of the labia
Supportive vulvovaginal featuresAcute injury (eg, localised erythema, oedema, abrasions, bruising)
Notch in the posterior hymen (below 3–9 o’clock)
Scar in posterior fourchette
Labial fusion following vulval coitus
Transverse hymenal diameter 1.5 cm
Supportive anal featuresAnal laxity without other explanation
Reflex anal dilatation >1.5 cm and reproducible
Acute changes (eg, erythema, swelling, fissures, bruising)
Venous congestion
Chronic anal changes (thickening of skin at the anal margin, increased elasticity, and reduction in the power of the anal sphincter)
Diagnostic vulvovaginal featuresFresh laceration of the hymen
Old tear of hymen with scarring or interruption of margin
Attenuation of hymen with enlargement of orifice
Pregnancy in a child under 16 years
Positive forensic evidence
Diagnostic anal featuresFresh laceration or scar of the anal mucosa extending beyond the anal margin and onto the perianal skin
Positive forensic evidence