Anogenital signs and suspected sexual abuse
| Classification | Physical sign |
|---|---|
| Normal vulvovaginal features | Periurethral 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 features | Erythema, vascular congestion |
| Friability of perineal skin | |
| Vaginal discharge (unless sexually transmitted infection) | |
| Fusion of the labia | |
| Supportive vulvovaginal features | Acute 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 features | Anal 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 features | Fresh 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 features | Fresh laceration or scar of the anal mucosa extending beyond the anal margin and onto the perianal skin |
| Positive forensic evidence |