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Evidence of Sexual Abuse May be Normal Variation

GALVESTON, Texas--Several genital features of prepubescent girls traditionally interpreted as red flags suggesting sexual abuse may simply be normal developmental variations, according to a study to be published June 6th in the Journal of Pediatrics. Abbey B. Berenson, professor of obstetrics and gynecology at the University of Texas Medical Branch at Galveston (UTMB) and director of the university's newly created Center for Interdisciplinary Research in Women's Health, and a colleague report in the journal that several anatomic features originally thought to be signs of sexual abuse are often congenital or the result of female genital development.

Berenson periodically examined more than 60 children between the ages of 3 and 9 to determine what appears to be "normal" in female genital development. The study, "A Longitudinal Study of Hymenal Development from 3 to 9 Years of Age" focuses on the overall development of the hymen, the fold of tissue partially or completely obstructing the external vaginal opening, in 63 young girls who have no history of sexual abuse.

The paper highlights several physical features that had previously been considered indicators of abuse. One such suggestion of abuse is a decrease in the amount of hymenal tissue. Berenson and her collaborator, James J. Grady of UTMB's Office of Biostatistics, documented gradual decrease of this tissue among some study participants between the ages of 3 and 5, demonstrating that such tissue loss can be a normal phenomenon.

Another supposed indicator of sexual abuse is the development of notches and mounds in the hymen. Traditionally, physicians pointed to notches and mounds that appeared where they had previously been absent as evidence of sexual abuse. However, Berenson and Grady showed that this is not so: both notches and mounds can develop on their own after 3 years of age. The study was funded by grants from the John Sealy Memorial Endowment Fund and the National Institutes of Health (NIH), National Center for Research Resources (NCRR) General Clinical Research Center (GCRC).

Berenson is a national leader in documenting the development of the female genitalia. This latest paper adds to evidence provided by an earlier study conducted by Berenson with faculty from the Baylor College of Medicine. The former study, "A case-control study of anatomic changes resulting from sexual abuse," appeared in the April 2000 issue of the American Journal of Obstetrics and Gynecology. By studying the cases of nearly 200 prepubescent, sexually abused children and two hundred children of similar age who had not been abused, Berenson and collaborators demonstrated that the genital appearance of abused versus non-abused children rarely differs.

"Basically what we found after several years of research," said Berenson, "is that you can find signs that are truly unique to sexually abused children in less than 5 percent of children with a history of sexual abuse." Berenson notes, however, that because the hymen can heal, signs of abuse may be undetectable when there is extensive time between the incident or incidents and examination.

---University of Texas Medical Branch at Galveston

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