Healing of Hymenal Injuries in Prepubertal and Adolescent Girls: a Descriptive Study

Objective: The objective of this study was to identify the healing process and outcome of hymenal injuries in prepubertal and adolescent girls.

Methods: This multicenter, retrospective project used photographs to document the healing process and outcome of hymenal trauma that was sustained by 239 prepubertal and pubertal girls whose ages ranged from 4 months to 18 years.

Results: The injuries that were sustained by the 113 prepubertal girls consisted of 21 accidental or noninflicted injuries, 73 secondary to abuse, and 19 "unknown cause" injuries. All 126 pubertal adolescents were sexual assault victims. The hymenal injuries healed at various rates and except for the deeper lacerations left no evidence of the previous trauma. Abrasions and "mild" submucosal hemorrhages disappeared within 3 to 4 days, whereas "marked" hemorrhages persisted for 11 to 15 days. Only petechiae and blood blisters proved to be "markers" for determining the approximate age of an injury. Petechiae resolved within 48 hours in the prepubertal girls and 72 hours in the adolescents. A blood blister was detected at 34 days in an adolescent. As lacerations healed, their observed depth became shallower and their configuration smoothed out. Of the girls who sustained "superficial," "intermediate," or "deep" lacerations, 15 of 18 prepubertal girls had smooth and continuous appearing hymenal rims, whereas 24 of 41 adolescents' hymens had a normal, "scalloped" appearance and 30 of 34 had no disruption of continuity on healing. The final "width" of a hymenal rim was dependent on the initial depth of the laceration. No scar tissue formation was observed in either group of girls.

Conclusions: The hymenal injuries healed rapidly and except for the more extensive lacerations left no evidence of a previous injury. There were no significant differences in the healing process and the outcome of the hymenal injuries in the 2 groups of girls.