Normal prepubertal genitalia
Normal prepubertal genitalia. Prepubertal
labia minora are typically small and underdeveloped, as shown here
(black arrows). During infancy and early childhood, some
estrogen effect may be present, resulting in a thickened, pale
appearance of the hymen. During middle and late childhood, as seen
in this figure, the hymen is thin, red in color due to prominent
vascularity, and sensitive to touch. The most common configurations
of the hymen are crescentic (no hymenal tissue anteriorly), and
annular (hymenal tissue surrounding the vaginal opening). This
figure demonstrates a magnified view of a normal crescentic
prepubertal hymen. The hymenal edges (white arrows) are
smooth. The anterior vaginal wall is seen (arrowhead)
internal to the hymen. Accidental blunt trauma injuries, such as
straddle injuries, result in anterior and external tissue injury,
most commonly bruising, due to crushing of the tissue between the
traumatic object and the underlying pubic bone. Penetrating
injuries to the hymen, such as injuries resulting from sexual
abuse, are posterior due to the laxity of supporting tissues, which
permits stretch in this direction. Thus, penetrating injuries to
the hymen are most common between the 4 and 8 o’clock positions
(with the 12 o’clock position corresponding to anterior structures
and 6 o’clock to posterior). Owing to the characteristics of the
prepubertal hymen, injuries to the hymen typically result in pain
and bleeding in the prepubertal child. Many forms of sexual abuse,
including fondling, digital-genital contact, and genital-genital
contact do not result in injuries. It is important to understand
that most abused children have normal physical examinations,
particularly in the absence of a history of vaginal bleeding. Thus,
a normal examination does not rule out the possibility of
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