908 Misinterpretation of the normal prepubertal hymen. (17th August 2022)

• Record Type: Journal Article
• Authors: Wallace, Jennifer; Moore, Rebecca; Livingstone, Alison; Tolson, Amy
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A291
• Page End: A291
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.471
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Medical assessment of the ano-genital area for signs of sexual abuse is a specialised field requiring specific training and expertise. However, within the course of their work, doctors (including paediatricians, emergency staff, gynaecologists or general practitioners) will need to inspect the genitalia of pre-pubertal children presenting with ano-genital symptoms, such as bleeding or discomfort. On occasion medical professionals have contacted the Sexual Assault Referral Centre for advice having falsely misinterpreted the finding of a normal hymenal orifice (or hole) in a pre-pubertal child as a sign of a previous penetrative hymenal injury. Many lay people and professionals believe the hymen to be a complete layer of tissue which breaks down leaving a hole following penetration. Whilst it is clearly important to detect physical signs of potential sexual abuse it is equally important not to trigger investigation for sexual abuse purely on misinterpretation of normal clinical anatomy or findings. Methods: During mandatory foundation year safeguarding teaching for the year 2021, FY2 doctors were shown a photo of a normal prepubertal hymen/hymenal orifice and were asked to anonymously vote on whether this was abnormal or normal. They were asked the question-'You can see a hole- is this pre-pubertal girl normal?' We then surveyed emergency and paediatric trainees, signed up to attend a genital teaching study day, on their own perceived confidence in assessing, documenting and describing male and female genital. This was done using a Likert scale. Results: 340 foundation doctors were surveyed, 121 correctly identified the picture as normal, 140 incorrectly identified it as abnormal and 79 were unsure. Over 64% of doctors either incorrectly identified or were unable to identify this photo as a normal hymenal orifice. In the survey of speciality trainees, 20 out of 32 described themselves as not confident or not at all confident in examining and documenting genital injury in paediatrics. 27 out of 32 described themselves as not so confident or not at all confident in specifically describing the hymen. Conclusion: Over 40% of the foundation year doctors misinterpreted the finding of an orifice (or hole) in the hymen of pre-pubertal children as abnormal. The survey of the more senior speciality trainees showed that 84% describe themselves as not confident in specifically describing the hymen. We think it is clear there needs to be further education of medical students and doctors in recognising normal prepubertal female genitalia, including inclusion in the undergraduate curriculum to avoid unnecessary misinterpretation of penetrative trauma.