General Medical Information

Physical Examination Of The Prepubertal Female Genitalia

Andrew S. Cook

The request for examination of prepubertal female genitalia may be initiated as a result of suspected sexual abuse. It is crucial for the clinician to be able to differentiate normal congenital findings from posttraumatic changes. An examination that is initiated based on suspected sexual abuse will focus primarily on the external genitalia, including the hymen, labia, posterior fourchette, and perineal body. Examination of potential genital anomalies, masses, or nontraumatic pain usually will focus on the internal genitalia.

The physical examination of the prepubertal female genitalia is unique. Success of the physical examination is highly dependent on the rapport and interaction established with the patient. The physician should be sensitive to the child’s emotions and fears, displaying gentleness, patience, and time. A lack of empathy toward the pediatric patient may, at minimum, adversely affect the ability to obtain adequate information from the physical examination and may, at worse, increase the potential risk of inadvertent nosocomial sexual abuse.

The office evaluation of the female prepubertal genitalia also requires both an understanding of the range of normal findings in a given age group and the advantages and disadvantages of the various examination techniques.