Accidental Hymenal Injury Mimicking Sexual Trauma

Abstract

Hymenal injury is considered to be nearly pathognomonic of child sexual abuse. Accidental injury of the hymen is felt to be a rare event. Child abuse experts often cite cases of picket-fence or bedpost impalements as the exception, and dismiss the likelihood of accidental injury to the hymen. Despite this sentiment, accidental injuries of the anogenital region, including the hymen, have been described in the literature. The following case documents such an accidental injury, and follows the injuries from the acute stage through initial healing. A 7-year-old white girl presented to the emergency department with the chief complaint of vaginal bleeding after a fall in the bathtub. The physician who examined her noted vaginal blood with no clear source and consulted a staff pediatrician experienced in evaluating child abuse. The patient was a comfortable, articulate child who readily agreed to being interviewed alone. She gave a history of “bowling” in the bathtub and hurting herself on the “horse's shoes.” On a request for elaboration, she recounted a connected narrative in which she had completed a shower and was setting her toy horses up at the drain end of the tub and sliding down the wet porcelain into them, knocking them down. On the final repetition of this game, she lost her balance, her legs went up in the air, and she hit the horses hard, causing pain in her genital area. She stood up and cried, touching her genital area with her hand, and then noted blood on her hands. Her father came in and blotted her with a towel. Shortly thereafter, her mother came home and used a spray bottle to clean her further. This was painful to her. Her parents then decided to bring her to the emergency department. Besides the above narrative, the patient also provided a … Address correspondence and reprint requests to Stephen C. Boos, MD, University of California, Davis, Medical Center, Center for Child Protection, 2516 Stockton Blvd, Sacramento, CA 95817.