The hymen is a thin membrane surrounding the opening of the vagina. Injury can come from accidents and activities like bicycle riding, but also from sexual abuse. Sexual abuse, while extremely concerning, should be considered with other causes if this is described by the child or witnesses, as slips involving toys or kids vehicles can easily injure a vagina, sometimes quite dramatically.
Beneficially for the child (but problematic for use as partial evidence of abuse) injuries of the hymen heal rapidly, though the hymen can easily be broken in the process, which quite frankly isn’t the worst thing in the world (unless you are from certain religious sects). A study of 239 girls with hymenal trauma were analysed, with about two or three days seeing broken capillaries (petechiae) disappearing, and blood blisters healing within a month.
Severe injuries also seem to heal without any scarring or marks, which is great news, as if the hymen breaks, it just stays broken – no harm done, and no point in wishing it would grow back. Interestingly, scarring from hymenal damage from sexual abuse was actually uncommon. Very few had any scarring at all, which if it did exist, was generally located on the posterior fourchette (the bottom of the vaginal opening which is easily torn at the best of times from the most vanilla of sex in adult women).
It is important to have any hymen injuries examined by a physician as soon as possible to ensure the wound is properly cared for, and not deeper than expected. In the case of sexual abuse, blood or semen samples will need to be obtained within 24 hours. After a day, these can be hard to recover, particularly after bathing, and if there was a lot of blood, it can wash away other evidence. Samples should be taken to test for sexually transmitted infections.
Keep in mind that any genital injuries to children are going to be subject to intense scrutiny by medical professionals, and sexual abuse must be ruled out as a matter of protocol. This can be frightening for parents who don’t want to put their child through endless questioning, be suspected of abuse that hasn’t (or has) actually occurred, or not believed because children are difficult to get the facts out of at the best of times.
This may be more pronounced in children who can’t yet explain themselves and are not articulate enough to say what happened. Be prepared for this, plus the extra swabs and so on, and know that this is standard procedure, and is designed to protect your child.
Who should do the examination?
When finding a physician to examine a child’s vagina, find someone who is trained in paediatrics – you don’t want just any old doctor doing this, as if the child has experienced trauma, they will need to be cared for delicately and professionally. If you are struggling to find somewhere, ask around at your local hospital for a child advocacy centre or a forensic nurse.
The child will need to be calmed and treated with kindness and respect, and follow-up care should be obtained, both psychologically and physically – damage to any body part can be scary, and anxiety may need to be allayed. If a child has been sexually abused, parents or caregivers also need psychological care – it is a very traumatising time for a parent to learn their child has been abused, and they weren’t there to protect them, or they trusted the perpetrator.