Prolapse of the urethra: confusion of clinical and anatomic characteristics with sexual abuse.

Sexual abuse is common; in one survey,1 38% of females reported an experience of sexual abuse before 18 years of age. Despite the increasing number of reports,2 there is evidence that many physicians are unable to recognize normal female prepubertal genital anatomy and deviations from it. In one study,3 41% of physicians were unable to recognize the hymen on a photograph of the genitalia; 50% of physicians said that they examined the genitalia more than 50% of the time. An inability to firmly establish a diagnosis of abuse is one reason given by physicians for not reporting their suspicions.4 A lack of familiarity with the genital anatomy of normal preadolescent females and the manifestations of trauma to and infection of the genitalia and rectum may cause physicians to misdiagnose sexual abuse.