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Injuries Indicative of Abuse
Class 4 Clear evidence
of blunt force or
penetrating trauma to
or beyond the hymen:
Findings that can have
no explanation other
than trauma to the
hymen or vaginal
tissues.
Acute trauma:
Partial or complete
tear of the hymen
Ecchymosis (bruising)
on the hymen
Vaginal laceration
Healed trauma:
Hymenal transection
(healed), defined as an
area where the hymen
has been torn through,
to the base, so there is
no hymenal tissue
remaining between the
vaginal wall and the
fossa or vestibular
wall.(viii) This finding
has also been referred to
as a “complete cleft” in
adolescent and young
adult women.(x)
Wide areas in the
posterior (inferior) half
of the hymenal rim with
an absence of hymenal
tissue, extending to the
base of the hymen,
which is confirmed
using additional
examination technique
(swab, Foley catheter,
Class 4 Clear evidence
penetration beyond the
anal sphincter:
Perianal lacerations
extending deep to the
external anal sphincter
(ix)
http://www.pathguy.com/adams.htm (4 of 10) [6/5/2005 8:46:54 PM]
Class 4 Clear
Evidence: Sexual
abuse/contact is
certain:
Pregnancy
Sperm or semen
found in or on child’s
body
Video or photo
documentation of child
being abused
Confirmed positive
genital, anal or
pharyngeal cultures for
Neisseria gonorrhea
Positive cultures (not
rapid antigen tests) from
genital or anal area for
Chlamydia trachomitis
Positive serology for
syphilis or HIV, if
perinatal or blood
transmission has been
ruled out (vii)