Inspection of female adolescent genitalia for the evaluation of suspected sexual abuse is often a difficult task for the examiner. The hymens of Tanner III through Tanner V adolescents are normally estrogenized and, therefore, often thickened and redundant on examination. Examination of the margins of the hymen is difficult by visual inspection alone. Many authors1-5 recommend the use of a cotton-tipped swab to explore the hymenal margin. Even this technique can offer little advantage if the hymen is excessively redundant.
One purpose of the sexual abuse examination is to examine the margins of the hymen for disruptions. These are especially concerning if the clefts extend to the hymental base, defined as the junction of the hymen and the vestibule.6 In the case of redundant tissue, it can be impossible to fully explore the entire hymen with use of a swab, because the tissue often folds back on itself