Anatomy

The external female genitalia (vulva) includes the mons pubis, the labia majora, the labia minora, the clitoris, and the vestibule (which incorporates the openings of the urethra and the vagina).

The hymen is the tissue that partially or completely surrounds the opening of the vagina. It appears that all females have hymenal tissue present at birth (91). The hymen may be annular (encircling the vaginal opening), cres-centic (present at the lateral and posterior margins), fimbriated (frilly edged), or, usually after childbirth, present only as interrupted tags or remnants. It is important that the reader refer to atlases that illustrate these variations (2,92). There is usually a single opening in the hymen. Uncommon congenital variants include two or more hymenal openings, referred to as septate or cribriform, respectively, and, rarely, complete absence of an opening (imperforate hymen).

Indentations or splits in the hymenal rim have been variously described as deficits, concavities, transections, clefts, notches, and, when clearly of recent origin, tears or lacerations (fresh and healed). In this text, the term notch will be used to describe divisions or splits in the hymenal rim. Superficial notches have been defined as notches that are less than or equal to half the width of the hymenal rim at the location of the notch, and deep notches have been defined as notches that are more than half the width of the hyme-nal rim at the location of the notch (93). Superficial notches of all aspects of the hymen have been described in both prepubertal (0-8 years) and postpu-bertal females (9.5-28 years) who have no history of sexual activity (9396). Notches ranging from 0.5 mm to 3 mm in depth were noted in the ventral half of the hymens of 35% of newborns examined by Berenson; this study does not subcategorize the notches as superficial or deep. Deep notches of the anterior and lateral aspects of the hymen have been found in 14 of 200 postpubertal females (9.5-28 years) who denied having sexual activity (96). Deep notches of the posterior hymenal margin have not been described in prepubertal females screened for abuse. Deep notches of the hymenal margin have been described among postpubertal females who deny having sexual activity, although because these females were not screened for abuse, it is not possible to state whether these were the result of unreported sexual abuse.

The other pertinent anatomic landmarks in this area are the posterior fourchette (where the labia minora unite posteriorly), the fossa navicularis (a relatively concave area of the vestibule bounded anteriorly by the vaginal opening, posteriorly by the posterior fourchette, and laterally by the labia minora), and the anterior fourchette (where the labia minora meet anteriorly and form the clitoral hood).

The skin of the labia majora and the outer aspects of the labia minora is keratinized squamous epithelium, but only the outer aspects of the labia majora are hair bearing. The skin of the inner aspects of the labia minora and the vestibule (including the hymen) is nonkeratinized. This area is usually pink, but in the nonestrogenized child, it may appear red because the skin is thinner and consequently the blood vessels beneath its surface are more apparent (97).

The forensically relevant areas of the internal female genitalia are the vagina and the cervix. The pertinent landmarks are the vaginal fornices (anterior, posterior, right, and left) and the cervical os (opening of the cervical canal).

The vagina and cervix are covered by nonkeratinized squamous epithelium that normally appears pink in the estrogenized female. Occasionally, the columnar endocervical epithelium, which appears red, may be visible around the cervical os because of physiological or iatrogenic (e.g., exogenous estrogens) eversion of the endocervical canal; these are sometimes erroneously referred to as cervical erosions.

Pregnancy And Childbirth

Pregnancy And Childbirth

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