External Genitalia

For penile penetration of the vagina to occur, the penis must first pass between the labia minora and through the hymenal opening. The apposition of the penis and the posterior fourchette in the majority of sexual positions means that this area may be stretched, rubbed, or receive blunt trauma as vaginal penetration is achieved. Lacerations, abrasions, or bruises at the posterior fourchette have all been described after consensual sexual activity, although in all these cases, the examinations were enhanced by the use of toluidine blue or a colposcope (90,128,129). Wilson (131) has also described macroscopi-cally visible hematomata of the labia with consensual sexual activity. These injuries usually heal completely without residual scarring (90).

Among 311 postpubertal females (age range 11-85 years) who made a "valid" (defined as "police investigation corroborated the victim's history and the victim did not recant") complaint of sexual assault, 200 had colposcopically detected injuries at one or more of the following sites on the external genitalia: posterior fourchette, labia minora, hymen, and fossa navicularis (90). Although all categories of injuries ("tears," bruises, abrasions, redness, and swelling) were described at all sites, the predominant injuries described were site dependent; for example, tears were most frequently described on the posterior fourchette (n = 83) and fossa navicularis (n = 28), whereas abrasions were most frequently described on the labia minora (n = 66) and bruises were the most frequent injuries seen on the hymen (n = 28) (90). Adams and colleagues found similar types and distributions of injuries among the adolescent complainants (14-19 years) they examined (132). In this population, tears of the posterior fourchette or fossa navicularis were the most common findings (40%). The studies of macroscopic findings among complainants of sexual assault have also found that most of the injuries detected are located on the external genitalia (133,134).

Healing of lacerations of the posterior fourchette is predominantly by first intention, with no residual scarring being detected at follow-up assessments (90). Nonetheless, scarring may occur occasionally in these areas, but it is important not to mistake a linear vestibularis, a congenital white line identified in the fossa navicularis (present in 25% of neonates), for a scar (135).

Accidental injuries of the external genitalia of female children are well documented in the literature. The site and nature of the injury will depend on the type of trauma and the conformation of any object involved (136,137).

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