1. Lacerations, ecchymoses, and newly healed scars of the hymen or the posterior fourchette
2. Absence of hymenal tissue from 3 to 9 o'clock (confirmed in various positions)
3. Healed hymenal transections, especially between 3 and 9 o'clock (complete cleft)
4. Perianal lacerations extending to external sphincter
A child with concerning physical signs must be evaluated by a sexual abuse expert for a complete history and sexual abuse examination.
*Any physical sign must be evaluated in light of the entire history, other parts of the physical examination, and laboratory data.
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