The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault

Abstract

Conclusions about women’s and girls’ sexual history are made in some settings based on assumptions about the hymen, a small membranous tissue with no known biological function, which typically occupies a portion of the external vaginal opening in females. Clinicians, however, continue to refer to changes in the hymen to assess for a history of consensual or nonconsensual sexual intercourse. We reviewed published evidence to dispel commonly held myths about the hymen and its morphology, function, and use as evidence in cases of sexual violence. An examination of the hymen is not an accurate or reliable test of a previous history of sexual activity, including sexual assault. Clinicians tasked with performing forensic sexual assault examinations should avoid descriptions such as “intact hymen” or “broken hymen” in all cases, and describe specific findings using international standards and terminology of morphological features. We call on clinicians to consider the low predictive value of a hymen examination and to: 1) avoid relying solely on the status of the hymen in sexual assault examinations and reporting; 2) help raise awareness of this issue among their peers and counterparts in law enforcement and the judicial system; and 3) promote fact-based discussions about the limitations of hymenal examinations as part of clinical education for all specialties that address the sexual or reproductive health of women and girls. Electronic supplementary material The online version of this article (10.1186/s12978-019-0731-8) contains supplementary material, which is available to authorized users.

Hymen and virginity: What every paediatrician should know

“…With the suppression of the hypothalamic‐pituitary‐gonadal axis in pre‐pubertal girls, the hymen may become thin, dry and smooth‐edged. During puberty, the exposure to oestrogen contributes to the thickening of the hymen and provides more elasticity, enabling it to stretch during penetration without leaving any trace of injury 5 . The post‐pubertal hymen has been compared to a scrunchy or a rubber band because of its elastic properties for educational purposes 9…”

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“…The duration between first engagement and sexual intercourse between the girls and their boyfriends was found to be alarmingly low. Though this window is relative, there should be a grace period of adequate time before the two can engage in intercourse (Mishori et al, 2019). Morans' 'Simba' room is the house that a Maasai boy is given after initiation.…”

Virginity testing: recommendations for primary care physicians in Europe and North America

“…Although there is published literature on the ethics of ‘virginity’ testing10 16 and on the lack of reliability and the low predictive value of a hymen examination to determine ‘virginity’,17 little practical guidance has been published for clinicians who may encounter requests for “virginity” testing in the clinical setting.…”

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