ADOLESCENT MEDICINE Hymenal findings in adolescent women: Impact of tampon use and consensual sexual activity S. Jean Emans, MD, Elizabeth R. Woods, MD, MPH, Elizabeth N. AIIred, MS, and Estherann Grace, MD From the Division of Adolescent/Young Adult Medicine, Children's Hospital, and Harvard Med- ical School, Boston, Massachusetts We undertook a prospective study of 300 postmenarcheal female subjects (me- dian age, 18.0 years) to examine (I) the relation of tampon use, sports partici- pation, prior gynecologic examination, and consensual sexual activity to hy- menal anatomy, (2) the factors leading to choice of tampons by girls not sex- ually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group I, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a his- tory of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p <0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymen- al opening diameter differed in the three groups (1.2 cm for group I vs 1.5 cm for group 2 vs 2.5 cm for group 3; p <0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable mater- nal attitude (odds ratio [OR], 5.3; 95% confidence interval [Cl], 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% Cl 3.5, 18.1). Only 26% of speculum exam- inations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p <0.001). The best pre- dictors of ease of speculum examination were sexual activity (OR 15.9; 95% Cl 1.9, 135.3) and tampon use (OR 3.6; 95% Cl 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic ex- amination in young women. (J PEDIATR 1994;125:153-60) Supported in part by a research grant from Tambrands, Inc. and by project No. MCJ-MA 259195 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and ServicesAdministration, U.S. Department of Health and Hu- man Services. Submitted for publication Nov. 30, 1993; accepted Feb. 22, 1994. Reprint requests: S. Jean Emans, MD, Division of Adolescent/ Young Adult Medicine, 300 LongwoodAve., Children's Hospital, Boston, MA 02115. Copyright ® 1994 by Mosby-Year Book, Inc. 0022-3476/94/$3.00 + 0 9/27/55476 Extensive data on the genital anatomy of both normal and sexually abused prepubertal girls have been published, 1-1° but few studies have systematically examined hymenal anatomy in postpubertal girls. In court testimony involving sexual abuse and assault cases, physicians are frequently asked to comment on whether the changes that have been noted in the hymen could have resulted from tampon use or participation in sports such as gymnastics. Testimony that tampon use and sports are unlikely to be the cause of hy- menal transections has been based largely on clinical expe- 153