Normal, vulvovaginal | Periurethral bands or ligaments |
| Longitudinal intravaginal ridges |
| Hymenal tags (in the newborn) |
| Smooth, non scarred hymenal bumps |
| Smooth clefts in the anterior hymenal rim (3–9 o’clock) |
| Septate hymen |
| Fourchette, midline avascular area |
| |
Non-specific, vulvovaginal | Erythema, vascular congestion |
| Friability of perineal skin |
| Vaginal discharge unless caused by STI |
| Fusion of the labia |
Supportive | |
Vulvovaginal | Acute injury—eg, localised erythema, oedema, abrasions, bruising |
| Notch in the posterior hymen (below 3–9 o’clock) |
| Scar in posterior fourchette |
| Labial fusion following vulval coitus |
| Transverse hymenal diameter, 1.5 cm |
| |
Anal | Anal laxity without other explanation |
| Reflex anal dilatation greater than 1.5 cm and reproducible |
| Acute changes—eg, erythema, swelling, fissures, bruising |
| Venous congestion |
| Chronic changes |
| thickening of the anal verge skin |
| increased elasticity and reduction in the power of the anal sphincter. |
Diagnostic | |
Vulvovaginal | Fresh laceration of the hymen |
| Old tear of hymen with scarring or interruption of the hymenal margin |
| Attenuation of the hymen with resultant enlargement of the hymenal orifice |
| Pregnancy in a child under 16 years |
| Positive forensic evidence |
| |
Anal | Fresh laceration or scar of the anal mucosa extending beyond the anal verge and onto the perianal skin |