Version June 2024
| Moderate specificity for abuse |
| Acute lacerations or extensive bruising of the labia, peri-hymenal tissues, scrotum, or perineum (may be from unwitnessed accidental trauma) |
| Scar of posterior fourchette (the assessment of scars is difficult unless there was documentation of acute injury at the same site) |
| Fresh laceration of the posterior fourchette, not involving the hymen (must be differentiated from dehisced labial adhesion or failure of midline fusion; may be caused by accidental injury) |
| Perianal scar not in the midline (the assessment of scars is difficult unless there was documentation of acute injury at the same site; may be due to other medical conditions such as Crohn's disease, or previous medical procedures) |
| High specificity for abuse |
| Acute laceration of the hymen (partial or complete) |
| Ecchymosis (bruising) of the hymen |
| Perianal lacerations extending deep to the external anal sphincter (not to be confused with partial failure of midline fusion) |
| Hymenal transection (healed) (ie, an area where there is no hymenal tissue remaining between the vaginal wall and the fossa or vestibular wall [also called a complete cleft]. The finding should be confirmed using additional examination techniques such as a swab, prone knee-chest position, Foley catheter, water to float the edge of the hymen) |
| Absence of hymenal tissue (wide areas in the posterior/inferior half of the hymenal rim with an absence of hymenal tissue, extending to the base of the hymen, which is confirmed using additional positioning or other methods) |
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