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Sexual Abuse, Sex Trafficking, and Rape
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Jacqueline Sugarman, S. Paige Hertweck
Findings highly suggestive of abuse, (unless a clear and convincing history of accidental trauma, straddle injury, impalement injury, or crush injury is provided), includeAcute injuries to the anogenital structuresInjuries to the hymen, vagina, posterior fossa, perianal laceration with exposure to the tissues below the dermis, healed transections of the hymen)Presence of STI in prepubertal or nonsexually active females (see Table 46.1)
Trauma in Women
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Tears to the hymen may occur following first coitus, resulting in brisk bleeding. Rarely, tears to the hymen extend posteri-orly into the perineum and anal sphincter. These injuries require assessment under general anaesthesia in an operating theatre. Vaginal lacerations result from the insertion of a variety of objects and may be situated in any part of the vaginal tract. Careful examination under anaesthesia is usually indicated to determine accurately the extent of injury. On rare occasions, injury may extend into the peritoneal cavity, necessitating laparotomy. Clinical decision-making is in no way different from other cases in which the peritoneum has been breached.
Gynaecology and obstetrics
Published in Bernadette N. Kumar, Esperanza Diaz, Migrant Health, 2019
Berit Austveg, Kathy Ainul Møen
Where virginity is a requirement for entering marriage, women who are going to be married may request hymen repair if they have had sexual intercourse or otherwise fear that the hymen has been broken. It is our experience from our clinical work that sometimes the mere explanation of the fact that the hymen has different forms and sometimes is absent all-together, is enough to relieve this anxiety. In societies that put a great emphasis on the hymen, and occasionally on a blood-stained sheet after the wedding night to ‘prove’ virginity, women have ways of dealing with it. The mother, aunt, or another trusted woman can be a good ally and help in difficult situations. Surgical intervention to ‘restore’ the hymen is therefore generally contraindicated and should be avoided (26).
Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran
Published in The Journal of Sex Research, 2019
Farideh Khalajabadi-Farahani, Sven-Axel Månsson, John Cleland
These female college students perceived that physical virginity is not a good marker for chastity anymore, because hymens may not tear and bleed during first vaginal sex, because of the availability of hymen repair, and due to the wide practice of penetrative nonvaginal sex among unmarried young women. An unmarried woman, age 24, with no experience of sexual relations, said, “I know a girl who had vaginal sex and her hymen [was] elastic, and she could easily have intercourse without rupture” (IDI 13). Another unmarried woman, age 28, who had practiced vaginal sex and had a regular partner, claimed: “Nowadays anal sex has become extremely common, merely because of the importance of an intact hymen” (IDI 14). When the interviewer asked about the popularity of anal sex among peers, a 21-year-old woman, with an experience of nonconsensual vaginal sex and having casual partners (i.e., partners with nonromantic relationships), said: “Among my peers, yes, there are those who have intact hymen. It is not possible [to preserve the hymen] from other ways [vaginal sex]. Yes, and anal sex is more prevalent” (IDI 10). This finding has important implications for increasing the risk of HIV and STIs through unprotected anal sex among young generations of women.
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
Atrophic vulvar tissues are comparatively pale and thin. There is a loss of labial fat. In some women the labia appear stretched and redundant, and in others the labia alternatively appear shrunken. Hymenal remnants regress so that the hymen becomes ill-defined. In women without prolapse, the introitus is narrowed and retracted. Similarly, the urethra retracts toward the introitus. The external meatus can become edematous, friable, and ampullated, the so-called ‘urethral caruncle’. Like the vulva, the menopausal vaginal epithelium is pale and dry. It can appear shiny because it reflects light without the dulling effect of mucus. Petechial hemorrhage from tissue handling is often seen, especially after speculum opening. If there is no prolapse, the vaginal caliber and length are reduced and the vagina feels stiff when manipulated on manual examination or when a speculum is inserted. There is loss of cervical bulk so that it appears flush with the vault and the os is a pinpoint. The cervix may bleed when cervical cytology screening (‘Pap’ smear) is performed. Vaginal pH is a useful clinical tool to help align the symptoms of GSM with objective physical findings; the expected finding with atrophy is pH > 5.068.
An Exploration of Coping with Childhood Sexual Abuse in Arab American Women
Published in Journal of Child Sexual Abuse, 2019
Shahrazad Timraz, Linda Lewin, Carmen Giurgescu, Karen Kavanaugh
Disclosure of CSA is a complex process, especially when there is no distinction between CSA and premarital sex, the latter being religiously and culturally prohibited among Arab women and violates the value of female virginity. Female virginity and family honor are intertwined in Arab culture. A female’s virginity is not only the presence of a hymen per se, but a broad concept that involves female behavior, modesty, and reputation (Fontes & Plummer, 2010). Thus, the disclosure of CSA can destroy the survivor and her family’s reputation in the community and can lead to social boycott of all its members (Baker & Dwairy, 2003). Baker and Dwairy (2003) stated “A family’s reputation is among the most important resource an Arab family has. A negative reputation may be attached to a family after cultural or religious misconduct” (p. 111). Thus, to preserve the family reputation, some survivors never disclosed their CSA. In addition to the value of female virginity, another barrier to abuse disclosure was preserving family ties. Arab society is a collective society, and it is difficult to disclose the CSAespecially if the perpetrator is a family member because maintaining the well-being of the family is expected from all members (Nassar-McMillan et al., 2013); CSA disclosure can result in survivor blame for dishonoring the family name and destroying its well-being.