Sexual Activity

Dear Lisa,

Can an exam by an Ob/Gyn determine how long ago a 15 year old female has had sex?

“Curious Father”

Dear “Curious Father”,

A gynecological examination of a teenager cannot necessarily reveal whether or not sexual activity has taken place. Nor can a vaginal examination tell you how long ago a female had sex. Many people are under the impression that an examination of the female's hymen can reveal if and when she had sex. This is not true. The appearance of a normal hymen is quite variable.(1,2) These many different presentations are all considered normal. Not only does the hymen’s appearance vary from person to person, but examination techniques and positioning can affect what the examiner sees.(3)

Once a female experiences puberty normal hormonal changes cause the hymen to become very elastic and distensible. Because of this elasticity, it is unlikely that injury will occur when vaginal penetration occurs.(4) Therefore if an adolescent with a history of vaginal penetration is examined, it is unlikely that there will be signs present that penetration occurred. Actually, genital examinations performed on sexually abused children are often normal.(5,6,7)

On the other hand, the presence of a Sexually Transmitted Disease (STD) in an adolescent is evidence that the child engaged in sexual activity. Although, this does not reveal what type of sexual activity occurred. When a child or an adolescent has a sexually transmitted disease the assumption is that the child had to have come in contact with infected genital secretions.(4) This contact with genital secretions could have been either direct genital to genital contact or indirect contact through touching with hands containing infected secretions.(4)

Some Sexually Transmitted Diseases such as Syphilis or Genital Herpes can present with visual skin manifestations that can be observed upon physical examination. Symptoms of Genital Herpes for example may develop within four to six days of initial exposure ,with healing of the lesions often taking several weeks. (8) Primary Syphilis causes a deep, indurated, painless lesion 10 days or more after infection.(9) Many times the Primary Syphilis lesion goes unnoticed. Secondary Syphilis symptoms can be seen 2 to 6 weeks after initial infection. These signs may include a diffuse rash on the arms, legs, trunk, palms and soles or wart like growths in the genital area.(9)

Other STD’s may not present with any physical findings or symptoms at all. These include Human Papillomavirus, Chlamydia, Gonorrhea and HIV. (10,11,12 ) Therefore specific testing for Sexually Transmitted Diseases needs to be performed in order to determine if a Sexually Transmitted Disease exists.

If you are interested in reading other Pediatric Advice Stories about topics discussed:

Preventing Sexually Transmitted Diseases

Signs of Sexually Transmitted Diseases

Child Abuse

Adolescent Sexual Behavior

References:
(1)Gardner JJ. Descriptive study of genital variation in healthy, non-abused premenarchal girls. J Pediatr. 1992. 120(2 Pt 1):251-257.
(2)Mccann J, Kerns DL. The Anatomy of Child And Adolescent Sexual Abuse. A CD-ROM Atlas/Reference. St. Louis, MO:Intercorp:1999.
(3)Finkel M, DeJong A. Medical findings in child sexual abuse. In: Reece, R, Ludwig, S. eds. Child Abuse: medical Diagnosis and Management. 2nd ed. Philadelphia, PA. Lippincott Williams & Wilkins. 2001:207-286.
(4)Giardino A, Finkel M. Evaluating Child Sexual Abuse. Pediatric Annals. 2005. 34(5):382-394.
(5)Adams JA, Harper K, Knudson S, Revila J. Examination findings in legally confirmed child sexual abuse: it’s normal to be normal. Pediatrics. 1994. 94(3):310-317.
(6)Heger A, Ticson L, Velasquez O, Bernier R. Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl. 2002. June 26(6-7):645-659.
(7)Adams JA. Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Child Maltreat. 2001. Feb:6(1):31-36.
(8)Greers TA, Isado CM. Update on antiviral therapy for genital herpes infection. Cleve Clin J Med. 2000. 67:567-573.
(9)Fortenberry JD. Sexually Transmitted Infections. Pediatric Annals. 2005. 34(10):803-810.(10)Grimshaw-Mulcahy L. Chlamydia: Diagnosing the Hidden STD. The Clinical Advisor. 2006. March:32-42.
(11)Reitman D. Update on Sexually Transmitted Diseases: Gonorrhea and Chlamydial Infections. Consultant for Pediatricians. 2006. March:155-160.
(12)Reitman D. Update of Sexually Transmitted Diseases: Human Papillomavirus Infection. Consultant for Pediatricians. 2006. June:353-360.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents with Teenagers