The limits of physical evidence in sex abuse cases

Historically, the hymen, a thin piece of skin-like tissue that stretches partly across the opening of the vagina, has been known as the “virginity shield.”

It’s commonly believed that if the hymen is undamaged, sexual penetration has not occurred, particularly in the case of a child.

But this idea is false. Sometimes, a woman may have an intact hymen and show no signs of physical damage even after having been sexually assaulted. And the same is true of a little girl.

Gail Hornor, a pediatric nurse practitioner and child maltreatment researcher at Nationwide Children’s Hospital in Columbus, Ohio, says the myth about the hymen has been around forever and comes up often in her work. People find it especially hard to believe that a sexually abused child would not show some physical evidence of what happened. 

“There isn’t a day that goes by where I don’t have to explain to parents that a normal anogenital exam does not mean that the abuse kids say happened isn’t true,” Hornor says. She says health care providers as well as parents need to understand this fact.

Hornor conducts physical examinations of child abuse victims at the hospital’s Center for Child and Family Advocacy. An anogenital exam is an inspection of the anus and genital areas for signs of abuse. She says the hymen is very elastic and may stretch to allow for penetration without leaving evidence of abuse.


Hornor says less than 10 percent of children who report sexual abuse will show physical signs of that abuse. Sometimes there are physical indicators, of course, which is why the examinations are conducted. But in many cases the signs that did exist have already disappeared by the time of the exam.

“There is often a lapse of weeks, months, or years between when the abuse occurred and when it was reported,” she says. “Any bruising or other scarring would have healed by then.”

Hornor says some abusers are careful not to leave signs. “You have to remember that the perpetrator does not want to cause the child much pain or leave behind any physical evidence because that puts the perpetrator at risk of being detected by authorities,” she says.

Finding physical evidence of sexual abuse in an adolescent is even more unlikely than in a child. Before puberty, the hymen is sensitive to touch, and that causes pain. Hornor says that as the body enters puberty, the hymen becomes less sensitive and more elastic.

She adds that anal abuse can be even more difficult to diagnose because the anus is designed to open to allow stool to pass out of the body and to allow an object to enter it without damaging tissues.

This myth that the hymen is a surefire indicator of whether abuse occurred is common nationwide. Dr. Jordan Greenbaum, a forensic pathologist at Children’s Healthcare of Atlanta, says this myth comes up frequently when she performs anogenital exams in Georgia.

“Parents are almost universally surprised when I explain that the findings from an exam were normal,” Greenbaum says.

Greenbaum, also the medical director of the hospital’s Child Protection Center, says she often explains to law enforcement, jurors and other authorities why this myth is false. She explains that an average, normal hymen has a small opening in it already. Because the hymen is behind the labia minora, a pair of inner skin flaps that surround vaginal opening, it is not always touched when penetration occurs.

“There can be penetration of the labia [minora] without there being penetration of the hymen,” Greenbaum says. “And people tend to only think about penetration but forget about other forms of sexual abuse such as fondling.”

Child sexual abuse is not limited to penetration. The World Health Organization (WHO) defines child sexual abuse as “any involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, is not developmentally prepared for, or that violates the laws or social taboos of society.” This can include physical actions, such as fondling and genital-to-genital contact. It can also include non-touching behaviors, such as taking pornographic photos of a child.

In 2013, more than 76,000 cases of alleged child maltreatment were reported in Georgia, according to an annual report from the federal government. More than 55,000 of those cases were screened-in, which means they required an investigation.

Hornor says parents should educate their kids about being on guard.

“Parents need to talk to their kids about private parts and about who is not allowed to touch those areas,” Hornor says. “And kids should be taught the correct anatomical names for those areas so that if a child discloses sexual abuse to another adult, then that adult will know exactly what the child is talking about.”

Georgia law requires physicians, nurses, hospital staff, school and day care staff, social workers, counselors and dentists to report any suspicion of child abuse. Mandated reporters vary by state.  But anyone can report suspected abuse by calling the state child abuse and neglect 24-hour hotline at 1-800-422-4453.

People reporting suspected abuse can choose to remain anonymous when reporting suspected abuse, and their names are not revealed to the alleged abuser nor the family involved.  Also, reports can be made on Georgia’s Department of Family and Children Services website. Suspicion of abuse is all that is needed to file a report.

April Bailey is a freelance journalist based in Atlanta. She has a master’s degree in health and medical journalism from the University of Georgia, and holds a bachelor’s degree in print journalism from Middle Tennessee State University.