Himen: un epónimo y mito de larga data en terminologia anatomica / Hymen: a long-standing eponym and myth in terminologia anatomica

RESUMEN: En Terminología Anatómica el término himen es identificado con el número 3530. Es un pequeño tejido membranoso que normalmente ocupa una parte de la abertura vaginal externa en la mujer. La pertinencia del término himen ha sido poco abordada en la literatura del campo terminológico anatómico, por tanto, el objetivo del presente trabajo fue analizar este término, verificar su etimología y funcionalidad, y determinar cómo este ha sido considerado en algunos aspectos de orden cultural, clínico y jurídico. El término himen proviene del latín hymen que es préstamo del griego hymḗn ὑμήν que significa membrana. Con el valor general de cualquier membrana fue usado en Grecia desde el siglo V a.C., sin embargo, a través de un fenómeno de especialización latina, a partir de los siglos I y II d.C., el término fue usado con su significado actual. Su origen proviene del nombre del dios griego del matrimonio llamado Himeneo, lo que vincula el término a un epónimo y mito a la vez. Pese a lo anterior, creemos que su conservación en Terminología Anatómica se podría deber a su larga data de uso, aun cuando podrían existir mejores opciones para denominar esta estructura. El himen no presenta una función biológica conocida, sin embargo, ha tenido gran valoración a nivel cultural, clínico y jurídico, en el que el examen físico ha determinado conclusiones sobre la historia sexual de mujeres y niñas aun cuando las evidencias demuestran que no es una prueba precisa o confiable de la actividad sexual.

SUMMARY: In Terminologia Anatomica the term hymen is identified with the number 3530. It is a small membranous tissue that normally occupies a part of the external vaginal opening in women. The relevance of the term hymen has been scarcely addressed in the literature of the anatomical terminology field. Therefore, the objective of this work was to analyze this term, verify its etymology and functionality, and determine how it has been considered in certain cultural clinical and legal aspects. The term hymen comes from the Latin hymen, borrowed from the Greek hymḗn ὑμήν , which means membrane. With the general value of any membrane, it was used in Greece from the 5th century BC, however, through a phenomenon of Latin specialization, from the 1st and 2nd centuries AD, the term was used applying its current meaning. Its origin comes from the name of the Greek god of marriage called Hymenaeus, which links the term to an eponym and a myth at the same time. Despite the above, we believe that its conservation in Terminologia Anatomica could be due to its long history, even though there may be better options to name this structure. The hymen does not have a known biological function, however, it has been highly valued at a cultural, clinical and legal level, in which the physical examination has determined conclusions about the sexual history of women and girls even when the evidence shows that it is not an accurate or reliable proof of sexual activity.

Himen imperforado con hematocolpos. A propósito de un caso / Imperforate hymen with hematocolpos. Apropos of a case

RESUMEN Los defectos en la canalización de la membrana himeneal causan obstrucción del tracto genital femenino. Como consecuencia aparece hematocolpos, resultante de la acumulación y retención de secreciones cervicovaginales -sangre en útero y vagina-, ante la imposibilidad de su evacuación por la presencia de un himen imperforado. Clínicamente aparece masa abdominal, asociada con malformaciones vaginales congénitas. Se presentó el caso de una adolescente de 13 años que refirió retención urinaria, disuria, dolor y masa en hipogastrio, y ausencia de la menarquía a pesar de un desarrollo puberal en estadio Tanner III. Al realizar ultrasonido se constató sangre en el útero, debido a imperforación himeneal que se resolvió mediante himenotomía. La patología de himen imperforado con hematocolpos debe estar entre los posibles planteamientos sindrómicos de aquellas pacientes con cuadros similares; puede diagnosticarse en la Atención Primaria de Salud a partir de una detallada anamnesis y exploración física, aunque la comprobación requiere ecografía (AU).

ABSTRACT The defects in the channeling of the himeneal membrane cause obstruction in the female genital tract. As consequence hematocolpos appears, resulting from the accumulation and retention of cervicovaginal secretions -blood in the uterus and vagina-, due to the impossibility of its evacuation because of the presence of an imperforate hymen. Clinically, abdominal mass appears associated to congenital vaginal malformations. We presented the case of teenager aged 13 years that referred urine retention, dysuria, pain, had a mass in the hypogastrium, and absence of menarche in spite of a Tanner III pubertal development. An ultrasound showed blood in the uterus due to hymeneal imperforation solved through hymenotomy. The pathology of imperforate hymen with hematocolpos should be among the possible syndrome considerations in those patients with the same characteristics; it can be diagnosed in the primary health care from anamnesis and physical exploration, although the verification requires an ultrasound (AU).

Hematocolpos secundario a himen imperforado / Hematocolpos secondary to imperforate hymen

RESUMEN El hematocolpos es la acumulación de sangre menstrual en la vagina, se produce por imperforación del himen o de la parte inferior de la vagina. El himen imperforado es una rara malformación congénita que ocurre en el 0,1 % de los recién nacidos del sexo femenino; este es un trastorno del desarrollo embriológico del himen que carece del orificio central por el que drenan las secreciones cervicales y uterinas. Se presentó una paciente de 15 años de edad, con antecedentes de haber nacido de parto eutócico a término, con dolor en bajo vientre y en la parte baja de la espalda hacia el lado derecho. El dolor abdominal es la forma de presentación clínica más frecuente de esta afección. El diagnóstico es clínico y se apoya en exámenes complementarios (ultrasonido abdominal y ginecológico). Esta afección se resuelve con la realización de una himenectomía.

ABSTRACT Hematocolpos is the accumulation of menstrual blood in the vagina; it is produced by imperforation of the hymen or the lower part of the vagina. Imperforate hymen is a rare congenital malformation that occurs in 0.1% of female newborns; this is an embryological developmental disorder of the hymen that lacks the central orifice through which uterine and cervical secretions drain. We present a 15-year-old patient with a history of having been born from eutocic delivery at term, pain in lower abdomen and in lower back towards the right side. Abdominal pain is the most common clinical presentation of this condition. Its diagnosis is clinical and is supported by complementary tests (abdominal and gynecological ultrasound). This condition is resolved by means of a hymenectomy.

Diagnóstico y manejo de Himen Imperforado en una lactante menor / Diagnosis and management of Imperforated Hymen in an infant

INTRODUCCIÓN: El himen imperforado es la malformación congénita más frecuente del tracto genital femenino. La mayoría de los casos no se pesquisan en la infancia, debido a un examen genital insuficiente. Su diagnóstico y resolución deben ser precoces y definitivas para evitar complicaciones posteriores. OBJETIVO: Presentar el caso de una lactante portadora de himen imperforado, y actualizar la información sobre las técnicas de examen genital para detectar esta patología en forma precoz y su tratamiento. CASO CLÍNICO: Lactante de 3 meses, consultó por aumento de volumen protruyente en la zona del introito. En el examen físico se realizó maniobra de valsalva que dio salida a una masa homogénea, nacarada de superficie lisa, entre los labios mayores, sugerente himen imperforado. Se complementó el estudio con ultrasonido ginecológico, el que demostró la presencia de hidrocolpos, descartando otras anomalías. Se realizó una himenotomía, que dio salida a abundante material seroso, sin mal olor, y luego se completó la himenectomía mediante la resección de la membrana himeneal. En control al 4to mes posterior a la intervención se constató un himen ampliamente permeable. CONCLUSIÓN: Los equipos de atención neonatal, requieren capacitación acerca de la técnica correcta del examen genital externo de la recién nacida y lactante. La himenectomía es la técnica que permite resolver definitiva mente el cuadro evitando complicaciones.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

Hematocolpos por himen imperforado en una adolescente / Hematocolpus due to non-perforated hymen in an adolescent

Se describe el caso clínico de una adolescente de 12 años de edad, quien había estado ingresada 5 años atrás en el Servicio de Terapia Intensiva del Hospital Pediátrico Docente Sur Antonio María Béguez César de Santiago de Cuba por presentar enfermedad estafilocócica y amenorrea primaria. Esta vez acudió a consulta con dolor abdominal recurrente desde hacía 3 meses, localizado en hipogastrio, acompañado de náuseas y vómitos, que se aliviaba con los analgésicos habituales. Se le realizó la prueba de embarazo cuyo resultado fue negativo y las imágenes ecográficas sugirieron la presencia de hematocolpos. Se le realizó himenotomía y egresó de la institución 48 horas después con evolución favorable.

The case report of a 12 years-old adolescent is described who had been admitted 5 years ago in the Intensive Therapy Service of Antonio María Béguez Caesar Southern Teaching Pediatric Hospital in Santiago de Cuba staphylococcal disease and primary amenorrhoea. This time she attended the service with recurrent abdominal pain for 3 months, located in hypogastrium, accompanied by nauseas and vomits that were alleviated with the habitual analgesic ones. The pregnancy test was carried out with negative result and the echographic images suggested hematocolpus. The himenotomy was practiced and was discharged from the institution 48 hours later with favorable clinical course.

Management of transverse vaginal septum by vaginoscopic resection: hymen conservative technique / Manejo do septo vaginal transverso por ressecção vaginoscópica: técnica conservadora do hímen

Abstract Transverse vaginal septum is a rare female genital tract anomaly, and little is described about its surgical treatment. We report the case of a patient who wished to preserve hymenal integrity due to social and cultural beliefs. We performed a vaginoscopic resection of the septum under laparoscopic view, followed by the introduction of a Foley catheter in the vagina, thus preserving the hymen. After 12 months of follow-up, no septal closure was present, and the menstrual flow was effective. Vaginoscopic hysteroscopy is an effectivemethod of vaginal septum resection, even in cases in which hymenal integrity must be preserved due to social and cultural beliefs.

Resumo Septo vaginal transverso é uma anomalia rara do trato genital feminino, e pouco é descrito sobre o tratamento cirúrgico. Relatamos o caso de uma paciente que desejava preservar a integridade do hímen devido a crenças sociais e culturais. Realizamos ressecção vaginoscópica do septo sob visão laparoscópica, seguida da introdução de um cateter de Foley na vagina, preservando assim o hímen. Após 12 meses de acompanhamento, não havia fechamento do septo, e o fluxo menstrual era eficaz. A histeroscopia vaginoscópica é um método eficaz de ressecção dos septos vaginais, incluindo os casosemque a integridade do hímen deve ser mantida devido a crenças sociais e culturais.

Imperforate hymen in a pediatric patient. Case report / Himen imperforado en paciente pediátrico. reporte de caso

Los trastornos congénitos del tracto genital femenino se presentan con una incidencia de 1: 10 000-20 000 nacidas vivas, tienen un amplio espectro de manifestaciones clínicas, se describe su detección de manera bimodal, con complicaciones que incluso pueden amenazar con la vida, sin embargo, con un tratamiento oportuno las pacientes pueden tener un buen pronóstico. Se reporta el caso de una paciente de 13 años con cuadro de retención urinaria súbita, estreñimiento agudo, sin menarca y características sexuales adecuadas para la edad, en quien se identificó himen imperforado, hematocolpos. Se descartaron otros posibles diagnósticos diferenciales y el manejo definitivo fue himenotomía más himenoplastía. El himen imperforado hace parte de los trastornos más frecuentes del desarrollo de los genitales femeninos, puede tener múltiples manifestaciones clínicas, leves y severas, con una adecuada identificación, se puede brindar un tratamiento oportuno, y evitar secuelas.

Congenital disorders of female genital tract occurs with an incidence of 1: 10 000 - 20 000 born alive, have a broad spectrum of clinical manifestations, their detection is described bimodally, with complications that may even threaten life, however, with timely treatment patients can have a good prognosis. We report the case of a 13-year-old patient with a sudden urinary retention, acute constipation, no menarche, and age appropriate sexual characteristics, in whom an imperforate hymen, hematocolpos was identified. Other possible differential diagnoses were ruled out and the management was hymenotomy plus hymenoplasty. The imperforate hymen is part of the most frequent developmental disorders of the female genitals, it can have multiple clinical manifestations, mild and severe, however, with an adequate identification, it can be given an opportune treatment, good prognosis and avoiding consequences.

A Case of Imperforate Hymen with Urinary Retention after Puberty

Imperforate hymen is rare, with a low incidence of 1/16,000–30,000 in newborns. Most symptoms occur because of the accumulation of menstrual blood after puberty. In rare cases it can be found before puberty. Periodic abdominal pain, discomfort of the pelvic region, and the like are most commonly observed, and these symptoms increase at bowel movement. Usually a 13- to 15-year-old girl does not experience menarche. Continuous accumulation of menstrual blood leads to vaginal hematoma, or even to hysterovaginal, ovarian, or abdominal hematomas. Rarely, compression of the surrounding tissues can result in upper back pain, dysuria, frequent urination, or oliguria. We report on a rare case of imperforate hymen with urinary retention.

Two cases of hymenal scars occurred by child rape

Children who have been raped some years back may have hymenal scars. However, medical professionals are not accustomed in assessing these scars because of the lack of experience in performing physical examinations of the external genitalia of children who suffered from rape some years back. Moreover, the importance of physical examination of the victim's external genitalia is sometimes overlooked. Two cases of rape victims with hymenal scars who visited Daegu Child Sexual Abuse Response Center several years after their first sexual abuse along with a literature review are presented here.

Congenital Hydrocolpos Mimicking a Mature Cystic Teratoma in the Pelvis

Neonatal hydrocolpos is a rare condition that involves fluid accumulation in the vagina. On diagnostic imaging, the dilated vagina, along with the compressed uterus, can simulate a mature cystic teratoma with a mural nodule. Herein, we report the case of a newborn girl with congenital hydrocolpos that was caused by an imperforate hymen; the hydrocolpos mimicking a mature cystic teratoma on abdominal ultrasonography and magnetic resonance imaging. Any newborn girl with a pelvic cystic mass should be suspected as having a congenital vaginal obstruction manifesting as hydrocolpos or hydrometrocolpos. Thorough examination of the external genitalia, as well as imaging of the uterus and vagina, enables correct diagnosis and optimal treatment.

Características y frecuencias de las lesiones genitales, paragenitales y extragenitales en mujeres víctimas de violacion sexual anal y vaginal en la ciudad de Arequipa, 2013 / Characteristics and frequency of genital, paragenital and extragenital lesions in women of anal and vaginal sexual rape in Arequipa city 2013

En la perpetración de la violación se utiliza la violencia física, la amenaza o uso de sustancias tóxicas. La presencia de lesiones indica el uso de violencia física; algunos juristas indican que para poder tipificar la violación es necesaria la presencia de lesiones. Objetivos: Determinar cuáles son las características y frecuencia de las lesiones genitales, paragenitales y extragenitales en mujeres víctimas de violación sexual anal y vaginal. Diseño: Estudio descriptivo retrospectivo, realizado en el Instituto de Medicina Legal de Arequipa (IML). La población de estudio fueron las mujeres que se les realizó examen de integridad sexual, durante el año 2013. Se revisó la base de datos y se seleccionaron las pericias de integridad sexual en las que las victimas refirieron violación, se clasificó según grupo etario, características himeneales, tipo y localización de lesiones. Resultados: En el 2013 se realizaron 27,485 reconocimientos medico legales el 3 .27% fueron exámenes de integridad sexual en mujeres. El grupo etario con mayor vulnerabilidad fue el de 16-20 años (27.8%), solo 445 confirmaron acto violatorio, el 26.07% de himenes fueron complacientes. De las mujeres que referían violación eI 43.8% presentaron lesiones mientras que el 56.2% no presentó lesiones. Fueron más frecuentes las lesiones extragenitales con 49.7% mientras que la presencia de lesiones en las tres áreas fue menos frecuente. Las lesiones contusas fueron de presentación más frecuente, mientras que solo en un caso se encontró herida cortante. Los signos de violación más frecuentes fueron el desgarro himeneal reciente y la hipotonía anal.

Objective: In the commission of the violation is used the physical violence, threat or use of toxic substances. The presence of lesions indicates the use of physical violence; some jurists suggest that to establish the violation is necessary presence of lesions. Objectives: To determine the characteristics and frequency of genital, paragenital and extragenital lesions in women victims of anal and vaginal rape. Design: Retrospective descriptive study at the Legal Medicine Institute of Arequipa. The study population were women who underwent forensic medical examinations of sexual integrity during 2013. The database was reviewed and sexual integrity, and among these, those that reported rape. They were classified far group age, hymenal characteristics, type and location of injury. Results: In 2013, 27.485 forensic tests were performed, with 3.27% for sexual integrity tests in women. The most vulnerable group was 16-20 years (27.8%), only 445 confirmed delict; 26.07% of the hymen were complacent. Of the women who reported rape 43.8% had lesions, while 56.2% had no injuries. Were more frequent extragenital lesions with 49.7%, while the presence of injuries in the three areas was less frequent. Blunt injuries were the most frequent presentation, while only one case was found with stab wounds. The most common signs of rape were the recent hymenal tear and anal hypotonia.

Dolor abdominal como síntoma de himen imperforado / Abdominal pain as a symptom of imperforate hymen

El himen imperforado es una anomalía congénita del desarrollo genital femenino. A pesar de ser la anomalía obstructiva más frecuente, presenta una incidencia estimada del 0,1% de las recién nacidas. Su diagnóstico es principalmente clínico, habitualmente ante la presencia de dolor abdominal cíclico en una adolescente que no ha presentado la menarquia. Presentamos el caso de una paciente de 12 años de edad que acudió al Servicio de Urgencias por dolor abdominal intenso, acompañado de alteración del hábito intestinal de dos días de evolución. Tras una detallada anamnesis y exploración física, es diagnosticada de himen imperforado con el apoyo de las pruebas complementarias. El cuadro clínico se resolvió tras la realización de una himenectomía.

Imperforate hymen is a congenital anomaly of female genital development. Although it is the most common obstructive anomaly has an estimated incidence of 0.1% of newborn. The diagnosis is primarily clinical, usually in the presence of cyclic abdominal pain in an adolescent who has not submitted menarche. We report the case of a 12 years old woman came to the emergency department by abdominal intense pain accompanied by altered bowel habit in two days. After a detailed history and physical examination, was diagnosed with imperforate hymen with the support of additional tests. The clinical symptoms resolved after performing a hymenectomy.

Imperforate Hymen Causing Hematocolpos and Acute Urinary Retention in a 14-Year-Old Adolescent

We report the case of a 14-year-old girl who visited the emergency room because of suprapubic discomfort and sudden acute urinary retention. She did not have any significant medical and surgical history, and her neurological examinations were all normal. Urinary catheterization led to the passage of 500 mL urine. Abdominal ultrasonography showed a hematocolpos that was compressing the urinary bladder. Gynecologic history taking revealed that the patient has not had menarche yet. Therefore, a cruciate incision was performed and her urination became normal. As the surgical outcome after adequate hymenotomy for imperforate hymen is usually good, the diagnosis of imperforate hymen is important. However, this condition is easily missed in the clinic because the first physician visited by the patient rarely takes a detailed gynecologic history or performs appropriate physical examinations. Although rare, imperforate hymen should be considered as a cause of acute urinary retention in the adolescence period. If an adolescent girl presents with abdominal pain and voiding dysfunction, a detailed gynecologic history and appropriate physical examinations of the genital introitus should be performed.

Lesiones del himen en reconocimientos médico legales (RML) ginecológicos por delitos contra la libertad sexual / Hymen injuries in medical legal recognition (MLR) for crimes against gynecological sexual freedom

Determinar las caracteristícas de las lesiones himeneales y lesiones genitales, paragenitales y extragenitales. Material y Métodos: Se realizó un estudio descriptivo prospectivo de enero a diciembre del 2013. Resultados: Se realizaron 47 RML Ginecólogicos por delitos contra la libertad sexual. El 38,29% (18/47) correspondio a peritadas entre 15 a 17 años. Los hallazgos fueron: himen Integro (18,92%), himen complaciente (8,11%), defloración reciente (8,11%) y defloración antigua (72,97%), entre otros hallazgos. Conclusión: Las desfloraciones antiguas pueden tener lesiones himeneales nuevas, ello debido al diámetro del orificio himenal, existiendo mayor frecuencia cuando el orificio himenal es pequeño y mediano; a diferencia de cuando el orificio himeneal es grande o muy elástico (himen complaciente) que crea dificultades en el reconocimiento de lesiones...

To determine hymenal injuries and genital, paragenital and extragenital lesions. Material and Methods: A prospective descriptive study was conducted January to December 2013. Results: 47 MLR were performed gynecological for crimes against sexual freedom; 38.29 % (18/47) corresponded to women between 15-17 years. The findings were: Integro hymen (18.92 %), willing hymen (8.11 %), Recent deflowering (8.11 %) and old deflowering (72.97 %), among others findings. Conclusion: Older Defloration hymens may have new lesions, this due to the diameter of the hymenal orifice, there most often when the hymenal orifice is small to medium; unlike when the hymen hole is large or very elastic we face a complacent hymen which creates difficulties in recognizing injuries...

Himen imperforado como causa de dolor abdominal en la adolescencia: A propósito de un caso / Imperforate hymen as a cause of abdominal pain in adolescents: a case report

El himen imperforado es una anomalía congénita del desarrollo genital femenino. Es una patología poco frecuente, con una incidencia estimada del 0,1% de los recién nacidos del sexo femenino. En muchas ocasiones, el diagnóstico pasa inadvertido hasta la pubertad y debuta con dolor abdominal cíclico en adolescentes que no han presentado la menarquia. El diagnóstico se basa en la anamnesis y la exploración física, aunque las pruebas complementarias, en especial la ecografía, permiten la comprobación del diagnóstico clínico y la exclusión de otras malformaciones genitales. Se presenta el caso clínico de una paciente de 13 años que fue diagnosticada tras consultar en varias ocasiones por dolor abdominal recurrente.

The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confrm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.

Rape, sodomy and murder of a minor girl.

In this short case of article on typical sexual assault, a 14 year old minor girl was killed and found in a ditch of a jungle nearby her house. The minor girl has died as a consequence of barbarous act of sexual assault, sustained bruises on labia, recent hymnal tears, and tears around anus with signs of ligature strangulation besides the generalized signs of asphyxia. The wearing garments were found torn at places with the presence of stains of mad and sand particles. The laboratory findings confirm presence of spermatozoa. The presence of marks of violence on the genitals of the child, when an early examination is made is the strong evidence that the sexual assault has been committed. The psychiatric analysis of all the accused of this kind of cases should be made mandatory for better assessment of the cases besides an active legislative and judicial actions, comprehensive quick approaches of investigative officers and healthcare providers.

Himen complaciente y peritaje médico-legal / Dilatable or complacent hymen legal medical expert work

Se define como himen complaciente (HC) aquel himen que se distiende sin dañarse durante la penetración al momento de la relación sexual, por lo que no quedan lesiones atribuibles al acto sexual. Su hallazgo al momento de realizar el peritaje médico-legal impide afirmar la existencia de penetración total o parcial en el acto denunciado. El objetivo de este trabajo es determinar la prevalencia de HC junto con analizar variables socio-bio-demográficas en mujeres que denuncian ser víctima de una agresión sexual. Se realizó un estudio retrospectivo-descriptivo, seleccionándose de la Unidad de Sexología Forense del Servicio Médico Legal de Temuco las denuncias por violación realizadas entre Enero/2000­ Diciembre/2003 (n=509). Los datos se registraron en planilla Excel y analizados con el software Winstat para Excel. Se verificó 46 mujeres con HC (9 por ciento). El 74 por ciento de las víctimas con HC pertenecía al área urbana, siendo el promedio de edad 16,7 años. El 51,2 por ciento denunció múltiples violaciones y el 89,2 por ciento de los imputados resultaban ser conocidos de la víctima. Al examen físico se constató lesiones extragenitales y coloproctológicas en el 29,9 por ciento y 4,4 por ciento respectivamente. Dentro de las pruebas biológicas realizadas, en el 8,7 por ciento se evidenció la presencia de espermios. En el 9 por ciento de las mujeres que denuncian ser víctima de violación se constata HC. Al examen físico se encuentra algún tipo de lesión en sólo el 28,3 por ciento, mientras que en el 8,7 por ciento se demuestra la presencia de espermios. Con estos resultados son escasas las evidencias que permiten al médico sugerir la existencia de un atentado sexual con o sin penetración total o parcial.

Dilatable or complacent hymen is defined as that which can be stretched without being damaged during sexual intercourse, and is the reason as to lack of injuries present that are attributable to the sexual act. The findings at the time the legal medical expert work is carried out, cannot confirm the existence of total or partial penetration in the denounced cases. The objective of this study was to identify the prevalence of dilatable or complacent hymens and analyze the social-bio-demographic factors of the victims of sexual assault. A descriptive, retrospective study was carried out selecting the reports of rapes from the Sexology Unit of the Legal Medical Service in the city of Temuco, between January 2000 and December 2003 (n=509). The information was registered with Excel program and analyzed by Winstat Software for Excel program. Dilatable or complacent hymen in 46 cases (9 percent), 74 percent of the victims were from urban areas, with an average of 16.7 years of age. 51.2 percent reported several episodes and 89.2 percent of the aggressors were individuals familiar to the victim. During physical examination extra genital and colorectal injuries were noted in 29.9 percent and 4.4 percent respectively. During biological exams presence of spermatocytes was confirmed in 8.7 percent. Dilatable or complacent hymen was reported in 9 percent of the rapes. During physical examination evidence of injury is reported only in 28.3 percent, while there is evidence of spermatocytes in 8.7 percent of the victims. As result there is little evidence that allows the physician to determine the existence of a sexual assault with or without penetration.

Análisis epidemiológico de los delitos contra la libertad sexual y la valoración médico legal en el departamento de Ucayali: enero - marzo 2008 / Epidemiological analysis of crimes against sexual freedom and forensic assessment in the department of Ucayali: January - March 2008

Introducción: Los delitos contra la libertad sexual constituyen la patología social emergente más importante de los casos de violencia contra la mujer, la presente investigación tiene por objetivo determinar las características epidemiológicas de las personas que acuden para determinar su integridad sexual, y las características anatómicas del himen al momento de la valoración médico legal de una supuesta violación sexual. Objetivos: Determinar que características epidemiológicas presentan los grupos afectados, así como las características anatómicas al examen ginecológico médico legal. Diseño: Estudio Descriptivo retrospectivo. Lugar: Instituto de Medicina Legal, División Médico Legal B - Ucayali. Participantes: La población de estudio consistió en 110 evaluaciones a pacientes que acudieron para determinar su integridad sexual, durante el primer trimestre del año 2008. Intervenciones: Se revisó la base de datos sistematizada y se seleccionaron los casos que requirieron una pericia ginecológica, se clasificó según grupo etáreo, procedencia, motivo del examen, y las características himeneales. Resultados: El 10,12% del total de reconocimientos médico legales correspondieron a DCLS (Delitos Contra la Libertad Sexual), el grupo etáreo con mayor vulnerabilidad fue el de 13-17 años (52,8%), sólo el 35% confirmaron acto violatorio en la consulta; el 46,6% de los hímenes no presentaban lesiones, fueron íntegros y el 44,3% fueron dilatables. Conclusiones: En este estudio se demuestra que no existe una adecuada tipificación del delito de violación sexual al momento de las denuncias en las instituciones encargadas, en el 10% de los casos se confirmó gestación que constituye evidencia definitiva de violación sexual con penetración y en el 2,7% se evidencia laceración anal que constituye hallazgo sugestivo de abuso sexual.

Introduction: The crimes against sexual freedom are the most important emerging social pathology of violence against women. This research aims to determine the epidemiological characteristics of people who come to determine their sexual integrity, and the anatomical characteristics of hymen at the time of medicolegal assessment of an alleged rape. Objective: To determine the epidemiological characteristics that show the affected groups, as well as anatomical features show at the forensic gynecological examination. Design: Retrospective descriptive study. Setting: Institute of Legal Medicine, Headquarters Ucayali. Participants: The population consisted in 110 patients attending evaluations to determine their sexual integrity in the first quarter of 2008. Interventions: We reviewed the systematic database and selected cases that required a gynecologic expertise, qualified by age group, origin, reason for examination, and hymenal characteristics. Results: 10.12% of total medical-legal examinations corresponded to DCLS (Crimes Against Sexual Freedom), the most vulnerable age group was 13-17 years (52.8%), only 35% confirmed act violation in the consultation, 46.6% of those without lesions were intact hymen and 44.3% were expandable. Conclusions: This study demonstrates that there is no adequate definition of the crime of rape when itÆs reported in the responsible institutions, in 10% of cases, it is confirmed that pregnancy constitutes conclusive evidence of rape and sexual penetration and in 2,7% the evidence of anal laceration is finding suggestive of sexual abuse.

Study on hymen: morphology, injuries of neonate and knowledge among students of faculty of nursing and education

Hymen is a thin membrane that surrounds the opening to a young Woman's Vagina, can present in different shapes. The most common hymen is shaped like a half moon. This shape allows menstrual blood flow out of girl's vagina [Adams, 2002]. Most Women are born with hymen, a thin piece of skin that partially covers the opening of the vagina [or introitus]. Hymen morphology has a medico-legal importance. Pediatricians are some times confronted with the challenge of documenting evidence of acute or chronic accidental or non accidental trauma to the hymen [Ann Saudi Med, 2001]. Identification of different types and percentage of hymen. Assess Knowledge of students about hymen in both Faculties Nursing and Education in Assiut University and Comparison between student's Knowledge indifferent years the [1st and 4th] years Faculty of Nursing to assess the improvements in their knowledge with program of study. A descriptive, analytic and retrospective design was used for this study The sample of this study was divided into three categories: A total of 220 consecutive girls [210 At birth 36 to 42 weeks of gestation and 10 from 8 to 12 month] were examined at labor ward, to observe hymnal configuration. A total of 20 defloration injuries who were recorded in statistical records from 3 December 2004 up to 3 December 2005. A total of 800 students were recruited for the study included [300 students from 1st year of faculty of Educations] and [500 students include 300 from the 1st year and 200 students from 4th year of faculty of Nursing]. Structured interviewing questionnaires Examination sheet of the hymen [At birth and one year of age] which include Gestational age Age of infant. Shape of hymen. The study result showed that annular configuration is the most common shape [79%] followed by posterior rim [12.7%], sleeve-like, fimbriated and cribiform hymen.-Distribution of defloration injuries who are recorded in statistical record 20 defloration injuries. Results of these students indicated that their mean age was [18.73 +/- 1.42] years. [64%, 55.5%, 50%] of the [1st and 4th grade]students Faculty of Nursing and the students Faculty of Education were residents in rural areas respectively-Regarding to the student's knowledge about the female genital organs, it was found that more than three quarters of the students [83.1%] had correct answer about female genital organs. The source of knowledge about female genital organs and hymen, it was found that [91. 4%] of the students had their knowledge from study books, mass media and teachers few students got their from house and relatives family. The student's knowledge about hymen, it was found that more than three quarters of the students [79.8%] know hymen. Beliefs about hymen, it was found that [72%] of the students defined it a thin membrane allows menstrual blood, [93.4%] that a sign of virginity and more than half of the students [55.5%] that has a different shapes of hymen. The causes of hymen tearing before marriage, it was found that [80.8%] of students mentioned that the main cause of hymen tearing before marriage was masturbation followed by illegal sexual relation, hard sports and [39.4%] by horse riding. Regarding to use of traditional method to rupture hymen in the wedding day, it was found that [100%] of the students didn't agree on use of traditional method to rupture hymen.-Regarding to relation between student's knowledge and parent's education, it was found that when parents were more educated, their daughters were bad information, it seems that education of the parents creates more barriers between their and their daughters, it also indicates that the education of the parents didn't necessarily to improve their knowledge. The comparison between class 1 and 4 of Faculty of Nursing, it was found highly percentage of knowledge about hymen in class 4 more than class 1 of Faculty of Nursing Finally the students need to know more information about hymen [definition, site, morphology, causes of hymen tearing before marriag