Hymen injuries in children

Hymen injuries in children can occur due to accidents and activities like bicycle riding, but also from sexual abuse.The hymen is a thin membrane surrounding or covering the opening of the vagina in children, which can be damaged prematurely in children.

Sexual abuse, while extremely concerning, should be considered only with other causes if this is described by the child or witnesses. Slips involving toys or kids vehicles can easily injure a vagina and hymen, sometimes quite dramatically, and are much more common as causes of hymen injuries in children than sexual abuse.

Healing time for hymen injury in children

Beneficially for the child (but problematic for use as partial evidence of abuse) injuries of the hymen heal rapidly. The hymen can easily be broken, which isn’t necessarily a bad thing, unless you are from certain religious sects where an intact hymen is considered as important evidence of a virgin.

The loss of an intact hymen may predispose a girl to more frequent vulvovaginal infections, since the opening to the vagina is unimpeded. The hymen doesn’t always protect against infection or foreign objects, but it does provide a physical protective shield.

A study of 239 girls with hymenal trauma were analysed, with about two or three days seeing broken capillaries (petechiae) disappearing, and blood blisters healing within a month.

Severe hymen injuries also seem to heal without any scarring or marks. If the hymen breaks, it just stays broken – no harm done, and no need for it to grow back. Scarring from hymenal damage from sexual abuse was actually uncommon. Very few girls in this category had any scarring at all, which if it did exist, was generally located on the posterior fourchette (the bottom of the vaginal opening which is easily torn at the best of times from the most vanilla of sex in adult women).

Physical examination of hymen injuries in children

It is important to have hymen injuries examined by a physician as soon as possible to ensure the wound is properly cared for, and not deeper than expected. In the case of sexual abuse, blood or semen samples will need to be obtained within 24 hours.

After a day, blood and semen samples can be hard to recover, particularly after bathing. If there was a lot of blood, it can wash away other evidence. Samples should be taken to test for sexually transmitted infections.

Keep in mind that any genital injuries to children are going to be subject to intense scrutiny by medical professionals, and sexual abuse must be ruled out as a matter of protocol. This can be frightening for parents who don’t want to put their child through endless questioning, be suspected of abuse that hasn’t (or has) actually occurred, or not believed because children are difficult to get the facts out of.

Difficulty in extracting information may be more pronounced in children who can’t yet explain themselves and are not articulate enough to explain what happened. Be prepared for this, plus the extra swabs and so on, and know that this is standard procedure, designed to protect your child.

Who should do the examination on a child?

When finding a physician to examine a child’s vagina, find someone who is trained in paediatrics. You don’t want just any old doctor doing this, as if the child has experienced trauma, they will need to be cared for delicately and professionally. If you are struggling to find somewhere, ask around at your local hospital for a child advocacy centre or a forensic nurse.

Psychological care for children with hymen injuries

The child will need to be calmed and treated with kindness and respect. Follow-up care should be obtained, both psychologically and physically – damage to any body part can be scary, and anxiety may need to be soothed.

If a child has been sexually abused, parents or caregivers also need psychological care. It is a very traumatising time for a parent to learn their child has been abused, and they weren’t there to protect them, or they trusted the perpetrator.

Ways to help a hymen heal

The purpose of healing hymenal tissue is not to regrow the hymen (which can occur naturally) but to treat the broken tissue as a wound. This means preventing infection and alleviating pain, itching and soreness.

Tips on wound care and pain management in hymen injuries

  • Keep the area clean and dry – moisture breeds microbes and can contribute to infections
  • Follow any advice given to you by your child’s doctor regarding antimicrobial creams, liquids or antibiotics
  • Avoid any irritating clothing – nothing tight or scratchy
  • Apply a small amount of pawpaw ointment or a vegetable oil to keep the outer vulvar tissue lubricated to avoid catching
  • Keep your eye on the vulvar area to check for heat or redness that may indicate infection
  • Check on your child’s pain levels, depending on their age – trying to touch the area, signs of distress, or if the child is old enough, complaining of pain
  • Use cold compresses, like a wet flannel, to soothe inflammation
  • Avoid unnecessary use of medications where possible, and check with your doctor as to what is appropriate for pain if it gets too much

The hymen has blood vessels and nerves, so any tear in the hymen can be initially painful, but the pain should subside quickly. The sensation is likely to be soreness, but it should clear up as any cut would, quickly over a matter of days.

Read about the hymen

Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)