Labial adhesions and posterior fourchette injuries in childhood sexual abuse.

Six cases involving six sisters, all of whom were sexually molested, are presented to illustrate the association between labial adhesions and posterior fourchette injuries in sexually abused children. Although labial adhesions are a relatively common lesion, they only recently have been associated with childhood sexual abuse. Labial adhesions are ordinarily found in girls between 2 months and 7 years of age and are usually very superficial and disappear spontaneously by the time the child approaches puberty. We encountered six sisters, all of whom had been sexually abused, who had labial adhesions. Four of the six had changes in the area of the posterior fourchette that were consistent with previous trauma. In addition, four of the girls' hymens had thickened, irregular edges or other changes that were considered abnormal. The father, the grandfather, and an uncle confessed to lewd and lascivious misconduct with the children. Although labial adhesions alone are not reason enough to make a report of sexual abuse, the physician is obligated to inquire as to the possible cause if the adhesions do not fit the usual pattern or if there are other suspicious findings.