A 5-year-old girl with a typical keyhole deformity of the hymenal ring at the 6 o’clock position resulting from penetration, laceration, and scarring—sexual abuse.

A 4-year-old girl with hematoma formation and questionable sexual abuse. No abuse in this case, just typical changes of lichen sclerosus with the white figure of eight extending from the vulva to perianal area, plus purpura and a normal hymenal ring.

Extensive deep and open self-inflicted ulcers with surrounding hyperpigmentation in a patient with molluscum contagiosum. Note molluscum on right thigh.

Tattoo of the vulva: outline is in black and the mons pubis and labia are colored red.

Straddle injury showing perineal lateral laceration on the left side with bleeding and swelling.

A resolving burn caused by hot water in a physically abused 3 year old.

A 6-year-old girl who presented with scratching, pain, bleeding, and vaginal discharge showing intact red hymenal ring with tissue paper just inside opening. (Courtesy Dr. G.D. Oliver.)

Vulvar hematoma and bleeding following surgery. (Courtesy Dr. P. Bryson.)

Ring inserted through the clitoral area. (Courtesy Dr. Howard Bierman and Dr. Norman Goldstein.)

Trauma, Piercing

Vaginal stenosis and loss of vulva after radical vulvectomy for cancer. (Courtesy Dr. P. Bryson.)

Anus of a sexually abused little girl showing tears, bruising and laxity with normal hymen above. (Courtesy Dr. G.D. Oliver.)

Same child (supine position) 2 years later with a healed scar at the 6 o’clock position.

Perineal laceration through the hymen and posterior fossa with hematoma formation and surrounding bruising in a raped child. (Courtesy Dr. G.D. Oliver.)

Chronic radiodermatitis of the vulva with extensive telangiectasia and marked scarring of the perineum.

A hematoma extending from the mons pubis and vulva to the left buttock area. (Courtesy Dr. P. Bryson.)