|Colposcopy and the Unknown||
systems for photographing
abused AND nonabused
children range from expensive and sophisticated colposcopic and 35mm
systems to less expensive and simpler cameras and instant or
Specifically, a colposcopic camera is a specialized unit for viewing or photographing abnormalities or injuries invisible to the naked eye. Primarily used thus far to find subtle or invisible abnormalities or injuries to the vagina, cervix, or anus, the colposcope has seen only very limited use in studies to determine what is normal about a hymen.
Recently I've heard rumors that testimony alone -- without photos -- is being used to describe the results of a colposcopic examination. While a colposcope may be used for viewing, surely the absence of photographs to produce in a courtroom after a colposcopic examination would invite defense attorneys to put the validity of the entire test in question.
Generally a photograph may be put into evidence through someone other than the photographer -- that is, a party to a lawsuit need not call the photographer to the witness-stand in order to get the photograph into evidence. But here, given that special training must be had before one can use a colposcope, defense counsel might want to consider whether the camera operator was properly trained in using the unit and if not, whether the improper training had any effect on the quality and validity of the photographs.
* * *
Currently, there is an outpatient study, UCSD Clinical Research Project Number 970857, to determine what the hymen looks like in adolescent girls who have never had sex and who have never been sexually abused. The lead doctor, Joyce Adams, in La Jolla, will be examining the hymen and genitalia with a colposcope with a video-camera attached. She wants to determine what the hymen in virginal adolescent girls looks like.
One use of the information will be in sexual abuse cases, where there is often a question as to whether there are changes in the hymen due to sexual abuse or whether there might be normal variations, because, other than for the La Jolla project, there appear to be no studies of non-abused girls using colposcopic photographs. Therefore not enough data have yet been gathered to properly interpret what can be seen using the colposcope: that is, the doctors do not yet know which "irregularities" are natural (i.e., from birth) and which might have been caused by sexual abuse.
Because the colposcope is not portable, is cumbersome to use, and generally only medical providers have been trained to use it, I hesitate to say -- as some people have -- that colposcopic examination has become the "standard" way of assessing sexual abuse.
In fact, because of the absence of definitive information regarding normal variations in the shape or form of the hymen in young girls, NO doctor should be able to testify to a medical certainty that a colposcopic examination which reveals variation in the morphology of a hymen is proof that the child was sexually abused.
Further, where there is a controversy or there is insufficient support in the medical community regarding the results of a colposcopic examination, a court should NOT allow the results of a colposcopic examination into evidence, . . . BUT a court MIGHT. It is important to know that courts do differ and some of them are NOT meticulous in following the rules of evidence.
Tearing and other scarring of the hymen might, however, be evidence of penetration, but tearing and scarring can happen from NON-sexual events also! That is, there might be a DIFFERENTIAL DIAGNOSIS to account for the tearing and scarring. For instance, a fall off a horse can jar and break the hymen. A hard bump on the seat of a bicycle or tricycle. A fall on a pull-along toy . . . a duck on string. Clearly, a little girl can tear or rip her hymen in many nonsexual ways. A good lawyer should know this. An intelligent court should also know this. But the lawyer must put that information into evidence before a court can accept it as a fact proved.
Normal Variations in Hymenal Morphology in Adolescent Girls: Documentation Using Colposcopic PhotographsPrincipal Investigator (ie., Lead Researcher):
This study will provide information on what the hymen looks like in adolescent girls who have never had sex, and have never been sexually abused. Subjects will have a careful examination of their genital area, looking on the outside only, and will have magnified photographs taken of the hymen. Subjects will also be able to see for themselves what their hymen and genitalia looks like, since the examination is done with a colposcope with a video-camera attached. The participant can watch on the video monitor as the doctor does the examination, and can learn about their own anatomy.
This information on the detailed appearance of the hymen in virginal adolescent girls because in cases of sexual abuse, there is often a question as to whether changes in the hymen are due to the abuse, or might be normal variations. There are no studies of non-abused girls using colposcopic photographs, which have become the standard way that suspected sexual abuse is assessed.
This project accepts normal volunteers
This is an outpatient study.
Perlman Ambulatory Care Center, La Jolla (one visit)
$50.00 in gift certificates
Joyce Adams, M.D.
Since this file was uploaded, an
consultant" has warned: