Sexual Assault Nurse Examiner (S.A.N.E.) Exam —
Hymenal Notch and Hymenal Cleft

SANE1 reports and SAFE2 reports often describe hymenal notches and hymenal clefts. In practice, “notch” and “cleft” are interchangeable.

A hymenal notch/cleft is a partial separation (an indentation, if you will) on the edge of the hymenal membrane. In contrast, a separation of the full width of the hymen is called a hymenal transection.

Joyce A. Adams, MD and nine additional preeminent authors recently published Update Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused.3 Pertinent portions of their updated guidelines include:

  1. Among findings commonly seen in non-abused children are “[a]ny notch or cleft of the hymen (regardless of depth) above the 3 and 9 o’clock locations” and “[s]uperficial notches of the hymen at or below the 3 and 9 o’clock locations”.
  2. Among findings with no expert consensus on interpretation with respect to sexual contact or trauma is: “[n]otch or cleft in the hymen rim, at or below the 3 or 9 o’clock location, which is deeper than a superficial notch and may extend nearly to the base of the hymen, but is not a complete transection.”
  3. “Complete clefts/transections at 3 or 9 o’clock are also findings with no expert consensus in interpretation.”
  4. Among injuries indicative of acute or healed trauma to the genital/anal tissues is “[h]ealed hymenal transection/complete hymen cleft — a defect in the hymen between 4 o’clock and 8 o’clock that extends to the base of the hymen, with no hymenal tissue discernible at that location.”

1Sexual Assault Nurse Examiner

2Sexual Assault Forensic Examiner

32016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.