The hymen : anatomically, medico-legally and historically considered / by E.S. M'Kee.

  • McKee, Edward S.
Date:
1908
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Licence: In copyright

Credit: The hymen : anatomically, medico-legally and historically considered / by E.S. M'Kee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    venereal disease in the victim appearing: at the proper time has served to convict a num- ber when this means was taken to cure the disease. The diagnosis of rupture of the hymen in its medico-legal sense permits a great display of tact on the part of the examining physi- cian. To differentiate between moral and mechanical rupture is sometimes so difficult as to be almost impossible. The persistence of the hymen during sexual intercourse and even after labor is ex- plained as follows: There are certain women in whom the hymen is relaxed and very dilatable, and in these cases, if there is no great disproportion between the male and female organs, the penis may readily pene- trate the vagina without rupturing the hymen. The opening of the hymen is generally at the superior portion of the vulva, rarely cen- tral. Sometimes we have a double hymen, being divided by a longitudinal or transverse band. Here, if the hymen is dilatable and lax, it is simply pushed up at the first sexual act, then yields and penetration follows with- out rupture. In some cases the hymen yields gradually, so that penetration is only attained after weeks or months, the hymeii being gradually dilated. In some cases the penis simply invaginates the hymen, copula- tion taking place in a vulva-vaginal sac of variable depth, according to the elasticity of the hymen and the vigor of the male organ. In some intromission does not occur, the semen being deposited upon the vulva and impregnation follows. Issues of the gravest import, the loss of life, liberty and what is to some much greater than either of these, the loss of char- acter and reputation, frequently hang upon the evidence of the medical man. It is a fact which we cannot deny that this evidence is sometimes founded upon the most super- ficial knowledge and careless and cursory examination, either clinical or pathological. While we should by no means shield the guilty, we should protect at all hazards the innocent. How often have we noticed that confident self-assurance in the witness-box concerning matters which require special experience to enable one to attempt a solu- tion! This is often noticed in cases of dis- puted chastity or attempts at abortion, or the pathological proofs of mechanical violence or other means said to have been used to empty the uterus. Varieties of the hymen of medico-legal interest include what might be termed the folding hymen. It is of normal appearance and structure, but of peculiarly yielding na- ture, readily admitting the entrance of an ordinary vaginal dilator or a fair-sized specu- lum. During the passage of these instru- ments it folds back against the vaginal wall and returns quite intact on their removal. Given an instance where a woman has been recently married and where some diffi- culty occurs on attempting intercourse on account of resistance and feigned pain on her part, we sometimes find the following: On examination a complete hymen is found, but of the folding type. An opinion has been given that the woman is intact. Sub- sequent developments prove that she has lived irregularly before marriage and had aborted. Suppose that a young girl brings a charge that a man has had sexual intercourse with her over a number of months. Medical examination finds the hymen complete and says that it would have been impossible, at least continued over such a length of time. Expert medical examination shows that the hymen yields completely and folds back, and ultimately without any force or difficulty a fair-sized conical speculum is passed without the least injury to the hymen. Ehe opinion should be given that frequent coition, partial or complete, was quite feasible under the conditions, but that the . chastity of the girl was not impugned. Cases occur in women who have been married a number of years, not having conceived, where the speculum is passed without difficulty, the membrane simply folding back in tubular form as the speculum is pushed back into the vagina, re- turning again to its natural position on the removal of the instrument. In fact, pes- saries may be introduced into some of these vaginae without rupturing the hymen. It is important to remember that it has been pretty clearly shown that the caruncuht* mytriformes are formed only by child-bear- ing and not by lacerations from sexual in- tercourse. Mere vulvar intercourse is con- stantly occurring, and it leaves no evidence behind it. The law does not define in what penetration consists. Many of the cases which have been related of pregnancy having occurred with an almost imperforate hymen are but examples of conception following these half-completed acts of coition. It is just these unusual occurrences which, arising suddenly, without warning, throw men off their guard, and we find them giving an opinion wrongly on which so much depends. Double hymen, according to Hart, is due to the permanent non-coalescence of the Wolfian bulbs, and not of the ducts of Mueller. This author has advanced a new