Prior Vaginal Trauma

[BBB167893]

How many times does RDI get to use that excuse?

You're one to talk! According to IDI, the police in this case couldn't do right for doing wrong!

 

[BBB167893]

Since we're broad-brushing the abuse reactions of children, as to 'typical' behavior and such,

I wasn't aware I WAS "broad-brushing," Chuck. Sounds more like I'm being brushed off to me.

let's continue with that to this point:

How many child-sex crimes, ending in murder of the child in their own home in what is labeled (by FBI in Ramsey case) as a "staged scene", with the guilty party being a family member?

I don't know just off the top of my head. I'm also not sure what your point is.

 

[BBB167893]

I think what you are saying is that NO EVIDENCE of sexual abuse is therefore EVIDENCE. This is what you are implying at least. It is an interesting argument, emotive, but totally baseless.

Well, you thought wrong, Murri. But it's cool. I'm used to strawman tactics like that.

It's really important to RDI that they have this "motive" for JBR's parents to kill their child. If it's not that, then it's bedwetting or soiling.

Pretty common causes of child killing.

 

[UKGuy]

I think for the reasons stated in the article I quoted.

The 'text book' that many experts had used to instruct them was written by someone who merely stated his own opinion. It was not backed up by research nor was it subjective. He examined abused girls, drew conclusions from what he saw, and concluded that he could recognise the signs of sexual abuse. Never did he examine groups of girls who had not been abused and compared them to abused girls. Many others used this publication as instruction when they examined abused girls also and drew conclusions from it.

However, when a 'blind' experiment was carried out by Dr McCann, he discovered that he was unable to tell the abused from non-abused girls using the accepted techniques he had learned. There was a quote something to the effect that the concurrence of a group of experts was no substitute for research. I think this is very telling, seeing as how it was McCann who said this.

We do know that JBR suffered a number of vaginal infections and also that she was abused on the night in question. This complicates the issue. Also, as the panel of 'experts' would be unlikely to have seen the genitals of many dead girls, I'm not sure how they could conclude that the 1cm dilation was excessive. Another quote from the article was also relevant, and it went something like Doctors who proclaim themselves 'experts' in the field and give the DA's the results they seek get to testify more often.

BTW, I wonder what the motivation for showing pictures of JBRs genitals to the BPD would have been? If they 'decided' it was prior molestation, by the instruction they were given, perhaps the instructor was same 'expert' who was used to giving prosecutors affirmative answers to questions about whether a girl was sexually abused or not and who also learned his 'trade' from a flawed text.

MurriFlower,

Fair enough, now if it can be shown that Detective Harmer used the teaching materials/methods you cite then there will be a case for police error.

Holly Smith was the head of the Boulder County Sexual Abuse team , she was removed from the JonBenet case. e.g.

Smith adds, "There was an indication of trauma in the vaginal area."

The coroner's autopsy discovered evidence investigators say indicates JonBenet suffered vaginal trauma the night she was murdered. However the autopsy report also describes evidence of possible prior vaginal trauma. Experts disagree about the significance of that.

It could indicate previous injury or infection, a sign of abuse, or nothing at all.

Arapahoe County Coroner Dr. Michael Doberson says you would need more information before you could come to any conclusion. That was part of Smith's job. But then she was abruptly pulled off the investigation and told police were handling everything.

"There was a lot of territoriality around the case,” she says.

Smith says she also saw things in the Ramsey investigation that she's seen in other cases, like the factor that money played in it.

"No one is exempt but people with money are able to keep themselves more cushioned,” she says.

She says she also saw a reluctance to even consider the issue of child sex abuse.

Says Smith, "It’s just not a place where you know it's so abhorrent to people that they can't even do it, they can't even wrap their heads around it but it's more common than we think. The sexual violation of children has been around for a long time."

Smith believes all of them involved with the case lost their way.

BTW, I wonder what the motivation for showing pictures of JBRs genitals to the BPD would have been? If they 'decided' it was prior molestation, by the instruction they were given, perhaps the instructor was same 'expert' who was used to giving prosecutors affirmative answers to questions about whether a girl was sexually abused or not and who also learned his 'trade' from a flawed text.

Presumably because these pictures were then compared with those of a normal, healthy six-year old. I'm assuming what was visible to the BPD officers was patently something that was abnormal and not caused by day to day events in JonBenet's life.

Looks to me as if someone in charge of the JonBenet case made sure no conclusion was ever reached regarding chronic abuse!


.

 

[MurriFlower]

Does this help:

In a September 1999 study for the Medical Journal Family Medicine titled "Genital Findings in Prepubertal Girls Evaluated for Sexual Abuse: A Different Perspective on Hymeneal Measurements," Dr. Perry Pugno said:
"Girls with no definitive signs of genital trauma exhibited a mean transhymenal diameter of 2.3 mm and in general showed an increase of approximately 1 mm per year of age. Girls with definitive signs of genital trauma exhibited a mean transhymenal diameter of 9.0 mm and no significant variance with age. Correcting for age differences, the transhymenal diameter was highly significant as a differentiating factor (F=1079, P<.001). When compared against the criterion standard, the transhymenal measurement is 99% specific and 79% sensitive as a screening tool."

Or maybe this:

Dr. Robert Kirschner, from the University of Chicago, Department of Pathology, weighed in as well. In a 1997 article for Vanity Fair magazine written by Ann Bardach, he stated:
"The vaginal opening, according to Dr. Robert Kirschner of the University of Chicago's pathology department, was twice the normal size for six-year-olds. "The genital injuries indicate penetration," he says, "but probably not by a penis, and are evidence of molestation that night as well as previous molestation." "If she had been taken to a hospital emergency room, and doctors had seen the genital evidence, her father would have been arrested"

Well, of course there's 'experts' and then there's 'experts':

Pediatrics. 2002 Feb;109(2):228-35.
Use of hymenal measurements in the diagnosis of previous penetration.
Berenson AB, Chacko MR, Wiemann CM, Mishaw CO, Friedrich WN, Grady JJ.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555-0587, USA. [email protected]
Abstract
OBJECTIVE: To determine the usefulness of measurements of the vaginal opening and amount of hymenal tissue present inferiorly and laterally in the diagnosis of vaginal penetration.
METHODS: The transhymenal diameters and the amount of tissue present between the hymenal edge and vestibule inferiorly at 6 o'clock and laterally at 3 o'clock and 9 o'clock were measured from photographs of 189 prepubertal children with a validated history of digital or penile penetration and 197 children who denied previous sexual abuse. Statistical analyses were conducted to compare the mean values and hymenal symmetry between groups as well as to determine the sensitivity and specificity of various cutoff points.
RESULTS: Comparison of the mean diameters demonstrated that children with a penetration history had a significantly larger transverse opening than nonabused children when examined in the knee-chest position (5.6 vs 4.6 mm). However, there was extensive overlap in measurements between the 2 groups. No significant differences were noted between groups in the size of the vertical diameter, the amount of tissue present inferiorly or laterally, or the symmetry of the hymen in either position. Children with previous penetration were more likely than nonabused children to have a horizontal opening measuring >6.5 mm in the knee-chest position, but the sensitivity and specificity of this test were low (29% and 86%, respectively). Higher values had better specificity but very low sensitivity. Less than 1.0 mm of hymenal tissue was detected at 6 o'clock only in those with a history of penetration (100% specificity), but the sensitivity was low (1%-2%).
CONCLUSION: Most hymenal measurements lack adequate sensitivity or specificity to be used to confirm previous penetration. Less than 1.0 mm of hymenal tissue at 6 o'clock was detected only in victims of abuse, but the usefulness of this test is limited by the rarity of this finding.

Or even this:

Child Abuse Negl. 2001 Aug;25(8):1109-20.
The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse.
Ingram DM, Everett VD, Ingram DL.
School of Medicine, University of North Carolina at Chapel Hill, USA.
Abstract
OBJECTIVE: To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old.
METHODS: Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse.
RESULTS: The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position.
CONCLUSION: Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?”

Help at all?

 

[BBB167893]

Well, of course there's 'experts' and then there's 'experts':

Pediatrics. 2002 Feb;109(2):228-35.
Use of hymenal measurements in the diagnosis of previous penetration.
Berenson AB, Chacko MR, Wiemann CM, Mishaw CO, Friedrich WN, Grady JJ.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555-0587, USA. [email protected]
Abstract
OBJECTIVE: To determine the usefulness of measurements of the vaginal opening and amount of hymenal tissue present inferiorly and laterally in the diagnosis of vaginal penetration.
METHODS: The transhymenal diameters and the amount of tissue present between the hymenal edge and vestibule inferiorly at 6 o'clock and laterally at 3 o'clock and 9 o'clock were measured from photographs of 189 prepubertal children with a validated history of digital or penile penetration and 197 children who denied previous sexual abuse. Statistical analyses were conducted to compare the mean values and hymenal symmetry between groups as well as to determine the sensitivity and specificity of various cutoff points.
RESULTS: Comparison of the mean diameters demonstrated that children with a penetration history had a significantly larger transverse opening than nonabused children when examined in the knee-chest position (5.6 vs 4.6 mm). However, there was extensive overlap in measurements between the 2 groups. No significant differences were noted between groups in the size of the vertical diameter, the amount of tissue present inferiorly or laterally, or the symmetry of the hymen in either position. Children with previous penetration were more likely than nonabused children to have a horizontal opening measuring >6.5 mm in the knee-chest position, but the sensitivity and specificity of this test were low (29% and 86%, respectively). Higher values had better specificity but very low sensitivity. Less than 1.0 mm of hymenal tissue was detected at 6 o'clock only in those with a history of penetration (100% specificity), but the sensitivity was low (1%-2%).
CONCLUSION: Most hymenal measurements lack adequate sensitivity or specificity to be used to confirm previous penetration. Less than 1.0 mm of hymenal tissue at 6 o'clock was detected only in victims of abuse, but the usefulness of this test is limited by the rarity of this finding.

Or even this:

Child Abuse Negl. 2001 Aug;25(8):1109-20.
The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse.
Ingram DM, Everett VD, Ingram DL.
School of Medicine, University of North Carolina at Chapel Hill, USA.
Abstract
OBJECTIVE: To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old.
METHODS: Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse.
RESULTS: The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position.
CONCLUSION: Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?”

Help at all?

You asked.

 

[MurriFlower]

MurriFlower,

Presumably because these pictures were then compared with those of a normal, healthy six-year old. I'm assuming what was visible to the BPD officers was patently something that was abnormal and not caused by day to day events in JonBenet's life.

Looks to me as if someone in charge of the JonBenet case made sure no conclusion was ever reached regarding chronic abuse!

I'm finding it a bit worrying that the BPD would need to see photos of her genitals and have instruction on how to tell that she had been (supposedly) abused prior to that night. Did BPD for example, see results of the fiber testing at the lab and get instruction from a technician on how to tell if fibers are a match? No -- according to ST, his superiors didn't show any such reports to him. Were the DNA results made available to the BPD with a Bode technician explaining the results? Was the coroner sent around to give them a talk on his findings?

Can't help but wonder!

 

[MurriFlower]

You asked.

I KNOW!!

Isn't it interesting how I can easily find results of actual research that totally contradicts the opinions of the 'experts' who commented on the case to the press?

 

[DeeDee249]

Via cash?

And what of Dr. Beuf's employees and / or co-workers, i.e.: attending nurse(s), day-off subs, etc?

Do you believe they, too, were paid to look the other way or that they never were permitted an opportunity to attend while Dr. Bleuf visited with JBR and presumably with PR in-the-exam-room?

It is a possibility, but there is no proof.

The coroner determined there were abrasions found on JB's hymen. They were probably fairly recent, and other that the complaints of vaginitis, her doctor may have not looked internally. Had he done so, he may have seen the eroded hymen but no abrasions. We have no way of knowing how close to her death they may have occurred. The blood, obviously, was from that night.
As far as other employees being paid off, I think that very unlikely. But I think that it is also probable that no one was in the examining room with he and JB except Patsy.

 

[BBB167893]

I KNOW!!

Geez, bite my head off.

I'm finding it a bit worrying that the BPD would need to see photos of her genitals and have instruction on how to tell that she had been (supposedly) abused prior to that night.

Wouldn't that be SOP?

Isn't it interesting how I can easily find results of actual research that totally contradicts the opinions of the 'experts' who commented on the case to the press?

As far as I know, Murri, NONE of the expert panel members spoke to the press.

And they don't contradict them at all. It's one thing to say "this hymen size doesn't mean" or "bedwetting doesn't mean." But try taking them all TOGETHER.

Listen, I've heard all of this "pet expert" stuff before. And McCann was one of the guys who blazed the trail AGAINST those people. I could believe what you're saying, Murri, if it was just one or two experts. But not seven of them who examined the actual tissue slides.

 

[joeskidbeck]

I absolutely do NOT believe Dr. Beuf was paid off. He didn't have to be. All he had to do was talk to Patsy in confidence that maybe JonBenet should talk to a therapist about all of the issues she seemed to be having. After all the visits JB had with this doctor you surely cannot believe that molestation didn't even enter his mind? What kind of doctor would he be? This child had major issues and maybe, just maybe, the good doctor offered to do an internal exam and Patsy refused (reckon she didn't want to know the truth?). I have to ask this question. Several of you have pointed out the fact that NONE of the family or friends had any notion of JonBenet being molested. Do you really believe that just because they told LE that? Several of her friends had planned an intervention on Patsy's behalf, supposedly on the pagent issue, but come on, do you think they would have really been honest with what their concerns were (after JB was murdered)? No way. Remember, John says the pagents werent a big deal, just a hobby Patsy and JonBenet enjoyed. Right, just ask the family friends.
Chuck, SD is right, I was being rather harsh with you in an earlier post and I apologize for that. I would not wish for anyone to have to go through the hell it is when someone you love is sexually abused at any age, but when it is a child who has no defense at all, there are no words to describe how bad it hurts. This case is textbook for familial molestation. I am not even considering the murder when I say that. I guess that's the part that really upsets me, she had to die because someone had too much pride, no matter which one was the culprit, that's what it comes down to, pride. This couldn't happen in the Ramsey family. They are good people and it doesn't happen to good people. Oh how I wish that were true and I bet a lot of others here do too. Sorry for the long post. As I'm sure you know, I hurt for JonBenet and what she endured, but unlike IDIs, I think she was enduring it for a lot longer than you believe. Also, knowing what I know now, if she were still alive, I would still hurt for her. Some wounds never heal.

 

[MurriFlower]

Geez, bite my head off.

Not at all, no malice intended. How's about this?

I KNOW!!:woohoo:

As far as I know, Murri, NONE of the expert panel members spoke to the press.

Ok, then I stand corrected. If Dr. Robert Kirschner, from the University of Chicago, Department of Pathology, was not on the panel of 'experts' then I should have said -- Isn't it interesting how I can easily find results of actual research that totally contradicts the opinions of 'experts' who commented on the case to the press?

And they don't contradict them at all. It's one thing to say "this hymen size doesn't mean" or "bedwetting doesn't mean." But try taking them all TOGETHER.

On the contrary, it does contradict the "experts" because they did not take any bedwetting into account, just the examination of the genitals of the dead child.

I agree that the research indicates that examination of genitals not definitive of sexual abuse (as may have been thought in the past). When they examined abused and non-abused children they could not pick the difference.

So you add the bedwetting to try to back up the accusation. Bedwetting is so common that even these two things together are no more than a coincidence.

Someone else has tried to add soiling, but as far as I can see, the only regular soiling was a failure to wipe effectively. Even so, as any parent or teacher can probably inform, every child of that age has 'accidents', indeed even older children do.

Her Doctor did not detect any problems, either physically or emotionally, despite her having seen him regularly. What about her teacher, dance instructor, others?

Listen, I've heard all of this "pet expert" stuff before. And McCann was one of the guys who blazed the trail AGAINST those people. I could believe what you're saying, Murri, if it was just one or two experts. But not seven of them who examined the actual tissue slides.

Believe it, I've put up the research. Even McCann said the consensus of experts is no substitute for research. Subsequent research indicates that it is not a reliable indicator.

 

[Tadpole12]

Wow Tad

What's with the BIG words??

Heyya MF.

Just the way it copied from the link, BIG , like that.

Bilingual link, scale of both languages.

 

[MurriFlower]

Heyya MF.

Just the way it copied from the link, BIG , like that.

Bilingual link, scale of both languages.

Ok, I thought you were yelling LOL.

 

[claudicici]

I 'm not educated or know much about anything but the 1 cm I just can't get out of my head.I have a child.1 cm.That is big.As big as Tadpole's font.Imagine that.I can't.
It blows my mind.

 

[LinasK]

Yes, we all "know" that child molesters are fantastic and magical about hiding their predilection, that no one ever suspects them, that no one is ever aware of the behind-closed-doors abuse going on under their very noses ... even to a point where it appears a conspiracy.

But, do we really know? Is that above paragraph text so definitive and factual that it is always without exception?

Now, there was something else you said, and it ties in with nobody knowing about possible abuse:



Well, I don't know about that, Chuck. All I have to go on is the record. And the sad fact is, the record is bleak. There's nothing magical or fantastical about it, either. I can honestly say I WISH there were! We think we're all so hip to the problem and that these creeps are so easy to spot, but the sad fact is that literally EVERY SINGLE THING has to go completely right for one of these creeps to get caught.

Let me try to put it in perspective for you: according to at least one FBI statistic I read, as many as 60% of rape victims do not report their rapes. Of the ones that do, only about 40% of the rapists are arrested. Of those arrested, only about 15% ever see prison time. The reason for this is obvious: because rape is the only crime where the victim can be victimized twice, first by the act itself, then by having to relive it to the police and then in court, where slimy defense lawyers will drag them through hell and back. For most of them, it's just not worth the trauma.

And bear in mind: these are adult women, supposedly in complete control of their faculties. Imagine now how hard it must be for a small child to come forward. It's their innocence and inability to fight back that makes them such tempting targets. They don't always know it's wrong, and if the perp is a loved one, they may come to associate it with love. More than one child has said that they liked it. Others simply process it as part of life and move on. We keep being told what to look for in abused children: sexual acting out, compulsive masturbation, exaggerated startle reflex, etc. But something like 80% of abused children show NO behavioral symptoms.

And even if they DO know it's wrong, children are extremely easy to manipulate through bribery or intimidation. Couple that with the child's own fear that if they do tell an adult, the adult won't believe them and might punish them for telling "lies," especially if the perp is a loved one.

But I'll tell you what. Don't take my word for any of this. The people you should be talking to are LinasK and joeskidbeck, among others. They know.

I can tell you for a fact in my case, when I was 4 or 5, my uncle used to rub up against me from behind on the pretext of "getting my coat"- just feet away from both my parents, but not visible!!! His wife, my aunt was present too!!!
When he molested me, I was 13 (my parents were in the house, but he & I were just in the backyard), I still did not tell for the very reason SD states above. It took many years for me to be able to talk about it.

 

[MurriFlower]

I 'm not educated or know much about anything but the 1 cm I just can't get out of my head.I have a child.1 cm.That is big.As big as Tadpole's font.Imagine that.I can't.
It blows my mind.

Here's a question for DD who seems to know about such things.

When someone dies, their muscles relax is this not so? Orifices, shall we say, that are normally tight shut open slightly, mouth becomes slack, and urine leaks out as does faeces?

Would it be also the case that the muscles of the vagina relax giving the impression in a small child that it is twice the normal opening size??

 

[ChuckMaureen]

Hi, superdave,

bbm

Does this help:

In a September 1999 study for the Medical Journal Family Medicine titled "Genital Findings in Prepubertal Girls Evaluated for Sexual Abuse: A Different Perspective on Hymeneal Measurements," Dr. Perry Pugno said:
"Girls with no definitive signs of genital trauma exhibited a mean transhymenal diameter of 2.3 mm and in general showed an increase of approximately 1 mm per year of age. Girls with definitive signs of genital trauma exhibited a mean transhymenal diameter of 9.0 mm and no significant variance with age. Correcting for age differences, the transhymenal diameter was highly significant as a differentiating factor (F=1079, P<.001). When compared against the criterion standard, the transhymenal measurement is 99% specific and 79% sensitive as a screening tool."

We are given:

"Girls with no definitive signs of gential trauma exhibited a mean transhymenal diameter of 2.3mm and in general showed an increase of 1mm per [age-year]."

(I believe 'diameter' is a misnomer in the sense that 'diameter' suggests a 'circle' opening, which is not always the case but I'll use it as in context.)

2.3mm = at birth.

JBR was 6 years of age at autopsy.

1mm x 6yrs = 6mm additional widening.

To wit:

2.3mm + (1 x 6)mm = 8.3mm = 0.83cm

JBR's transhymenal 'diameter' @ autopsy: 1.0cm

I do not believe a deviation of +1.7mm is significant to suggest penetration.

Given that JBR's transhymenal 'diameter' was measured some hours after time of death, the +1.7mm could be explained as from autolysis.

Or maybe this:

Dr. Robert Kirschner, from the University of Chicago, Department of Pathology, weighed in as well. In a 1997 article for Vanity Fair magazine written by Ann Bardach, he stated:
"The vaginal opening, according to Dr. Robert Kirschner of the University of Chicago's pathology department, was twice the normal size for six-year-olds. "The genital injuries indicate penetration," he says, "but probably not by a penis, and are evidence of molestation that night as well as previous molestation." "If she had been taken to a hospital emergency room, and doctors had seen the genital evidence, her father would have been arrested"

It was actually Jane Harmer, one of the detectives.

".. twice the normal size for six-year-olds."

We've calculated a 'normal' size for JBR as = 0.83cm.

2 x 0.83cm = 1.66cm

JBR's transhymenal 'diameter' @ autopsy: 1.0cm

Dr. Kirschner's statements do not fall in line with the "September 1999 study for the Medical Journal Family Medicine" conclusions.

Next.

 

[ChuckMaureen]

You're one to talk! According to IDI, the police in this case couldn't do right for doing wrong!

By their own admission, to a degree.

 

[ChuckMaureen]

Hi, deedee,

bbm

The coroner determined there were abrasions found on JB's hymen. They were probably fairly recent, and other that the complaints of vaginitis, her doctor may have not looked internally. Had he done so, he may have seen the eroded hymen but no abrasions. We have no way of knowing how close to her death they may have occurred. The blood, obviously, was from that night.
As far as other employees being paid off, I think that very unlikely. But I think that it is also probable that no one was in the examining room with he and JB except Patsy.

According to the autopsy, the 'abrasion' was suggested to have extended to an "anterior to the hymen", meaning above the hymenal tissue and orifice:

bbm

The area of abrasion is present at approximately the 7:00 position and appears to involve the hymen and distal right lateral vaginal wall and possibly the area anterior to the hymen.

I expect Dr. Beuf could not miss such an abrasion, given it's reported location. No internal examination required.