A 12-year-old girl is being seen for chronic abdominal pain by her family physician. The physician asks the mother to step out of the room and does a complete history including the HEADSS (home life, education level, activities, drug use, sexual activity, suicide ideation/attempts) questions. The girl tearfully reports that her stepfather has been touching her in her private areas when her mother is not home. On examination with a female nurse chaperone in the room, the physician finds that the girl's hymen initially appears normal (Figure 9-1). However, when the girl is more carefully examined with a cotton-tip applicator, a healed posterior hymenal transection is seen (Figure 9-2). When the girl is asked whether any other types of sexual abuse occurred with her stepfather, she admits to repeated penile penetration. Although rare, sometimes the examination reveals more than what the child is willing to disclose about the abuse. Partial disclosures of abuse are common in children. In addition, the findings of sexual abuse tend to be subtle and are easily missed if a careful examination and special techniques are not used. Attempts are made to reassure the girl that this should never happen and that this is not her fault. Her mother is brought back into the room and after a sensitive discussion, the police are called and Child Protective Services notified.