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Posterior fourchette lacerations are suggestive of sexual assault, and toluidine blue dye has increased the detection of these lacerations in adult rape victims. This study investigated the use of toluidine blue dye in the pediatric (0 to 10 years) and adolescent (11 to 18 years) patients to detect posterior fourchette lacerations in sexually abused and control populations. Application of toluidine blue dye increased the detection rate of posterior fourchette lacerations from 4% (1/25) to 28% (7/25) (P less than .05, Fisher exact test) in adolescent sexually abused patients and from 16.5% (4/24) to 33% (8/24) (P = .318, Fisher exact test) in pediatric sexually abused patients. Posterior fourchette lacerations occurred with the same frequency in sexually abused adolescents and sexually active controls adolescents. In the pediatric aged population, 33% of the sexually abused group had lacerations detected, whereas none of the control patients had lacerations. The presence of posterior fourchette lacerations in the pediatric aged patient is strongly suggestive of sexual abuse. Toluidine blue increases the detection of posterior fourchette lacerations in children and adolescents (P less than .001, Fisher exact test). The application of toluidine blue dye to highlight posterior fourchette lacerations is an important addition to tools already used in the evaluation of the sexually abused patient.
McCauley et al. (Mon,) studied this question.