SummaryBackground The age when pelvic-perineal injury patterns shift after child sexual abuse has not been formally identified, hindering development of age-specific examination protocols, especially in conflict zones with severe injuries and limited expertise. This study aimed to determine the association between age and pelvic-perineal trauma prevalence, identify the age threshold where injury patterns shift, and compare injury co-occurrence before and after this threshold. Methods Medical records of 5692 females Findings Methods converged on 9–11 years; age 10 was selected and validated using menarche data (>98% of ≤10 group pre-menarcheal; 99.4% of >10 group post-menarcheal). All injuries except vaginal were more prevalent in the ≤10 group. Injury burden was higher prepubertally with 4–6 concurrent sites occurring in the ≤10 group (1.85 vs 1.18; d=0.59). Network analysis showed anal injury was central prepubertally (EIF = +16.92) and vaginal injury central post-pubertally (+10.79). The perineal–anal association reversed from positive (+2.82) ≤ 10 to negative (−6.16) thereafter. Interpretation Age 10 marks two distinct injury profiles. Prepubertal trauma is multifocal with an anal focus, whereas adolescent trauma centers on vaginal injury with sparser patterns. These findings support age-stratified examination protocols, including systematic ano-rectal assessment in prepubertal cases and vaginal-focused evaluation in adolescents. Funding No funding was provided for this research.
Maroyi et al. (Fri,) studied this question.