Abstract
A 2-year-old girl presented to the Emergency Department with genital complaints and a concern for sexual abuse. A perineal defect and absence of a segment of the posterior hymen were observed; the caregiver denied a past history of trauma. No other signs consistent with abuse or neglect were noted on examination. Pediatric surgery conducted an exam under anesthesia and confirmed a perineal fistula. While trauma is the most likely explanation for a large segmental defect in the posterior hymen, the co-occurrence of an anatomical variant of the anus and perineum in this patient raises questions about the etiology of both findings. This case underscores the importance of adequate examinations with careful inspection and documentation of anogenital structures in the newborn period.