When performing a vaginal examination on a prepubertal girl, it is important to be familiar with normal variants of hymen anatomy. Evaluation of the hymen is one of the most challenging aspects of the female genital examination. Experience is needed to evaluate due to the number of normal anatomic variants. The most common hymenal variants are crescentic, annular, cuff-like, fimbriated, and septate.

The appearance of the hymen changes with age in response to hormonal influences. Peripartum estrogen causes the newborn's hymen to have a thick, pale, elastic, and redundant appearance. This effect often lasts until ages 2-3 years and then reappears at puberty. During this time, the hymen is small enough that to adequately visualize it and determine if there are notches or clefts or disruptions requires magnification. Between infancy and adolescence, the prepubertal unestrogenized hymen is typically characterized as thin, vascular, reddened, and often innervated, leading to increased sensitivity.