The study population consisted of 1,975 of the 2,058 consecutive girls evaluated for sexual abuse by the WakeMed Child Sexual Abuse Team (CSAT) in Raleigh, NC, over the 10-year period from May 1988 through May 1998. The method used to measure the THOD was the separation technique with enough labial traction to maximize the hymenal orifice. Linear regression was performed to assess how well the THOD, as measured by the separation technique, distinguished between the three risk groups. The study found that the size of the THOD did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma, namely, the narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal cleft between 5 and 7 o'clock in the supine position. Since this study used one method for measuring the THOD, the authors state that they do not mean to imply that some other method of measuring the THOD would produce the same findings. Some other method of measurement might prove to be associated with established markers of sexual abuse and thus prove useful in determining whether a child had been sexually abused. This study simply rules out the separation technique as a useful means for determining whether sexual abuse of a child has occurred. 5 tables and 22 references