We read with interest the recent report by Moore et al1 detailing a case of pelvic inflammatory disease in a "virginal" 15-year-old female. While there is a possibility that the patient's history is as presented, we wish to urge caution when making clinical decisions based on an adolescent's expressed "virginal" or "nonvirginal" state. The reliability of adolescents' reporting of sexual behavior is variable2,3 and may be influenced by social desirability factors. Sexual histories may also be less reliable in younger adolescents,4 in teenagers who are in unfamiliar environments, or when teenagers perceive that physicians may be blaming their medical issues on sexual activity. Another issue in the case of the patient described by Moore et al is her history of recurrent cystitis. In females, sexual activity significantly increases the risk of developing a urinary tract infection, and the more recent the sexual activity, the higher the risk.5 Again, one must evaluate the patient's history in the context of these other issues.
Bravender T, Emans SJ, Laufer MR. Use Caution When Determining "Virginal" vs "Nonvirginal" Status. Arch Pediatr Adolesc Med. 1999;153(7):770-773. doi: