Is there any treatment available for a four-year-old girl in Africa whose vagina was damaged by sexual abuse? Her vagina looks wide open, like an older woman's. Is it possible to tighten it to look as good as a virgin's?

J.Z.

More important than how this child looks is how she is doing emotionally. I certainly hope she is getting extensive, high-quality counseling to deal with such a horrible trauma. Also, with the extremely high incidence of HIV in Africa, I hope she has been (and will continue to be) tested for infection with this virus.

There are surgical techniques to tighten the vagina and even to reconstruct the hymen. Frankly, I am not sure if it would be advisable to do this at such a young age. My first concern with operating on this young girl now is that she has already been through enough trauma. My second concern is that the repair may not be elastic enough to stretch well as she grows.

As the mother of a daughter who is not quite two years old, it makes me cringe to think that someone could sexually abuse such a young child. I hope this girl has the strength of spirit, the resilience of youth and the love of other people to help her move beyond this unspeakable abuse.