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Kane D, Kennedy KM, Eogan M. The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review. Int J Legal Med 2024; 138:997-1010. [PMID: 37971512 DOI: 10.1007/s00414-023-03117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies. AIMS AND OBJECTIVES We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed. METHODS Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms. RESULTS Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized. CONCLUSIONS This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.
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Affiliation(s)
- D Kane
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland.
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland.
| | - K M Kennedy
- School of Medicine, University of Galway, Galway, Ireland
| | - M Eogan
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland
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Majeed-Ariss R, Martin GP, White C. Identifying the prevalence of genital injuries amongst patients attending Saint Mary's sexual assault referral centre following an allegation of digital penetration. J Forensic Leg Med 2024; 102:102656. [PMID: 38387234 DOI: 10.1016/j.jflm.2024.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
This study aimed to (1) add to the limited evidence base regarding genital injury associated with digital vaginal penetration and (2) identify predisposing or protective factors to the identification of a genital injury. Data collection was performed retrospectively on the paper case files of 120 female adult (>18 years) patients alleging digital vaginal penetration with no penile vaginal penetration that had an acute FME at Saint Mary's Sexual Assault Referral Centre (SARC) Manchester. Descriptive statistics were used to investigate differences in the demographics of those reporting digital penetration, with and without injuries. Overall, 18% had genital injuries noted at the time of the FME. Posterior fourchette was the most common location of genital injury and abrasion was the most common injury type. It is worth further noting that all 22 patients where an injury was noted were of white ethnicity, only 12 patients in the sample were not white so caution is needed in interpretating this finding of a non-significant difference. Future research should consider injury and ethnicity more specifically. The findings from this study add to the existing evidence base and should prove useful to expert witnesses when called upon to interpret examination findings of sexual assault complainants as they relate to an allegation of digital penetration.
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Affiliation(s)
- Rabiya Majeed-Ariss
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK.
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Catherine White
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Institute for Addressing Strangulation Sexual Offences, Manchester, UK
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Dlamini NS, Masango BZ, Chiao C, Lin WH. Associations between forced non-consensual first-sex and HIV among sexually active women in the Kingdom of Eswatini. AIDS Care 2024; 36:87-97. [PMID: 37187024 DOI: 10.1080/09540121.2023.2206099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Studies continue to underscore the profound impact of sexual violence on women's health. Yet, little is known about the impact, via a complex matrix of behavioural and social factors, of first intercourse, namely forced non-consensual on HIV status, particularly among sexually active women (SAW) in low-income countries where HIV prevalence remains high. Using a national sample from Eswatini, we employed multivariate logistic regression modelling to estimate the associations between forced first-sex (FFS), subsequent sexual behaviour and HIV status among 3555 SAW aged from 15 years to 49 years. The results found that women who experienced FFS had a greater number of sexual partners compared to those who had never experienced FFS (aOR = 2.79, p < .01), although there were no significant differences in condom use, early sexual debut and casual sex involvement between these two groups. FFS remained significantly associated with a higher risk of having HIV (aOR = 1.70, p < .05) even after controlling for risky sexual behaviours and various other factors. These findings further reinforce the relationship between FFS and HIV, and suggest that addressing sexual violence is a critical component of HIV prevention among women in low-income countries.
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Affiliation(s)
- Nompilo Sibonakele Dlamini
- International Health Program, College of Medicine, Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Department of Community Health Nursing Science, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | | | - Chi Chiao
- International Health Program, College of Medicine, Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- College of Medicine, Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen-Hsu Lin
- College of Medicine, Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Naumann DN, Morris L, Bowley DM, Appleyard TL, Cumming J, Wardle D. Anogenital injury following sexual assault and consensual sexual intercourse: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102266. [PMID: 37842551 PMCID: PMC10570717 DOI: 10.1016/j.eclinm.2023.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023] Open
Abstract
Background Sexual violence is a grave human rights violation and a serious global public health challenge. Rates of reporting of sexual violence and subsequent passage of cases through the criminal justice system are poor all over the world. The presence or absence of anogenital injury following sexual assault may influence survivors in their willingness to report a crime, and law enforcement officers and jurors in their decision making regarding the laying of charges and/or conviction of offenders. The aim of this systematic review was to compare rates of identification of anogenital injury (AGI) in women following sexual assault and consensual sexual intercourse using the same examination techniques. Methods In this systematic review and meta-analysis, Medline, Embase and Google Scholar were searched for relevant studies (in any language, with no age or sex criteria) published between February 25, 1993, and February 25, 2023, that directly compared AGI between individuals after either sexual assault or consensual sexual intercourse. Abstracts, conference proceedings, and case reports were excluded. The primary outcome of interest was any form of detected AGI. The Mantel-Haenszel method was used for meta-analysis using random effects modelling to determine the risk ratio (RR) of AGI between sexual assault and consensual sexual intercourse. Quality assessment was undertaken using the Newcastle-Ottawa scale tool. The I2 statistic was used to determine heterogeneity among studies. An I2 >75% was considered high heterogeneity. Funnel plots were used to assess the risk of publication bias, by determining any visually apparent asymmetry. This analysis is registered with PROSPERO, CRD42023402468. Findings We included 10 studies, accounting for 3165 study participants. All participants were female. AGI was detected in 901 (48%) of 1874 participants following sexual assault and 394 (31%) of 1291 participants following consensual sexual intercourse. Meta-analysis of all included studies demonstrated that the presence of AGI was significantly more likely for participants following sexual assault than consensual sexual intercourse (RR 1.59 (95% CI 1.21, 2.09); p < 0.001). There was a significant heterogeneity among studies and funnel plots suggest that this RR may be an over-estimation. Subgroup analysis including only high-quality studies showed no significant difference between groups. Interpretation Although AGI was significantly more likely to be detected after sexual assault than consensual sexual intercourse, more than half of survivors of sexual assault have no detectable injuries. The presence of AGI, therefore, does not prove there has been sexual violence and absence of injury does not refute that sexual assault has occurred. Funding The University of Birmingham.
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Affiliation(s)
- David N. Naumann
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B152TT, UK
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise Morris
- Department of Paediatric Surgery and Urology, Alder Hey Children's Hospital, Liverpool, UK
| | - Douglas M. Bowley
- Department of Trauma and Emergency General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tracy-Louise Appleyard
- Women's and Children's Division, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Julie Cumming
- NHS Education for Scotland, 3rd Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, UK
| | - Deborah Wardle
- NHS Education for Scotland, 3rd Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, UK
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Kuchukhidze S, Panagiotoglou D, Boily MC, Diabaté S, Imai-Eaton JW, Stöckl H, Mbofana F, Wanyenze RK, Maheu-Giroux M. Characteristics of male perpetrators of intimate partner violence and implications for women's HIV status: A pooled analysis of cohabiting couples from 27 countries in Africa (2000-2020). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002146. [PMID: 37672520 PMCID: PMC10482294 DOI: 10.1371/journal.pgph.0002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
Intimate partner violence (IPV) may increase women's HIV acquisition risk. Still, knowledge on pathways through which IPV exacerbates HIV burden is emerging. We examined the individual and partnership-level characteristics of male perpetrators of physical and/or sexual IPV and considered their implications for women's HIV status. We pooled individual-level data from nationally representative, cross-sectional surveys in 27 countries in Africa (2000-2020) with information on past-year physical and/or sexual IPV and HIV serology among cohabiting couples (≥15 years). Current partners of women experiencing past-year IPV were assumed to be IPV perpetrators. We used Poisson regression, based on Generalized Estimating Equations, to estimate prevalence ratios (PR) for male partner and partnership-level factors associated with perpetration of IPV, and men's HIV status. We used marginal standardization to estimate the adjusted risk differences (aRD) quantifying the incremental effect of IPV on women's risk of living with HIV, beyond the risk from their partners' HIV status. Models were adjusted for survey fixed effects and potential confounders. In the 48 surveys available from 27 countries (N = 111,659 couples), one-fifth of women reported that their partner had perpetrated IPV in the past year. Men who perpetrated IPV were more likely to be living with HIV (aPR = 1.09; 95%CI: 1.01-1.16). The aRD for living with HIV among women aged 15-24 whose partners were HIV seropositive and perpetrated past-year IPV was 30% (95%CI: 26%-35%), compared to women whose partners were HIV seronegative and did not perpetrate IPV. Compared to the same group, aRD among women whose partner was HIV seropositive without perpetrating IPV was 27% (95%CI: 23%-30%). Men who perpetrated IPV are more likely to be living with HIV. IPV is associated with a slight increase in young women's risk of living with HIV beyond the risk of having an HIV seropositive partner, which suggests the mutually reinforcing effects of HIV/IPV.
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Affiliation(s)
- Salome Kuchukhidze
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Souleymane Diabaté
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de Médecine et Spécialités Médicales, Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Infectious Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany
| | | | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada
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Buswell H, Majeed-Ariss R, Rajai A, White C, Mills H. Identifying the prevalence of genito-anal injuries amongst clients attending St Mary's Sexual Assault Referral Centre following an allegation of anal penetration. J Forensic Leg Med 2022; 90:102392. [DOI: 10.1016/j.jflm.2022.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
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Mezzatesta Gava M, Miquel L, Jarvis GE. Gender-based violence among refugee women referred to a Cultural Consultation Service in Montreal. Transcult Psychiatry 2022; 59:202-213. [PMID: 34726100 DOI: 10.1177/13634615211043767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gender-based violence (GBV) among female refugees/asylum seekers is a major underreported/understudied psychosocial issue. The aims of this study were: to describe the proportion of GBV-related experiences among female refugees/asylum seekers referred to a Cultural Consultation Service (CCS) in Montreal; to describe their sociodemographic and clinical characteristics; and to compare these characteristics among women who make GBV their principal refugee claim (Group A), those who did not but had suffered GBV (Group B1), and those who had never reported GBV (Group B2). Data on sociodemographic and clinical variables and GBV were gathered by chart review. Data were analyzed using chi-square for categorical and ANOVA for continuous comparisons. A total of 91 female refugees/asylum seekers were evaluated from 2000 to 2013; 80% (73/91) having reported GBV, with 38.5% (35/91) using GBV as the principal reason for seeking asylum in Canada (Group A), mainly due to intimate partner violence (IPV). Fully 66.6% (38/56) of women who sought asylum for reasons other than GBV reported having experienced GBV (Group B1). When compared to the other groups, Group A women exhibited a number of statistically significant differences: they tended to migrate alone (p < .001), be divorced/single (p = .02), have more suicidal thoughts/behaviors (p < .001), and report a history of IPV (p < .001). Women from Group B1 were more likely to be diagnosed with Affective Disorders (p = .045), and to have suffered sexual violence (p < .001). Results suggest that GBV is frequently experienced by refugee/asylum seeker women in this small, tertiary care clinical sample. When assessing refugee women such as these, differences in the kind of violence suffered, migration process, family/social support, and clinical related features should be taken into account and explored by clinicians in a culturally appropriate and safe manner.
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Affiliation(s)
- Marcela Mezzatesta Gava
- Child and Adolescent Mental Health Department, 16512Sant Joan de Deu Hospital & Fundación Salud y Comunidad, Barcelona, Spain
| | - Laia Miquel
- Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurociències, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain & Spanish Network of Addictive Disorders (RTA). RETICS, Madrid, Spain
| | - G Eric Jarvis
- Culture and Mental Health Research Unit, 5621Jewish General Hospital and McGill University, Montreal, QC, Canada
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Barbara G, Albertini V, Tagi VM, Maggioni L, Gorio MC, Cattaneo C, Parazzini F, Ricci E, Buggio L, Kustermann A. Characteristics of Sexual Violence Against Adolescent Girls: A 10 Years' Retrospective Study of 731 Sexually Abused Adolescents. Int J Womens Health 2022; 14:311-321. [PMID: 35273451 PMCID: PMC8901429 DOI: 10.2147/ijwh.s343935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Sexual violence against young girls is a pervasive multifaceted phenomenon which embraces several different forced sexual acts, including attempted and/or completed rape, sexual coercion and harassment, and sexual contact with force or threat of force. The aim of this study is to evaluate the characteristics of sexual violence in adolescent girls, by a retrospective analysis of 731 consecutive cases of sexually abused girls. Materials and Methods We analyzed demographic characteristics, risk factors for rape, and the eventual subsequent presence and type of ano-genital lesions. Results We found that sexual violence with penetration was perpetrated in 591 (80%) cases. Vulnerability factors related with a major risk of rape were age >17 years old and consumption of alcohol and/or other drugs. About 196 (55%) victims had at a least one genital lesion. Conclusion A prompt identification of red flags of sexual violence may help physicians in suspecting and managing cases of sexual assault in adolescent girls, even in the absence of typical lesions.
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Affiliation(s)
- Giussy Barbara
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Albertini
- Department of Emergencies, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Lidia Maggioni
- Department of Biomedical Science, Legal Medicine Section, University of Milan, Milan, Italy
| | - Maria Carlotta Gorio
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Cristina Cattaneo
- Department of Biomedical Science, Legal Medicine Section, University of Milan, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Buggio
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chong EY, Goh DWX, Lim AHS, Goh SSN, Balasubramaniam S. A systematic review of penetrating perineal trauma in a civilian setting. Eur J Trauma Emerg Surg 2022; 48:4365-4383. [PMID: 35262749 DOI: 10.1007/s00068-022-01908-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Penetrating injuries to the perineum and associated pelvic organs have largely been reported in the military. Given the rarity of presentation and unique clinical characteristics of these injuries, we set out to address the gap in the literature in civilian settings. METHODS A systematic review of studies addressing penetrating perineal trauma from January 2000 to April 2021 was performed. Outcomes of interest were the epidemiology, associated injuries, management, follow-up, and patient outcomes. RESULTS 26 studies were included in this review, reporting on a total of 2316 patients. Most injuries occurred in males (88.1%), with gunshot wounds (88.2%) representing the most common aetiology, followed by knife wounds (5.0%), impalement (3.1%), coital injuries/sexual assault (1.5%), and others (2.4%). Regarding associated injuries, anorectal (n = 1419, 69.4%), bladder (n = 351, 32.4%), penile (n = 282, 20.8%), scrotal (n = 375, 27.7%), and testicular (n = 229, 16.9%) occurred frequently. Bony injuries involved the pelvis (n = 88, 8.1%) and femoral fractures (n = 5, 0.5%), while soft-tissue injuries involved the inguinal region (n = 19, 1.6%) and buttocks (n = 14, 1.3%). Vascular injuries occurred in 79 (7.8%) patients. Regarding patient outcomes, 65 (4.8%) deaths were reported, and significant morbidity was detected with a mean injury severity score of 18.4 detected in the cohort. In terms of complications of injury, wound/infective complications (n = 135, 61.3%) and fistula formation/leakage (n = 16, 0.7%) featured prominently. CONCLUSION Penetrating perineal trauma in the civilian population poses a considerable challenge to clinicians, compounded by the potential for multisystem injury requiring involvement of different medical and surgical specialties.
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Affiliation(s)
- Elliot Yeung Chong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Daniel Wen Xiang Goh
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Angela Hui-Shan Lim
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore city, Singapore
| | - Serene Si Ning Goh
- Department of General Surgery, Tan Tock Seng Hospital, Singapore city, Singapore
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Lalumière ML, Sawatsky ML, Dawson SJ, Suschinsky KD. The Empirical Status of the Preparation Hypothesis: Explicating Women's Genital Responses to Sexual Stimuli in the Laboratory. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:709-728. [PMID: 32026221 DOI: 10.1007/s10508-019-01599-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 05/15/2023]
Abstract
Research conducted in our laboratory and in other laboratories has revealed that (1) women's genital responses to visual and auditory stimuli are strongly affected by the presence of sexual cues, but that (2) specific sexual cues (e.g., gender of actors, the presence of sexual violence) often have little impact on the magnitude of the responses-that is, similar genital responses are observed to very different sexual stimuli. In addition, (3) women's genital responses do not strongly correspond with self-reported sexual partner and activity preferences, or (4) with self-reported sexual arousal during the presentation of sexual stimuli. Taken together, these facts represent a puzzle, especially considering that men's genital responses are highly affected by specific sexual cues and strongly correspond to stated preferences and self-reported sexual arousal. One hypothesis to explain female low cue-specificity and low concordance (relative to men) is the preparation hypothesis: Women's indiscriminate genital responses serve a protective function. That is, they do not indicate or necessarily promote sexual interest and motivation, but rather prepare the vaginal lumen for possible sexual activity and therefore prevent injuries that may occur as a result of penetration. We review evidence for and against this hypothesis. We conclude that the evidence is favorable but not entirely convincing, and more work is required to reach a firm conclusion. We offer directions for future research.
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Affiliation(s)
- Martin L Lalumière
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada.
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada.
| | - Megan L Sawatsky
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5, Canada
| | - Samantha J Dawson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Kelly D Suschinsky
- Substance Abuse and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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11
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Bourne K, Croston M, Namiba A. What are the current factors that impact on health-related quality of life for women living with HIV? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S16-S22. [PMID: 35019751 DOI: 10.12968/bjon.2022.31.1.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Since the start of the HIV epidemic, care has often had a strong focus on quality of life. In the early days, this was in part due to the limited treatment options available for people living with HIV, alongside the strong humanistic desire of those working in the specialty to provide optimum care. Advances in HIV treatments have led to care having more of a medical focus, with national and international targets concentrating on the prevention of new infections. Despite medical progress, the impact of being diagnosed and living with HIV has a significant impact on many people, across all aspects of their life. Factors that impact on health-related quality of life for women living with HIV are often poorly understood and under-explored in healthcare settings.
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Affiliation(s)
- Kathryn Bourne
- Clinical Psychologist, Greater Manchester Mental Health NHS Foundation Trust, Wythenshawe Hospital, Manchester; Clinical Psychologist, Department of Infectious Diseases, North Manchester General Hospital, Manchester University NHS Foundation Trust, Manchester; Research Tutor, Lancaster University Clinical Psychology Training Programme, Lancaster
| | - Michelle Croston
- Associate Professor of Nursing, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham
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12
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Lohner L, Nigbur L, Klasen C, Witzel I, Garland J, Ondruschka B, Anders S. Vaginal injuries after consensual sexual intercourse - a survey among office-based gynecologists in Hamburg, Germany. Forensic Sci Med Pathol 2022; 18:352-358. [PMID: 35716294 PMCID: PMC9587115 DOI: 10.1007/s12024-022-00488-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
Studies on the occurrence of injuries following consensual sexual intercourse (CSI) among patients treated by office-based gynecologists are lacking. This survey aimed to assess the presence and medical relevance of vaginal injuries after CSI in gynecological office-based practice, associated risk factors, and their significance for forensic medical assessment practice. All office-based gynecologists in Hamburg, Germany (n = 316), were asked to fill in a one-page questionnaire via a fax survey. The questionnaire covered various aspects such as having observed CSI-related injuries, injury severity, risk factors, and concomitant factors (bleeding, need for surgical care, hospitalization). Response rate was 43.2% (n = 115). Overall, 83.5% of office-based gynecologists reported having observed vaginal injuries after CSI at least once and 59.1% repeatedly. Regarding maximum injury severity, 52.1% observed mucosal erosions, 32.3% mucosa penetrating injuries, and 14.6% injuries penetrating the vagina. Having observed bleeding was reported by 56.3%, 28.1% had to perform surgical suture care, and hospital admission was initiated by 20.8%. Menopause (37.5%), use of objects (19.8%), alcohol, and/or drug use (16.7%) were reported as the most frequently observed associated risk factors. Vaginal injuries after CSI have been observed by the majority of office-based gynecologists in Hamburg involving a wide spectrum of severity, including the necessity of surgical care and hospital admission. Complementing published work in clinical and emergency medicine, these findings are highly relevant to the forensic evaluation of injuries in an allegation of sexual assault, as the severity of a vaginal injury in this setting does not necessarily support a conclusion on the issue of consent.
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Affiliation(s)
- L. Lohner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - L. Nigbur
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - C. Klasen
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I. Witzel
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Garland
- Forensic and Scientific Services, Coopers Plains, Brisbane, Australia
| | - B. Ondruschka
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - S. Anders
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
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Oliphant J, Nicolson B, Coomarasamy C, Foley C, Laking A. A retrospective observational study of genital findings in adult women presenting to a New Zealand Adult Sexual Abuse Assessment and Treatment Service following an allegation of recent sexual assault. J Forensic Leg Med 2021; 86:102301. [PMID: 34999298 DOI: 10.1016/j.jflm.2021.102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/14/2021] [Accepted: 12/18/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to report on the prevalence of genital findings documented in women attending a forensic examination following an allegation of recent sexual assault. A secondary aim was to investigate for any associations between genital findings and variables related to population demographics and clinical factors. STUDY DESIGN A retrospective review of clinical records was undertaken for 593 women, aged between 17 and 45 years of age, who underwent a forensic examination within 72 h following an alleged sexual assault at the Pohutukawa clinic, adult Sexual Abuse Assessment and Treatment Service (SAATS) in Auckland, New Zealand over a four-year period. Statistical analysis to examine for any associations between any documented genital findings and subject variables was performed. RESULTS The key finding was that 66.4% (394/593) of the women had a normal genital examination. Of the 182 women with genital findings the presence of skin disruption and/or bruising was noted in 21.1% (125/593) and non-specific findings in 9.6% (57/593). 17 women were not included as the genital examination was incomplete. For 9.5% (56/593) of women the presence of abnormal genital skin was documented. From the adjusted odds ratios obtained by multivariate analysis there was a statistically significant association between the presence of genital findings and abnormal skin condition (OR 3.13, p = 0.0004). CONCLUSION The study demonstrated that the majority of women seen within 72 h of an alleged sexual assault had a normal genital examination. Given the strength of the association between the presence of genital findings and skin condition, we recommend that documentation of the genital skin condition should become a routine part of a forensic examination following sexual assault. This is particularly important if genital findings are present, in order to present the full complexity of clinical examination findings to the court and provide an expert opinion regarding the limitations of attributing causation.
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Affiliation(s)
- Jeannie Oliphant
- Auckland Sexual Health Service, Greenlane Clinical Centre, 214 Greenlane West, Auckland, 1051, New Zealand.
| | - Bridget Nicolson
- Pohutukawa Service, Adult Sexual Abuse Assessment and Treatment Service, Greenlane Clinical Centre, 214 Greenlane West, Auckland, 1051, New Zealand
| | - Christin Coomarasamy
- Research and Evaluation Office, Ko Awatea, Counties and Manukau District Health Board, Auckland, New Zealand
| | - Christine Foley
- Pohutukawa Service, Adult Sexual Abuse Assessment and Treatment Service, Greenlane Clinical Centre, 214 Greenlane West, Auckland, 1051, New Zealand
| | - Anne Laking
- Pohutukawa Service, Adult Sexual Abuse Assessment and Treatment Service, Greenlane Clinical Centre, 214 Greenlane West, Auckland, 1051, New Zealand
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Ouellette L, McCoy J, Bush C, Rossman L, Kolacki C, Rossman P, Jones JS. Comparative prevalence of anogenital injury following sexual assault in women who have had recent consensual sexual contact. Am J Emerg Med 2021; 51:124-126. [PMID: 34735970 DOI: 10.1016/j.ajem.2021.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the frequency and types of anogenital trauma in rape victims as a function of the time interval between the assault and recent (72 h) consensual sexual intercourse. METHODS This retrospective cohort trial evaluated consecutive female patients, age 13 years or older, presenting to a community-based nurse examiner clinic (NEC) during a 5-year study period. The NEC facility is staffed by forensic nurses trained to perform medical-legal examinations using colposcopy with nuclear staining and digital imaging. Eligible patients were classified into five different groups based on the time interval from the last consensual intercourse to the forensic examination (none, 0-24 h, 25-48 h, 49-72 h, 73-96 h). Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. RESULTS A total of 947 cases of sexual assault met the inclusion criteria and were divided into five groups. The age range was 13 to 87 years (mean, 23.9 years); 78% were examined within 24 h following sexual assault. The five study groups were comparable in terms of demographics, assault history, and incidence of non-genital injuries. The overall frequency, type, or location of anogenital injury did not vary significantly between groups (p > 0.5). CONCLUSION This is the first clinical study to systematically compare the prevalence and typology of anogenital injuries in sexual assault victims who have had consensual intercourse within four days before a forensic exam. The frequency, type or location of anogenital trauma did not vary significantly based on the time interval from last consensual intercourse to the forensic examination.
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Affiliation(s)
- Lindsey Ouellette
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Jessica McCoy
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Colleen Bush
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Spectrum Health Hospitals, Grand Rapids, MI, United States
| | - Linda Rossman
- YWCA West Central MI, Nurse Examiner Program, Grand Rapids, MI, United States
| | | | - Peter Rossman
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States
| | - Jeffrey S Jones
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States; Spectrum Health Hospitals, Grand Rapids, MI, United States.
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Female genital injury-which findings have to be considered physiological using colposcopy with and without toluidine blue dye? Forensic Sci Med Pathol 2021; 17:634-642. [PMID: 34613594 PMCID: PMC8629788 DOI: 10.1007/s12024-021-00417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.
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Edwards KM, Changilwa P, Waterman E, Bikeri C, Mweru C, Khayanje N, Obel P. A Promising Approach to Preventing Gender-Based Violence and HIV Among Slum-Dwelling Youth in Nairobi, Kenya. Violence Against Women 2021; 28:1379-1397. [PMID: 34247565 DOI: 10.1177/10778012211014562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gender-based violence (GBV) and HIV are interrelated public health problems affecting numerous global communities. To date, few prevention initiatives have demonstrated reductions in GBV and HIV, and thus there is an urgency to identify effective strategies to prevent these interconnected public health crises. The purpose of the current article is to describe a gender-enhanced life skills training curriculum (GE-LSTC) currently being developed in Nairobi, Kenya. We discuss previous research relevant to the GE-LSTC; the theoretical underpinnings of the GE-LSTC; the history and context of the GE-LSTC; preliminary implementation, feasibility, and acceptability data on the GE-LSTC; and plans for further refinement and rigorous evaluation of the GE-LSTC.
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Affiliation(s)
| | | | | | | | - Cecelia Mweru
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Noel Khayanje
- Life Skills for Behavior Change Center, Nairobi, Kenya
| | - Patrick Obel
- Life Skills for Behavior Change Center, Nairobi, Kenya
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17
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Jaiswani AK, Kumar NB, Jaiswani K, Kukde HG, Dere RC. The pattern of genito-anal injuries in female sexual assault cases in Mumbai, India. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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McNair SM, Boisvert L. Prevalence of Adult Female Genital Trauma After Acute Sexual Assault: The Need for a Universal Definition of Genital Trauma. JOURNAL OF FORENSIC NURSING 2021; 17:140-145. [PMID: 34091536 DOI: 10.1097/jfn.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Examination of the adult female genitalia after an acute sexual assault may reveal findings interpreted by the examiner as injuries, which may be linked to later legal outcomes. There is no consistent definition in the literature regarding what findings constitute genital trauma after sexual assault. We studied how the prevalence of genital trauma is impacted by the inclusion/exclusion of various genital findings reported in the literature. METHODS A retrospective descriptive chart review of the sexual assault forensic records from a provincial regional sexual assault treatment center was conducted over a 4-year period and included 67 female patients, 12 years old and over, who reported being sexually assaulted in the previous 72 hours and received a complete forensic examination. We studied the prevalence of genital trauma, using eight definitions of trauma, as well as the percentage of each type of genital finding within this population. RESULTS The prevalence of genital trauma in this population ranged from 52%, the majority, to 31% of women, depending on the definition of trauma utilized. Forty-one percent of the findings, the greatest number overall, were redness. Bruises, abrasions, and tears (lacerations), the components of blunt force trauma, accounted for 4%, 15%, and 14% of the findings, respectively. INTERPRETATION A universal definition of what findings constitute genital trauma after acute sexual assault is required if the examiner, as expert witness, is to compare findings in a given case with the broader literature and assist the court in ensuring an informed process of decision making.
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Affiliation(s)
| | - Leslie Boisvert
- Division of Paediatric Emergency Medicine, London Health Sciences Centre
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19
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Astrup BS, Kreiner S, Lauritsen J. Comment to the article: Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females. J Forensic Leg Med 2021; 81:102201. [PMID: 34144466 DOI: 10.1016/j.jflm.2021.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Birgitte Schmidt Astrup
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløvs vej 17, Odense C, Denmark.
| | - Svend Kreiner
- Institute of Public Health, University of Copenhagen, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Ortopedic Dept. Odense University Hospital, J.B. Winsløws Vej 4, DK 5000, Odense C, Denmark; Dept. of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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20
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Genital injuries and allegation of digital vaginal penetration - A retrospective examination of forensic case notes. J Forensic Leg Med 2021; 80:102154. [PMID: 33892330 DOI: 10.1016/j.jflm.2021.102154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the prevalence of genital injuries following alleged sexual assault by digital penetration of the vagina in the absence of penile penetration of the vagina or anus in women age 16 and over; and to compare with the prevalence of genital injuries following alleged sexual assault by penile vaginal penetration in the absence of penile penetration of the anus or digital penetration of the vagina and/or anus. POPULATION 1428 adults and children attending a forensic medical examination between September 2017 and January 2020 at the Haven sexual assault referral center situated in Paddington, London, UK. DESIGN Retrospective review of forensic notes. METHODS Eligible cases were identified through the standardized forensic notes and relevant data was extracted. RESULTS 109 cases of women 16 years and over alleging digital penetration only and 110 cases of women 16 years and over alleging penile vaginal penetration only were included. The 110 cases of penile vaginal penetration only were randomly selected for comparison purposes. 7.6% of Haven attenders fulfilled the digital penetration only category. In this category, the patients mean age was 27.2 years. Thirteen patients (11.9%) sustained genital injuries; of those with genital injuries, eleven (84.6%) sustained one or more abrasions. The most common site of injury was the labia minora (46.2%). There were no significant differences between the 2 groups (digital penetration only and penile vaginal penetration only) in terms of number of patients with genital injuries, type or location of injury. There were differences regarding the relationship between patient and assailant: more stranger assaults in the digital penetration group 27/109 (29%) vs 13/110 (12%) in the penile penetration group. There was one assault by multiple assailants in the digital penetration group and 8 (7.3%) in the penile penetration group. In the digital penetration group there was more alcohol use [71/109 (65.1%) vs 62/110 (56.4%)] but less drug use [21/109 (19.3%) vs 30/110 (27.3%)] than in the penile vaginal penetration group. CONCLUSION The majority of patients examined following an allegation of digital vaginal penetration without penile penetration sustained no injuries. Of those who did, abrasions were the most common type of injury, with the inner labia minora being the most common location for injury. There were no significant differences with the injuries seen in the penile vaginal penetration group in terms of number of patients with genital injuries, type or location of injury.
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Hartmann M, Otticha S, Agot K, Minnis AM, Montgomery ET, Roberts ST. Tu'Washindi na PrEP: Working With Young Women and Service Providers to Design an Intervention for PrEP Uptake and Adherence in the Context of Gender-Based Violence. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:103-119. [PMID: 33821679 PMCID: PMC8384060 DOI: 10.1521/aeap.2021.33.2.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition among adolescent girls and young women (AGYW). Existing evidence suggests that uptake and adherence are low among AGYW and that relationship factors such as gender-based violence (GBV) are important barriers. Through a community-based participatory research (CBPR) process, a youth advisory board (YAB), service providers (SP), and a study team developed the Tu'Washindi na PrEP intervention to support AGYW PrEP use in the context of GBV. The YAB also guided the formative research and interpretation of results. The authors pretested the intervention with SP, AGYW and their partners, and community change agents, and then developed guides for AGYW support clubs, community-based male sensitization sessions, and couples-based events that included formulation of story lines for dramatized PrEP negotiation and information dissemination skills. Stakeholder engagement led to an intervention responsive to AGYW's needs for PrEP support in the context of their relationships, which was evaluated through a 6-month pilot community randomized controlled trial.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Kawango Agot
- Impact Research Development Organization, Kisumu, Kenya
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, California
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'I thought he was going to kill me': Analysis of 204 case files of adults reporting non-fatal strangulation as part of a sexual assault over a 3 year period. J Forensic Leg Med 2021; 79:102128. [PMID: 33618205 DOI: 10.1016/j.jflm.2021.102128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is growing awareness internationally around the prevalence and dangerousness of non-fatal strangulation (NFS). The aim of this study was to: (i) identify the prevalence of NFS in patients presenting to the Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK for an acute forensic medical examination (FME) after a report of rape or sexual assault, (ii) explore the characteristics of patients reporting NFS compared to those who did not and (iii) explore the prevalence of various symptoms and signs associated with NFS. METHOD Data from case files of all patients attending in a three year period, January 1, 2017 to December 31, 2019, were analysed. There was not any age or gender related exclusion criteria. In the NFS cases the Saint Mary's SARC NFS pro-forma used as part of the contemporaneous medical notes was also reviewed. RESULTS A total of 2196 adults (≥18 years old) attended Saint Mary's SARC for an acute FME during the three year study period. This comprised 1994 (90.7%) non-NFS cases and 204 (9.28%) NFS cases. The prevalence of NFS was 18.9% where the alleged perpetrator was a partner or ex-partner. For NFS cases, 96.6% (n = 197) of the patients were female and the alleged perpetrator was male in 98% (n = 200) of the NFS cases. 40% of the NFS cases had been strangled in their own homes and in 33% of cases children lived in that home. In 27% (n = 55) of the NFS cases the patient said that the alleged perpetrator had also strangled them on a previous occasion. 46.6% had an injury to the neck or above attributable to the NFS. 15.7% (n = 32) of the NFS cases reported loss of consciousness, 8.8% (n = 18) were incontinent of urine and 2% (n = 4) incontinent of faeces as a result of the NFS. Over a third of the patients (36.6%) thought that they were going to die during the NFS. CONCLUSION The study shows that NFS in sexual assault is a gendered crime, with most victims female and most assailants male. NFS is prevalent and this prevalence increases where the alleged perpetrator is a partner or ex-partner. Many are assaulted in their own homes, homes frequently shared with children. Visible NFS injuries are not the norm yet fear of death is not uncommon. Over 1 in 6 (15.7%) reported loss of consciousness suggesting that they were victims of a near lethal assault. That 27% had previously been a victim of NFS by the same alleged perpetrator indicates that there are considerable numbers potentially living in fear and at risk. Awareness of the risk of NFS, and an enhanced response to it, is required by those looking after victims and all those in the criminal justice system.
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Logie CH, Kaida A, de Pokomandy A, O'Brien N, O'Campo P, MacGillivray J, Ahmed U, Arora N, Wang L, Jabbari S, Kennedy L, Carter A, Proulx-Boucher K, Conway T, Sereda P, Loutfy M. Prevalence and Correlates of Forced Sex as a Self-Reported Mode of HIV Acquisition Among a Cohort of Women Living With HIV in Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:5028-5063. [PMID: 29294828 DOI: 10.1177/0886260517718832] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gender-based violence (GBV) is a global epidemic associated with increased HIV exposure. We assessed the prevalence and correlates of HIV acquisition via forced sex among women living with HIV (WLWH) in Canada. Baseline questionnaire data were analyzed for WLWH (≥16 years) with data on self-reported mode of HIV acquisition, enrolled in a community-based cohort study in British Columbia, Ontario, and Québec. We assessed forced sex (childhood, adulthood) as a self-reported mode of HIV acquisition. Of 1,330 participants, the median age was 42 (interquartile range [IQR] = 35-50) years; 23.5% were Indigenous, 26.3% African/Caribbean/Black, 43% White, and 7.2% of Other ethnicities. Forced sex was the third dominant mode of HIV transmission at 16.5% (n = 219; vs. 51.6% consensual sex, 19.7% sharing needles, 5.3% blood transfusion, 3.8% perinatal, 1.3% contaminated needles, 0.4% other, 1.6% do not know/prefer not to answer). In multivariable analyses, significant correlates of HIV acquisition from forced versus consensual sex included legal status as a landed immigrant (adjusted odds ratio [aOR] = 1.99; 95% confidence interval [CI] = [1.12, 3.54]) or refugee (aOR = 3.62; 95% CI = [1.63, 8.04]) versus Canadian citizen; African/Caribbean/Black ethnicity versus Caucasian (aOR = 2.49; 95% CI = [1.43, 4.35]), posttraumatic stress disorder symptoms (aOR = 3.00; 95% CI = [1.68, 5.38]), histories of group home residence (aOR = 2.40; 95% CI = [1.10, 5.23]), foster care (aOR = 2.18; 95% CI = [1.10, 4.34]), and having one child relative to having three or more children (aOR = 0.52; 95% CI = [0.31, 0.89]). GBV must be considered a distinct HIV risk factor; forced sex is a significant underrecognized risk factor and mode of women's HIV acquistion. Public health reporting systems can separate consensual and forced sex in reporting modes of HIV acquisition. Practitioners can engage in screening practices to meet client needs.
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Affiliation(s)
- Carmen H Logie
- Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Angela Kaida
- Simon Fraser University, Vancouver, British Columbia, Canada
| | | | | | - Pat O'Campo
- University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Uzma Ahmed
- University of Toronto, Toronto, Ontario, Canada
| | | | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shahab Jabbari
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Allison Carter
- Simon Fraser University, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | | | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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24
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Minimally invasive search for a missing vibrator. Obstet Gynecol Sci 2020; 63:679-681. [PMID: 32933228 PMCID: PMC7494772 DOI: 10.5468/ogs.20121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To report a unique surgical procedure that was utilized to locate a missing vibrator in the pelvis of a patient. Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff of hospitals in the United States usually are skilled in the detection and removal of these devices. Occasionally, surgical intervention is warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator that was lost during sexual activity. A flat plate X-ray showed it to be in the abdominal cavity. Careful questioning of the patient revealed that the device had an unusually small diameter. Surgical intervention showed that the device ultimately ended up in the bladder without causing traumatic injury. Methods We created a narrated video to demonstrate the surgical procedure (Canadian Task Force Classification III). Results Laparoscopy and cystoscopy were used to visualize and successfully remove the device. The patient recovered uneventfully. Conclusion Following laparoscopic confirmation of the location of the device, it was removed via cystoscopy. This case demonstrates how background information, such as the size of the missing device in this case, can be critical to providing high quality patient care.
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25
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Busman M, Ladaga N, Ouellette L, Rossman L, Solis S, Seamon J, Kolacki C, Jones JS. Non-obstetric vulvovaginal lacerations: Conservative versus surgical management. Am J Emerg Med 2020; 44:470-471. [PMID: 32653244 DOI: 10.1016/j.ajem.2020.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Meredith Busman
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Nathaniel Ladaga
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Lindsey Ouellette
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Linda Rossman
- YWCA West Central Michigan Nurse Examiner Program, Grand Rapids, MI, United States of America
| | - Stephanie Solis
- YWCA West Central Michigan Nurse Examiner Program, Grand Rapids, MI, United States of America
| | - Jason Seamon
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Christian Kolacki
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America
| | - Jeffrey S Jones
- Spectrum Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI, United States of America.
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Unusual Case of a Missing Vibrator Device in the Pelvis. Case Rep Obstet Gynecol 2020; 2020:8023798. [PMID: 32158571 PMCID: PMC7061129 DOI: 10.1155/2020/8023798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022] Open
Abstract
Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff in the United States are commonly skilled in the detection and removal of some of these frequent occurrences. Occasionally, surgical intervention can be warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator which was lost during sexual activity and appeared on flat plate X-ray to be in the abdominal cavity. A careful history showed that the device was of an unusually narrow diameter, and surgical intervention showed the device ultimately ended up in the bladder without traumatic injury. Following laparoscopic confirmation of the device's location in the bladder, cystoscopic removal was performed and the patient recovered uneventfully.
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Lincoln CA. Sexual Assault: Forensic Examination in the Living and Deceased. Acad Forensic Pathol 2019; 8:912-923. [PMID: 31240080 DOI: 10.1177/1925362118821490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/22/2018] [Indexed: 11/16/2022]
Abstract
The forensic examination of a person suspected of having been sexually assaulted encapsulates the breadth of forensic medicine possibly more completely than any other situation in forensic practice. Whether in the living or deceased, detection of injury and biological material to support or exclude sexual activity requires a careful, methodical approach to ensure robust evidentiary value and an understanding of genito-anal anatomy and sexual physiology to interpret its significance for the courts. This paper is not intended as an exhaustive guideline but aims to provide a general overview of the key components of forensic sexual assault examination highlighting the common and different aspects in living and deceased persons.
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McGuire JA, Abramowitch SD, Maiti S, De Vita R. Swine Vagina Under Planar Biaxial Loads: An Investigation of Large Deformations and Tears. J Biomech Eng 2019; 141:2720658. [DOI: 10.1115/1.4042437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Indexed: 12/26/2022]
Abstract
Vaginal tears are very common and can lead to severe complications such as hemorrhaging, fecal incontinence, urinary incontinence, and dyspareunia. Despite the implications of vaginal tears on women's health, there are currently no experimental studies on the tear behavior of vaginal tissue. In this study, planar equi-biaxial tests on square specimens of vaginal tissue, with sides oriented along the longitudinal direction (LD) and circumferential direction (CD), were conducted using swine as animal model. Three groups of specimens were mechanically tested: the NT group (n = 9), which had no pre-imposed tear, the longitudinal tear (LT) group (n = 9), and the circumferential tear (CT) group (n = 9), which had central pre-imposed elliptically shaped tears with major axes oriented in the LD and the CD, respectively. Through video recording during testing, axial strains were measured for the NT group using the digital image correlation (DIC) technique and axial displacements of hook clamps were measured for the NT, LT, and CT groups in the LD and CD. The swine vaginal tissue was found to be highly nonlinear and somewhat anisotropic. Up to normalized axial hook displacements of 1.15, no tears were observed to propagate, suggesting that the vagina has a high resistance to further tearing once a tear has occurred. However, in response to biaxial loading, the size of the tears for the CT group increased significantly more than the size of the tears for the LT group (p = 0.003). The microstructural organization of the vagina is likely the culprit for its tear resistance and orientation-dependent tear behavior. Further knowledge on the structure–function relationship of the vagina is needed to guide the development of new methods for preventing the severe complications of tearing.
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Affiliation(s)
- Jeffrey A. McGuire
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061 e-mail:
| | - Steven D. Abramowitch
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261 e-mail:
| | - Spandan Maiti
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261 e-mail:
| | - Raffaella De Vita
- STRETCH Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061 e-mail:
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La Harpe R, Burkhardt S, Ricard-Gauthier D, Poncet A, Yaron M, Fracasso T. Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault. J Forensic Sci 2018; 64:1119-1124. [PMID: 30556905 DOI: 10.1111/1556-4029.13971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Abstract
In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.
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Affiliation(s)
- Romano La Harpe
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Sandra Burkhardt
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Dominique Ricard-Gauthier
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
| | - Antoine Poncet
- Hôpitaux Universitaires de Genève, unité d'appui méthodologique, 4 rue G. Perret-Gentil, 1211, Genève 14
| | - Michal Yaron
- Hôpitaux Universitaires de Genève, Service de Gynécologie et Obstétrique, 30 bd de la Cluse, 1205, Genève
| | - Tony Fracasso
- University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland
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Genitoanal Injury in Sexually Assaulted Adult Women: Six-Year Retrospective in Bangkok. Am J Forensic Med Pathol 2018; 39:312-324. [PMID: 30198915 DOI: 10.1097/paf.0000000000000430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sexual assault persists as a global problem. Even when sexual assault does not result in obvious visible wounds, genitoanal injury must be evaluated because it is often pertinent for legal outcomes. Macroscopic ("naked eye") examination is valuable when colposcope is not available or when patients do not consent. This study reviewed the genitoanal injuries of 117 sexually assaulted adult women evaluated macroscopically. Genitoanal injury prevalence was 47%, and nongenitoanal injury prevalence was at 44%. The most common injury type was abrasion, and the most common site was posterior fourchette. Most injury patterns were singular. The number of women who did not report a history of sexual intercourse in the sample and usage of fingers/palm during assault may have affected pattern and/or injury type. There was a significant relationship between hymenal old tear below the 3- to 9-o'clock area and prior sexual intercourse. Factors related to genitoanal injury were prior sexual intercourse, vaginal delivery, and spermatozoa detection. In conclusion, all sexually assaulted women should be encouraged to have a pelvic examination: nothing overtly visible does not mean that nothing happened.
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Hartmann M, Palanee-Phillips T, O'Rourke S, Adewumi K, Tenza S, Mathebula F, Wagner D, Ayub A, Montgomery ET. The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from the CHARISMA study in Johannesburg, South Africa. AIDS Care 2018; 31:660-666. [PMID: 30309246 DOI: 10.1080/09540121.2018.1533227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite being designed for autonomous use, research suggests partner approval is often in women's microbicide use. Microbicide study participants have described many ways product use affects relationships, from improving sexual pleasure to increasing harm, including exacerbating intimate partner violence (IPV). As the dapivirine ring proceeds closer to licensure, supporting women's agency to use microbicides safely is a priority. We conducted 42 in-depth interviews with former participants of the Microbicide Trials Network (MTN)-020 trial of the dapivirine vaginal ring and their male partners in Johannesburg, South Africa, to explore how ring use and partnership dynamics interacted. We sampled women who reported harms or partner non-support and women with supportive partners. Male and female narratives revealed high background levels of IPV. Women described how study participation/ring use exacerbated violence, and for a few couples served as a rationale for additional abuse. In response, women described feeling powerless and fearful of conflict, resulting in product nonuse. For one participant violence was reduced, and for several others, empowerment was sparked. These findings suggest future providers have the opportunity to shift more women from a place of fear/violence to one of safety/empowerment through the integration of IPV screening and relationship counselling.
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Affiliation(s)
- Miriam Hartmann
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | | | - Shannon O'Rourke
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Konyin Adewumi
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Siyanda Tenza
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Florence Mathebula
- b Wits Reproductive Health and HIV Institute , Johannesburg , South Africa
| | - Danielle Wagner
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
| | - Asha Ayub
- a Women's Global Health Imperative , RTI International , San Francisco , CA , USA
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Ohayi SR, Ezugwu EC. Prevalence and pattern of genital injuries among adolescent rape victims attending Enugu State University Teaching Hospital, South East Nigeria. J OBSTET GYNAECOL 2018; 39:190-194. [PMID: 30257575 DOI: 10.1080/01443615.2018.1474189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The study aimed to determine the prevalence and pattern of genital injuries among the female adolescents alleged to have been raped that presented at the Enugu State University Teaching Hospital (ESUTH) from January 1 2013 to August 31 2014. All of the adolescents alleged to have been raped that presented within the study period were studied, and the relevant data were extracted from their records. The data were analysed using the Epi info statistical software, Version 7. There were 78 adolescents alleged to have been raped within the study period. They were all female, with a mean age of 14.12 ± 5.6 years. The majority of them were virgins (n = 47, 60.3%). Five of them (6.4%) had multiple perpetrators. The prevalence of genital injuries was 44.9%, while the genital injury frequency rate was 1.2. Laceration was the commonest injury type, while the hymen was the most affected site (n = 15; 35.7%). Being a virgin at the time of the rape was significantly associated with the presence of genital injury (p < .001). This suggests that the absence of genital injury is not sufficient evidence to rule out the possibility of rape. Impact Statement What is already known on this subject? Rape is a global problem with a severe negative impact on the victim. Apart from the associated psychological and emotional trauma, a genital injury could result. However, it appears that so much emphasis are usually placed on the presence of a genital injury in establishing an incident of rape in the developing world. Genital injuries seem to be the main substantive evidence of rape in the developing world including Nigeria. Convicting the perpetrator of rape in law court is usually difficult in the absence of genital injuries after medical examination. What the results of this study add? The result of this study shows that a genital injury is not be found in all cases of an alleged rape, especially among the adolescents. In fact, more than half of the rape survivors had no genital injury. What the implications are of these findings for clinical practice and/or further research? The absence of a genital injury does not exclude the possibility of a rape, neither does its presence confirm a rape, as genital injuries can occur even in consensual sex. Adopting a modern method of establishing a rape case is very important for the provision of concrete evidence in court that will enable the proper and sound dispensation of justice.
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Affiliation(s)
- Samuel Robsam Ohayi
- a Department of Pathology , Enugu State University Teaching Hospital , Enugu , Nigeria
| | - Euzebus Chinonye Ezugwu
- b Department of Obstetrics and Gynaecology, Faculty of Medical Sciences College of Medicine , University of Nigeria , Enugu , Nigeria
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Zilkens RR, Smith DA, Mukhtar SA, Semmens JB, Phillips MA, Kelly MC. Male sexual assault: Physical injury and vulnerability in 103 presentations. J Forensic Leg Med 2018; 58:145-151. [DOI: 10.1016/j.jflm.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
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Song SH, Fernandes JR. Comparison of Injury Patterns in Consensual and Nonconsensual Sex: Is It Possible to Determine if Consent was Given? Acad Forensic Pathol 2017; 7:619-631. [PMID: 31240011 DOI: 10.23907/2017.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/27/2017] [Accepted: 09/08/2017] [Indexed: 11/12/2022]
Abstract
Matters of sexual consent and sexual assault are hotly debated issues among professionals and laypersons alike. A widespread misconception of sexual assault is that most victims of sexual assault sustain significant physical trauma. It is the purpose of this review article to compare the patterns of physical injury (both genital and extragenital) in victims of sexual assault and participants of consensual sex to conclude if physical injury alone can indicate whether consent was given. Interpretations of injury have great forensic significance as it can influence the outcome of sexual assault cases. Several articles indicate that extragenital injuries are commonly found in sexual assault victims (46%-82%) and that most of such injuries are deemed minor. Articles report a wide range of genital injury detection rates in both sexual assault victims (6%-87%) and consensual sex participants (6%-73%). Usage of different examination techniques may partly explain the wide range of detection rates reported. Out of all those who sustained genital injuries, only a small portion of people required hospitalization. In both consensual and sexual assault cases, genital injuries in the 6 o'clock position were most common. Studies of genital injury lacked standardization of factors that significantly influence the results, such as time to examination after sex, examination techniques, and injury severity scales. Therefore, medicolegal personnel should be aware that sexual assault victims can present with a wide range of physical trauma and should avoid relying on physical trauma alone to conclude whether consent was present.
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Affiliation(s)
- Sung Hoon Song
- McMaster University Faculty of Health Sciences - Health Sciences
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35
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36
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Neilson EC, Norris J, Bryan AEB, Stappenbeck CA. Sexual Assault Severity and Depressive Symptoms as Longitudinal Predictors of the Quality of Women's Sexual Experiences. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:463-478. [PMID: 27390081 PMCID: PMC5219874 DOI: 10.1080/0092623x.2016.1208127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Depressive symptoms are one consequence of adult/adolescent sexual victimization (ASV) and are linked to sexual health. Female nonproblem drinkers (N = 419) with an ASV history participated in a one-year longitudinal study. Participants completed measures of lifetime ASV severity and four quarterly assessments of depressive symptoms, ASV severity, and sexual experience quality. Multilevel models revealed that depressive symptoms interacted with ASV severity: Women with low-lifetime ASV severity reported higher ratings of sexual pain as depressive symptoms increased. ASV reported during assessment months predicted sexual experience quality. Interventions to improve survivors' sexual experiences should consider incorporating treatment for depressive symptoms.
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Affiliation(s)
- Elizabeth C. Neilson
- Corresponding author: Elizabeth C. Neilson, MSW, MPH, University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195,
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37
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Zilkens RR, Smith DA, Phillips MA, Mukhtar SA, Semmens JB, Kelly MC. Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault. Forensic Sci Int 2017; 275:195-202. [DOI: 10.1016/j.forsciint.2017.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/24/2017] [Accepted: 03/20/2017] [Indexed: 11/29/2022]
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38
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Aldous A, Magnus M, Roberts A, DeVore H, Moriarty T, Hatch Schultz C, Zumer M, Simon G, Ghosh M. Challenges in conducting research on sexual violence and HIV and approaches to overcome them. Am J Reprod Immunol 2017; 78. [PMID: 28467001 DOI: 10.1111/aji.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/04/2017] [Indexed: 11/28/2022] Open
Abstract
Studies have implicated sexual violence as a strong correlate of HIV acquisition in women. Characterizing how such violence affects the female immune system may provide insight into the biological mechanisms of HIV transmission and ultimately improve global HIV prevention strategies. Little research has been carried out in this domain, and the obstacles to investigation can be daunting. Here, we describe methodological challenges encountered and solutions explored while implementing a study of dysregulation of immune biomarkers potentially indicative of increased HIV susceptibility in women following sexual assault. Challenges included accessing sexual assault survivors and defining sexual assault, promoting study participant well-being during research engagement, reducing selection and information bias, collecting and processing biological samples, and adjusting for confounders such as reproductive tract infections and emotional and physical abuse. We found that many survivors of sexual assault welcomed the attention from study staff and felt empowered by the opportunity to help other women at risk for violence. Well-trained research staff and well-articulated community and medical partnerships were key methods to overcoming challenges while promoting the safety and welfare of vulnerable study participants.
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Affiliation(s)
- Annette Aldous
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Afsoon Roberts
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Heather DeVore
- District of Columbia Forensic Nurse Examiners, Washington, DC, USA
| | | | | | - Maria Zumer
- Medical Faculty Associates, Inc., The George Washington University, Washington, DC, USA
| | - Gary Simon
- Division of Infectious Diseases, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Mimi Ghosh
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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39
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Nguyen GH, Lang N, Lautenschlager S. Nympho-hymenal tear: a distinctive entity? J Eur Acad Dermatol Venereol 2016; 31:e293-e294. [PMID: 27896881 DOI: 10.1111/jdv.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G H Nguyen
- Department of Dermatology, University of Colorado Anschutz Medical College, Aurora, Colorado, 80045, USA
| | - N Lang
- Private practice, Kohlrainstrasse, 10, 8700 Küsnacht, Switzerland
| | - S Lautenschlager
- Outpatient Clinic of Dermatology & Venereology, Triemli Hospital, Zürich, 8004, Switzerland
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40
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Bruce AC, Cao Y, Henry C, Peirce SM, Laughon K. Preclinical Assessment of Safety and Efficacy of Fluorescent Dye for Detecting Dermal Injuries (the injuries were both abrasions and incision) in a Murine Model. J Forensic Sci 2016; 61:1493-1497. [DOI: 10.1111/1556-4029.13173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/29/2015] [Accepted: 01/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony C. Bruce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Yiqi Cao
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Catherine Henry
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Shayn M. Peirce
- Biomedical Engineering; University of Virginia; PO Box 8008383 Charlottesville VA 22903
| | - Kathryn Laughon
- School of Nursing; University of Virginia; PO Box 800826 Charlottesville VA 22903
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George PE, Bayer AM, Garcia PJ, Perez-Lu JE, Burke JG, Coates TJ, Gorbach PM. Is Intimate Partner and Client Violence Associated with Condomless Anal Intercourse and HIV Among Male Sex Workers in Lima, Peru? AIDS Behav 2016; 20:2078-89. [PMID: 26880321 PMCID: PMC4985504 DOI: 10.1007/s10461-016-1327-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Violence experience can increase HIV risk behaviors; however, literature is scarce on violence among male sex workers (MSWs) globally. In 2014, 210 Peruvian MSWs (median age 24.9) were interviewed about their experience of physical, emotional, and sexual violence and condom use with non-paying intimate partners and clients and were tested for HIV. Multivariable models examined relationships between violence in the past 6 months, condomless anal intercourse (CLAI) in the past 3 months and HIV infection. HIV infection (24 %), CLAI (43 %), being a violence victim (42 %) and perpetrator (39 %) were common. In separate multivariable models, being a violence victim [adjusted prevalence ratio aPR = 1.49 (95 % CI 1.09-2.03)] and perpetrator [aPR = 1.39 (1.03-1.87)] were associated with CLAI. Further, being a victim [aPR = 1.65 (1.04-2.62)] was associated with HIV infection. Violence, which was significantly associated with CLAI and HIV infection, is common among Peruvian MSWs, reinforcing the importance of violence awareness and prevention as HIV risk-reduction strategies.
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Affiliation(s)
- Paul E George
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA.
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Angela M Bayer
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J Garcia
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jose E Perez-Lu
- Epidemiology, STD, and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jessica G Burke
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
| | - Pamina M Gorbach
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, 10833 LeConte Ave., CHS 12-105, Los Angeles, CA, 90095, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Exploring Genitoanal Injury and HIV Risk Among Women: Menstrual Phase, Hormonal Birth Control, and Injury Frequency and Prevalence. J Acquir Immune Defic Syndr 2016; 71:207-12. [PMID: 26334741 DOI: 10.1097/qai.0000000000000824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Genital, anal, and oral injuries sustained from sexual intercourse may explain HIV transmission among women. We determined the variability in genitoanal injury frequency and prevalence in women after consensual sexual intercourse, exploring the role of menstrual phase and hormonal birth control. METHODS We used a longitudinal observational design with a convenience sample of 393 women aged 21 years and older. Participants had a baseline interview with gynecological examination, followed by consensual sexual intercourse with a male partner and a second gynecological examination. We analyzed injury prevalence with logistic regression and injury frequency with negative binomial regression among women who were (1) menstrual, not using hormonal birth control, (2) menstrual, using hormonal birth control, or (3) menopausal. We also compared injury among menstrual women in the follicular, ovulatory, and luteal phases. FINDINGS Women using hormonal birth control had 38% more external genitalia injuries [adjusted rate ratio (ARR) = 1.38, P = 0.030] and more than twice the anal injuries (ARR = 2.67, P = 0.005) as the nonhormonal birth control menstruating group. Menopausal women had more than 3 times the anal injuries (ARR = 3.36, P = 0.020) than those in the nonhormonal menstrual group. Among menstrual women, those in the follicular phase had a greater prevalence and frequency of external genitalia injuries than those in other phases. INTERPRETATION Increased rates of postcoital genitoanal injuries are noted among women using hormonal birth control and/or in the follicular phase of menstruation. Biological factors that influence women's risk for HIV warrant further investigation.
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Boukhanni L, Dhibou H, Zilfi W, Housseini KI, Benkeddour YA, Aboulfalah A, Asmouki H, Soummani A. [Postcoital bleeding: 68 case-reports and review of the literature]. Pan Afr Med J 2016; 23:131. [PMID: 27279958 PMCID: PMC4885701 DOI: 10.11604/pamj.2016.23.131.9073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 11/11/2022] Open
Abstract
L'acte sexuel consenti ou imposé, peut être à l'origine des traumatismes. L'hémorragie post coïtale est un symptôme gynécologique commun. Elle peut révéler de sérieux problèmes. Le but de notre travail est d’étudier le profil épidémiologique, diagnostique et thérapeutique ainsi que les moyens préventifs en cas de déchirure post coïtale. Il s'agit d'une étude prospective, étalée sur deux ans, mené au service de gynécologie obstétrique du CHU Med VI de Marrakech. Nous avons colligé 68 patientes. L’âge moyen est de 27 ans, la majorité des patientes étaient des nullipares soit 89,7% des cas. La moitié des patientes avaient un mariage traditionnel. Le rapport était consentent dans 74% des cas. L'hémorragie génitale a constitue le motif de consultation le plus fréquent soit 98% des cas. Les lésions hyménales ont été retrouvées dans 39% des cas et la lésion siégeait dans le cul de sac postérieur chez 35% des cas. La prise en charge thérapeutique a consisté en une suture chirurgicale chez 97% des cas, associé à une transfusion sanguine chez deux patientes et une abstinence sexuelle pendant minimum deux semaines chez toutes nous patientes. Le contexte social ainsi que le manque d’éducation sexuelle sont souvent incriminé d'où l'intérêt d'une prise en charge psychologique pour prévenir aussi bien le retentissement du traumatisme sur la sexualité que les récidives.
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Affiliation(s)
- Lahssen Boukhanni
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hanane Dhibou
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Wafaa Zilfi
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Kawtar Iraki Housseini
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Yasser Ait Benkeddour
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderrahim Aboulfalah
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hamid Asmouki
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderraouf Soummani
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
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Vu A, Wirtz A, Pham K, Singh S, Rubenstein L, Glass N, Perrin N. Psychometric properties and reliability of the Assessment Screen to Identify Survivors Toolkit for Gender Based Violence (ASIST-GBV): results from humanitarian settings in Ethiopia and Colombia. Confl Health 2016; 10:1. [PMID: 26865857 PMCID: PMC4748528 DOI: 10.1186/s13031-016-0068-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool will help service providers identify GBV survivors and refer them to appropriate GBV services. To date, no such GBV screening tool exists. We developed the 7-item ASIST-GBV screening tool from qualitative research that included individual interviews and focus groups with GBV refugee and IDP survivors. This study presents the psychometric properties of the ASIST-GBV with female refugees living in Ethiopia and IDPs in Colombia. Methods Several strategies were used to validate ASIST-GBV, including a 3 month implementation to validate the brief screening tool with women/girls seeking health services, aged ≥15 years in Ethiopia (N = 487) and female IDPs aged ≥ 18 years in Colombia (N = 511). Results High proportions of women screened positive for past-year GBV according to the ASIST-GBV: 50.6 % in Ethiopia and 63.4 % in Colombia. The factor analysis identified a single dimension, meaning that all items loaded on the single factor. Cronbach’s α = 0.77. A 2-parameter logistic IRT model was used for estimating the precision and discriminating power of each item. Item difficulty varied across the continuum of GBV experiences in the following order (lowest to highest): threats of violence (0.690), physical violence (1.28), forced sex (2.49), coercive sex for survival (2.25), forced marriage (3.51), and forced pregnancy (6.33). Discrimination results showed that forced pregnancy was the item with the strongest ability to discriminate between different levels of GBV. Physical violence and forced sex also have higher levels of discrimination with threats of violence discriminating among women at the low end of the GBV continuum and coercive sex for survival among women at the mid-range of the continuum. Conclusion The findings demonstrate that the ASIST-GBV has strong psychometric properties and good reliability. The tool can be used to screen and identify female GBV survivors confidentially and efficiently among IDPs in Colombia and refugees in Ethiopia. Early identification of GBV survivors can enable safety planning, early referral for treatment, and psychosocial support to prevent long-term harmful consequence of GBV.
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Affiliation(s)
- Alexander Vu
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Andrea Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Sonal Singh
- Department of Medicine, Johns Hopkins University, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Leonard Rubenstein
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins University, School of Nursing , Baltimore, USA
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing , Baltimore, USA ; Center for Health Research Kaiser Permanente Northwest, Portland, OR USA
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Tchounzou R, Chichom-Mefire A. Retrospective Analysis of Clinical Features, Treatment and Outcome of Coital Injuries of the Female Genital Tract Consecutive to Consensual Sexual Intercourse in the Limbe Regional Hospital. Sex Med 2015; 3:256-60. [PMID: 26797059 PMCID: PMC4721037 DOI: 10.1002/sm2.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Nonobstetrical genital injuries are gradually becoming a common cause of genital injuries. Consensual sex has been reported to be a possible cause of this type of injuries, but its contribution to traumatic lesions of the female genital tract is not well known. It has been suggested that injury consecutive to consensual sex can be extensive and life‐threatening. Aim The aim of this study was to analyze the clinical features, treatment modalities, and the outcome of injuries to the female genital tract consecutive to a consensual sexual intercourse. Methods A retrospective review of records of female patients admitted in our institution with a complaint of genital injury over a 5‐year period. We collected data regarding patient and injury characteristics, findings of the gynecologic examination, modalities of management and final outcome. Main Outcome Measures Anatomic location and nature of injury, modalities of management, admission rate and mortality rate. Results Forty six cases could be analyzed. Their mean age was 25.6 years. Almost 35% of patients sustained the injury during their first sexual contact. The majority presented with bleeding, often combined with pain. One patient presented with features of peritonitis. During examination, no anatomic lesions could be identified in 16 (34.8%) of patients. When a lesion was present, it concerned mostly the posterior fornix (28.3%) and the lateral vaginal wall (10%). The most frequently described lesion was a laceration. The majority of patients (83%) were treated with suturing under local anesthesia. The admission rate was 28%, and was significantly higher in patients with a laceration of the posterior fornix. No death was recorded. Conclusions Coital injuries following consensual sex often present in the form of a life‐threatening condition and young female with no previous sexual experience are particularly exposed. Most lesions can be treated with a simple suture. TchounzouRandChichom‐MefireA. Retrospective analysis of clinical features, treatment and outcome of coital injuries of the female genital tract consecutive to consensual sexual intercourse in theLimbeRegionalHospital.SexMed 2015;3:256–260.
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Affiliation(s)
- Robert Tchounzou
- Faculty of Health Sciences University of Buea and Regional Hospital Limbe Limbe Cameroon
| | - Alain Chichom-Mefire
- Faculty of Health Sciences University of Buea and Regional Hospital Limbe Limbe Cameroon
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Walker G. The (in)significance of genital injury in rape and sexual assault. J Forensic Leg Med 2015; 34:173-8. [PMID: 26165680 DOI: 10.1016/j.jflm.2015.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
Abstract
The forensic significance of genital injury following rape and sexual assault has been the subject of considerable academic and research interest, in terms of the contribution it may provide to the body of evidence in criminal proceedings. This essay takes a critical look at such research, in the context of modern understandings of what actually constitutes rape and sexual assault. Written from the author's perspective as a forensic physician practising in Scotland, it illustrates the fascinating interface between medical evidence and the legal system.
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Affiliation(s)
- Graeme Walker
- NHS Highland Forensic Medical Service, c/o Medical Room, Burnett Road Police Station, Inverness IV1 1RL, Scotland, United Kingdom.
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Eg MB, Hansen LA, Sabroe S, Charles AV. Hymenal lesions and legal outcome in sexually abused girls with a history of vaginal penetration. Forensic Sci Int 2015; 252:163-7. [PMID: 26005856 DOI: 10.1016/j.forsciint.2015.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/04/2014] [Accepted: 04/22/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE In many cultures, it is commonly accepted that the hymen remains unchanged throughout childhood, until it is torn at the first episode of sexual intercourse. Therefore, the definition of virginity is directly linked to a normal hymen. However, most girls referred for medical forensic colposcopic examination have normal or nonspecific findings, the prevalence of abnormal findings in girls with a history of genital penetration being only 4-6%. The aim of this study was to investigate the relation between hymenal findings seen at the colposcopic examination and the legal outcome: prosecution in court and conviction in court. RESULTS During the 80-month period of our study, 426 girls with a median age of 9 years (range 0-15 years) were included. A history of at least one vaginal penetration was given in 226 of the girls with a median age of 12 years (range 2-14 years). The hymenal findings were described as normal in 125 of the 226 cases (55%). In 50 cases (22%), hymenal clefts were found, 17 (34%) of which were complete and 33 (66%) incomplete. The finding of hymenal clefts increased with age. Of the 226 cases of girls being sexually assaulted with vaginal penetration, 119 cases (53%) were prosecuted in court, 102 of which (86%) resulted in conviction. Thirty-five (70%) of the cases with hymenal clefts and 100 (57%) of the cases without hymenal clefts were prosecuted in court, showing a correlation between hymenal clefts and conviction; however, the correlation was not significant (χ(2) test=2.1 and P=0.14). In total, 29 (58%) of the cases with hymenal clefts and 88 (50%) of the cases without hymenal clefts were convicted in court, which shows no significance (χ(2) test=1.0 and P=0.33). CONCLUSIONS The single most important feature for conviction in court is the child's testimony and not hymenal findings seen at the colposcopic examination. Especially the testimony of the older children leads to conviction, raising the question whether the videotaped testimonies are aimed at the court proceedings, or whether hearing the child's testimony directly in court has a more powerful effect. Overall, it is crucial that the videotaped police questioning of the younger children is performed by specialized personnel, with the aim of presenting the testimony in a detailed and credible manner in court, giving children of all ages a fair trial.
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Affiliation(s)
- Marlene Beyer Eg
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Lene Aagaard Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Svend Sabroe
- Department of Epidemiology, Aarhus University, Bartholins Allé 1, DK-8000 Aarhus C, Denmark
| | - Annie Vesterby Charles
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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Genito-anal injury patterns and associated factors in rape survivors in an urban province of South Africa: a cross-sectional study. BMC WOMENS HEALTH 2015; 15:29. [PMID: 25887051 PMCID: PMC4396864 DOI: 10.1186/s12905-015-0187-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022]
Abstract
Background The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries. Methods In a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins. Results In the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age. Conclusions This study found that being a virgin, multiple perpetration rape and the examiner’s qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.
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Martínez P, Santiago B, Alcalá B, Atienza I. Semen searching when sperm is absent. Sci Justice 2015; 55:118-23. [DOI: 10.1016/j.scijus.2015.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/08/2015] [Accepted: 01/29/2015] [Indexed: 11/16/2022]
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Strategic categorization of available research relating to sexual assault and rape facilitates more accurate interpretation of injury data. Am J Forensic Med Pathol 2015; 36:31-5. [PMID: 25581484 DOI: 10.1097/paf.0000000000000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The available research evidence pertaining to anogenital injury in victims of sexual violence presents a very wide range of injury prevalence data. As such, it is extraordinarily challenging for health care practitioners involved in clinical forensic examination of victims of sexual violence to place their examination findings in to context. It is generally accepted that the broad range of existing injury prevalence data is reflective of heterogeneous research study methodologies and clinical practice techniques. Thus, health care practitioners should be encouraged to present their evidence in the context of the prevalence data that are most representative of their clinical practice. Presented herein is a simple categorization of existing prevalence data in accordance with national clinical practice guidelines. The range of anogenital injury prevalence is narrower when presented in this manner than when taken as a whole. This will facilitate health care practitioners in presenting their examination findings in the context of research literature that is most representative of their clinical practice.
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