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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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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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Luong R, Parkin JA, Cunningham N. Acute concomitant injury and intoxication in complainants of recent sexual assault: A review. J Forensic Leg Med 2022; 92:102448. [DOI: 10.1016/j.jflm.2022.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
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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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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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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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Stokbæk S, Kristensen CL, Astrup BS. Police reporting in cases of sexual assault - a 10-year study of reported cases, unreported cases, and cases with delayed reporting. Forensic Sci Med Pathol 2021; 17:395-402. [PMID: 34272659 DOI: 10.1007/s12024-021-00390-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to identify characteristics of reported, later-reported and unreported cases of sexual assault. All cases with female complainants (> 15 years) of sexual assault, who had been examined at the Centre for Victims of Sexual Assault (CVSA) in the Region of Southern Denmark in a 10-year period, were included. Retrospective data were collected from medico-legal examination reports and police reports. Descriptive bivariate analysis and logistic analysis were performed. Forensic pathologists examined 850 complainants of sexual assault in 2009-2018, of which 753 cases were included in this study. Of these, 191 cases (25%) were initially not reported to the police, but 53 women (7%) filed a police report, days, weeks or months later. There was a higher relative risk (RR) of not-reporting for young adults, for single women, if the accused was well known to the complainant, if the complainant experienced amnesia, or if there had been some degree of consensual physical interaction at time of the incident but before the assault. The non-reporters also showed a higher degree of delayed examination. The later-reporters only differed from the non-reporters in one parameter - they had a higher degree of partial amnesia. Interestingly, injuries (ano-genital or other) or verbal/physical resistance was not associated with reporting tendency, reflecting the modus of the local judicial system. The opportunity of a reflection period after a high-quality forensic examination, which is not dependent of police involvement, is essential for sexual assault complainants. Furthermore, education and guidance of victims and of the police and judicial system on the unique nature of sexual assault cases is important.
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Affiliation(s)
- Sofie Stokbæk
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløwsvej 17, Odense C, Denmark
| | - Cecilie Ls Kristensen
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløwsvej 17, Odense C, Denmark
| | - Birgitte Schmidt Astrup
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløwsvej 17, Odense C, Denmark.
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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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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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Anal/anogenital lesion revealing child sexual abuse: A case series of an unusual situation in a black African setting. Int J Surg Case Rep 2020; 76:341-344. [PMID: 33074133 PMCID: PMC7569259 DOI: 10.1016/j.ijscr.2020.09.186] [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] [Received: 08/25/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Child sexual abuse (CSA) remains a big taboo in black Africa with an underestimated prevalence. In our context, the majority of cases are known by revelations of the child at least one year after the facts. PRESENTATION OF CASES We report three cases of CSA revealed by an anal/anogenital lesion requiring surgery. All of these patients were female with ages ranging from 20 months to 8 years. The lesions encountered were: an anal abscess, a fissure-in-ano with permanent anal mucosal eversion and a complex perineal tear including partial anal sphincter rupture with partial section of the rectovaginal septum. The outcome was favorable in all cases after surgery. The abuser was subsequently able to be identified after the statements of two of these three children. DISCUSSION Detection of anogenital lesions during a pediatric consultation should make practitioners aware of the possibility of sexual abuse. Surgical repair of these lesions can be simple or complex, requiring major reconstructions. In such cases, it's important to listening to the child's voice. CONCLUSION Anogenital lesions discovered during pediatric consultation must evoke sexual abuse. The silence and the taboo surrounding these abuses in Africa must be break down.
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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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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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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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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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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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Fernandes K, Cardoso JS, Astrup BS. Automated Detection and Categorization of Genital Injuries Using Digital Colposcopy. PATTERN RECOGNITION AND IMAGE ANALYSIS 2017. [DOI: 10.1007/978-3-319-58838-4_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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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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Astrup BS. Further comments to the discussion regarding the article: macroscopically detected female genital injury after consensual and non-consensual vaginal penetration. J Forensic Leg Med 2015; 29:54-5. [PMID: 25572086 DOI: 10.1016/j.jflm.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Birgitte Schmidt Astrup
- Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark.
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Schmidt Astrup B, Lykkebo AW. Post-coital genital injury in healthy women: A review. Clin Anat 2014; 28:331-8. [PMID: 25346095 DOI: 10.1002/ca.22476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/08/2022]
Abstract
Female genital injury following penile sexual intercourse in healthy women is a matter of importance and debate in many parts of society. However, the literature on the subject is sparse. There are a few studies regarding minor injury that does not require treatment in adult, pre-menopausal women, a single study of adolescent women, and none regarding post-menopausal women. Larger lesions requiring treatment are described casuistically. The purpose of this article is to provide a short, easy-to-read review of the literature regarding the prevalence and nature of female genital injury following consensual sexual intercourse in otherwise healthy women.
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Affiliation(s)
- Birgitte Schmidt Astrup
- Department of Forensic Pathology, Institute of Forensic Medicine, University of Southern Denmark, Odense, Denmark
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Larsen ML, Hilden M, Lidegaard Ø. Sexual assault: a descriptive study of 2500 female victims over a 10-year period. BJOG 2014; 122:577-84. [PMID: 25315463 DOI: 10.1111/1471-0528.13093] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the victims of sexual assault and the circumstances in which the assaults occur. DESIGN Descriptive case study. SETTING Centre for Victims of Sexual Assault (CVSA), Rigshospitalet, Copenhagen, Denmark. POPULATION OR SAMPLE A total of 2541 women attending CVSA from 2001 to 2010. METHODS All women attending CVSA underwent a standardised data collection procedure. Descriptive bivariate analysis and logistic regression analysis were performed. MAIN OUTCOME MEASURES Associations between different assault characteristics and (1) the age of the victim and (2) the relationship between victim and perpetrator. RESULTS Two-thirds of the victims were aged 15-24 years. Seventy-five percent had met the perpetrator before the sexual assault and 70% reported the assault to the police. A physical injury was found in 53, and 27% sustained an anogenital lesion. Alcohol was involved in 60% of the cases. One-third of the victims had experienced a previous sexual assault(s). Women were more likely to report to the police when they were assaulted by a stranger (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.3-2.6) and sustained a physical injury (OR 1.7, 95% CI 1.4-2.2) or anogenital lesion (OR 1.5, 95% CI 1.1-2.0). Women aged 45 years or older were more likely to sustain a physical injury (OR 2.0, 95% CI 1.2-3.2) or an anogenital lesion (OR 2.1, 95% CI 1.4-3.2). CONCLUSIONS Our results challenge the typical stereotype of a violent rape attack by a stranger, which is important in creating an environment where women are not reluctant to seek help after a sexual assault. Young age and drinking alcohol were risk factors for sexual assault, and we need to address this when considering preventive strategies.
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Affiliation(s)
- M-L Larsen
- Centre for Victims of Sexual Assault, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Beaufrère A, Vincent R, Chariot P. Patterned genital injury in cases of sexual assault. J Forensic Leg Med 2013; 20:1145-6. [PMID: 24237840 DOI: 10.1016/j.jflm.2013.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Aurélie Beaufrère
- Department of Forensic Medicine, Hôpital Jean-Verdier (AP-HP), Bondy F-93140, France
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