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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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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Dawnay N, Sheppard K. From crime scene to courtroom: A review of the current bioanalytical evidence workflows used in rape and sexual assault investigations in the United Kingdom. Sci Justice 2023; 63:206-228. [PMID: 36870701 DOI: 10.1016/j.scijus.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
Sexual assault casework requires the collaboration of multiple agency staff to formalise an investigative pipeline running from crime scene to court. While the same could be said of many other forensic investigations, few require the additional support of health care staff and the combined forensic involvement of body-fluid examiners, DNA experts and analytical chemists. The sheer amount of collaborative effort between agencies is laid out through a detailed examination of the investigative workflow from crime scene to courtroom with each step in the pipelines detailed and discussed. Beginning with a review of sexual assault legislation in the United Kingdom this article details how sexual assault investigations are initiated by police and supported by sexual assault referral centre (SARC) staff who are often the first responders providing primary healthcare and patient support to victims while simultaneously collecting and assessing forensic evidence. Detailing the myriad of evidential material that can be documented and collected at the SARC, the review identifies and categorises key forensic tests to first detect and identify body-fluids recovered from evidence through to the secondary analysis of DNA to help identify the suspect. This review also focusses on the collection and analysis of biological material used to support the allegation that the sexual activity was non-consensual and provides a breakdown of common marks and trauma as well as a review of common analytical methods used to infer Drug Facilitated Sexual Assault (DFSA). The culmination of the investigative pipeline is discussed by reviewing the Rape and Serious Sexual Assault (RASSO) workflow used by the Crown Prosecution Service before providing our thoughts on the future of forensic analysis and possible changes to the described workflows.
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Affiliation(s)
- Nick Dawnay
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, United Kingdom.
| | - Kayleigh Sheppard
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, United Kingdom
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Miziara ID, Miziara CSMG, Salguero Aguiar L, Alvez B. Physical evidence of rape against children and adolescents in Brazil: Analysis of 13,870 reports of sexual assault in 2017. SAGE Open Med 2022; 10:20503121221088682. [PMID: 35342626 PMCID: PMC8943547 DOI: 10.1177/20503121221088682] [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] [Received: 10/22/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The medical literature reports child and adolescent maltreatment since the
8th century. Unfortunately, even today, the incomplete knowledge of this
event persists. Several forms of violence are applied to children and
adolescents, mainly sexual violence including rape and sexual assault.
Forensic medical examinations routinely include the genital area, anus, and
the body of the victims for signs of a recent or old injury. The main goal
of this study is to show the results of physical and sexual examinations
regarding confirmation of rape in children and adolescents, based on the
medicolegal reports. Methods: We made a descriptive cross-sectional study conducted by collecting data from
Medicolegal Institute (IML-São Paulo, Brazil) in 2017. We examined 13,870
reports of sexological examinations of victims of the alleged rape. The
variables analyzed were age; sex; physical examination; sexological
examination; and direct search for sperm in the vaginal, anal, or oral
cavity. We selected 11,725 reports from victims under 18 years. Results: As for the medical-legal findings, only 1735 reports (14.8%) confirmed sexual
abuse. The most affected ages were between 3 and 5 years in the male group
and 11 to 14 years in the female group. The most frequent injuries were
bruises and abrasions, fissures in the anal region. In 96.2% of the examined
males and 85.8% of the females under 14 years old, the examination was
inconclusive, and somebody cannot prove the alleged rape. Only 1735 reports
(113 from men and 1622 from women) concluded beyond any doubt the alleged
rape (14.8%). The search for sperm was positive in only 1582 cases
(13.5%). Conclusion: This study shows that the results of the medicolegal examinations were quite
limited in recording evidence. Sexual violence against children and
adolescents reaches mostly females under 13 years of age. Besides, it is a
complicated crime to prove, as 85.8% of female examinations and 96.2% of
male exams revealed: “no supporting elements” or “undetermined” to
characterize the felony. Therefore, to prevent it, the communication of the
alleged rape must be made as quickly as possible.
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Affiliation(s)
- Ivan Dieb Miziara
- Department of Legal Medicine, Ethics and Occupational Health, São Paulo University School of Medicine, São Paulo, Brazil
| | | | - Luan Salguero Aguiar
- Discipline of Legal Medicine and Bioethics, ABC School of Medicine, Santo André, Brazil
| | - Beatriz Alvez
- Discipline of Legal Medicine and Bioethics, ABC School of Medicine, Santo André, Brazil
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Barbara G, Buggio L, Micci L, Spinelli G, Paiocchi C, Dridi D, Cetera GE, Facchin F, Donati A, Vercellini P, Kustermann A. Sexual violence in adult women and adolescents: a narrative review. Minerva Obstet Gynecol 2022; 74:261-269. [PMID: 35147019 DOI: 10.23736/s2724-606x.22.05071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.
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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 -
| | - Laura Buggio
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laila Micci
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Spinelli
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Paiocchi
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dhouha Dridi
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Agnese Donati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- 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
| | - Alessandra Kustermann
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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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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Murugan V, Holzer KJ, Vaughn MG, Carbone JT, Jackson DB, Bitter CC. Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study. West J Emerg Med 2021; 22:291-296. [PMID: 33856314 PMCID: PMC7972378 DOI: 10.5811/westjem.2020.12.49045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as “alleged.” Methods This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample. Results Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault. Conclusion Implications of this coding are discussed.
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Affiliation(s)
- Vithya Murugan
- Saint Louis University, School of Social Work, St. Louis, Missouri
| | - Katherine J Holzer
- Washington University School of Medicine, Division of Clinical and Translation Research, St. Louis, Missouri
| | - Michael G Vaughn
- Saint Louis University, School of Social Work, St. Louis, Missouri.,Yonsei University, Graduate School of Social Welfare, Seoul, Republic of Korea
| | - Jason T Carbone
- Wayne State University, School of Social Work, Detroit, Michigan
| | - Dylan B Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Cindy C Bitter
- Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri
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8
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Sommers MS, Fargo JD. Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females. J Forensic Leg Med 2021; 79:102138. [PMID: 33657467 DOI: 10.1016/j.jflm.2021.102138] [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: 11/25/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases. OBJECTIVES To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables. METHODS We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted. RESULTS We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears. CONCLUSION External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, 513-314-9967, USA.
| | - Jamison D Fargo
- Utah State University Department of Psychology, 2810 Old Main Hill, Logan, UT 84322, 435-797-8558, USA.
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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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10
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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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11
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Sommers MS, Regueira Y, Tiller DA, Everett JS, Brown K, Brignone E, Fargo JD. Understanding rates of genital-anal injury: Role of skin color and skin biomechanics. J Forensic Leg Med 2019; 66:120-128. [PMID: 31299484 DOI: 10.1016/j.jflm.2019.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status. PROCEDURES We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status. FINDINGS We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40). CONCLUSIONS Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
| | - Yadira Regueira
- University of Puerto Rico School of Nursing, Medical Sciences Campus, Box 365067, San Juan, PR, 00936, USA.
| | - Deborah A Tiller
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
| | - Janine S Everett
- Franklin and Marshall College, 415 Harrisburg Avenue, Lancaster, PA, 17603, USA.
| | - Kathleen Brown
- University of Pennsylvania, Fagin Hall, 418 Curie Boulevard, Philadelphia, PA, 19104, USA.
| | - Emily Brignone
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA.
| | - Jamison D Fargo
- Utah State University Department of Psychology, 2810 Old Main Hill, Logan, UT, 84341, USA.
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Kjærulff MLBG, Bonde U, Astrup BS. The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends. Forensic Sci Int 2019; 297:90-99. [PMID: 30797159 DOI: 10.1016/j.forsciint.2019.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape. METHODS All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included. RESULTS The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015. CONCLUSION The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.
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Affiliation(s)
- Mette Louise B G Kjærulff
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløws Vej 17, Odense C, Denmark
| | - Ulla Bonde
- Department of Gynecology and Obstetrics, Odense University Hospital, Kløvervænget 23, -55, Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J.B. Winsøwsvej 19, 3., Odense C, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Birgitte Schmidt Astrup
- Institute of Forensic Medicine, University of Southern Denmark, J.B. Winsløws Vej 17, Odense C, Denmark.
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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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Smith D, Cunningham N, Willoughby M, Young C, Odell M, Ibrahim J, Bugeja L. The epidemiology of sexual assault of older female nursing home residents, in Victoria Australia, between 2000 and 2015. Leg Med (Tokyo) 2018; 36:89-95. [PMID: 30469073 DOI: 10.1016/j.legalmed.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022]
Abstract
Sexual assault is the least acknowledged, detected, and reported type of assault against nursing home residents. Nursing home staff are responsible for reporting suspected allegations to the police, who will contact a clinical forensic examiner to conduct a forensic medical examination. This study examined the epidemiology of sexual assaults of older women (aged 65 years and older) residing in nursing homes in Victoria, Australia, between 2000 and 2015, whose alleged incidents were referred to a clinical forensic examiner for a forensic medical examination. A retrospective analysis of alleged sexual assaults reported to the Clinical Forensic Medicine Unit at the Victorian Institute of Forensic Medicine between 1 January 2000 and 31 December 2015 was conducted. The study identified 28 forensic medical examinations performed for alleged sexual assault. The alleged victims frequently had cognitive impairments; injuries were infrequent; and alleged victims were cooperative. The forensic medical examiner responded within 72 h of reporting; and frequently noted limitations to physical examinations of the alleged victim. The actual number of sexual assaults during this period may be masked by under-reporting and, lack of identification by nursing home staff. There are many unresolved issues including: incidence, levels of reporting, nature of investigations, responses required to assist the victim, and the interventions needed to prevent sexual assault. Better data is vital. This data should be standardized, validated, reliable, and gathered prospectively across Australia and internationally.
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Affiliation(s)
- Daisy Smith
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia.
| | - Nicola Cunningham
- Victorian Institute of Forensic Medicine, Clinical Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Melissa Willoughby
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Carmel Young
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Morris Odell
- Victorian Institute of Forensic Medicine, Clinical Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Joseph Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
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15
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A retrospective study of sexual offences in Zambia. J Forensic Leg Med 2018; 54:23-33. [PMID: 29306795 DOI: 10.1016/j.jflm.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/04/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
Abstract
Zambia has recently reported high incidences of sexual abuse against women and children. Zambian law categorises sexual offences into rape, defilement, incest and others, with defilement constituting the majority of the reported cases (>89%). Between 2010 and 2012, convictions of defilement cases were achieved in only 13% of cases reported to the police. DNA evidence has shown prominence in resolving crimes, specifically as an identification tool in sexual offences. Currently there is no empirical evidence describing the role of forensic evidence in sexual crimes in Zambia; as such a retrospective study was conducted to evaluate this between 2007 and 2014 (n = 1154). Only 14 (0.1%) of the cases had forensic samples collected in the form of a vaginal swab for semen analysis. In all cases where a suspect was identified (60%), identification was based on the witness/victim testimonies, and in no case, was forensic DNA evidence used to assist in identification or corroborate the testimonies. Overall, 28.1% of cases were taken to court and the conviction rate was 12.4%. These findings support the use of employing DNA evidence in sexual offence cases to aid the identification of suspects, which is hypothesised to increase the number of cases prosecuted in Zambia.
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16
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Kolopp M, Delbaere-Crespo E, Lecossec C, Guillet-May F, Coudane H, Martrille L. [Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes]. ACTA ACUST UNITED AC 2017; 45:158-163. [PMID: 28682757 DOI: 10.1016/j.gofs.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe the medical and legal characteristics of sexual assault victims and to highlight which aspects of the medical examination may be associated with a conviction of the alleged offender. METHODS This study included all women who consulted to the center for the victims of sexual assault in Nancy between 2008 and 2012 and who filed a complaint. Associations were evaluated with a logistic regression trying to explain the presence of a conviction at the end of the legal proceeding. RESULTS Three hundred seventy-six victims were included. Following aspects were associated with a reduced probability of conviction: the use of psychoactive substances, the prescription of an antiretroviral therapy and the presence of more than one assailant. The prescription of pain killers were contrarily related to the conviction of an assailant. CONCLUSION A detailed description, an interpretation of the physical injuries and the prescription of toxicological tests if needed are decisive in the outcome of the legal proceedings of victims of sexual assault. The education of populations at risk and the accompanying of the victims can reduce the delay of care and optimize the collection of evidence.
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Affiliation(s)
- M Kolopp
- Service de médecine légale, CHRU de Nancy, 54000 Nancy, France; Laboratoire de médecine légale, université Lorraine, 54511 Vandœuvre-lès-Nancy, France.
| | - E Delbaere-Crespo
- Manitowoc Crane Group, 803, route de Pouilly, 42190 Saint-Nizier-sous-Charlieu, France.
| | - C Lecossec
- Direction de l'organisation médicale et des relations avec les universités, Assistance publique-Hôpitaux de Paris, 3, avenue Victoria, 75004 Paris, France.
| | - F Guillet-May
- Maternité, CHRU de Nancy, rue Heydenreich, 54000 Nancy, France.
| | - H Coudane
- Laboratoire de médecine légale, université Lorraine, 54511 Vandœuvre-lès-Nancy, France.
| | - L Martrille
- Service de médecine légale, CHRU de Nancy, 54000 Nancy, France; Laboratoire de médecine légale, université Lorraine, 54511 Vandœuvre-lès-Nancy, France.
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