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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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Brady PQ, Zedaker SB, McKay K, Scott D. The Darker the Skin, the Greater the Disparity? Why a Reliance on Visible Injuries Fosters Health, Legal, and Racial Disparities in Domestic Violence Complaints Involving Strangulation. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7602-7629. [PMID: 36695177 DOI: 10.1177/08862605221145726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The reliance on external injuries for justice is misguided given that assault injuries may be less visible among victims of color due to increased melanin in the skin. To date, however, less is known whether racial/ethnic disparities extend to officers' identification of signs of nonfatal strangulation (NFS). The current study estimates the extent of NFS indicators identified by officers who completed a standardized strangulation assessment in 133 family violence complaints. Breathing difficulties were the most common symptoms identified by officers (98%), followed by external signs (89%), and symptoms of impeded blood circulation (87%). Compared to cases involving White/Asian survivors, officers were less likely to identify external injuries on Black survivors' neck, chin, and chest/shoulders. While racial/ethnic differences did not emerge for symptoms of disrupted airflow, Hispanic survivors were twice as likely to report losing control of bodily functions. Implications for policy and practice are discussed.
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Affiliation(s)
- Patrick Q Brady
- The University of Northern Colorado, Greeley, USA
- The University of Colorado Colorado Springs, USA
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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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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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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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Kumar A, Paswan SS, Paswan A, Anand T. An unusual vaginal injury in a young primigravida patient: A rare case report. Int J Surg Case Rep 2020; 75:172-175. [PMID: 32950950 PMCID: PMC7508689 DOI: 10.1016/j.ijscr.2020.09.020] [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: 08/15/2020] [Revised: 09/06/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Assault with iron made belan causing penetration of it into vagina and perforation of posterior fornix is extremely rare. The commonly used weapon in assault are knife, wood, iron stick, wire, bomb or gun and most commonly affected body parts are cheeck, throat, back, abdomen, chest wall and extremities. PRESENTATION OF CASE We report a case of iron made belan penetrated into vagina with posterior fornix perforation and mesenteric tear in a 30 years old lady with history of pregnancy of 14 weeks. She was haemodynamically unstable at the time of presentation. She was treated with advanced trauma life support Protocol (ATLS), taken to operation room where iron made belan was removed with repair of posterior fornix and mesentery was done. DISCUSSION Assault to genital organ in female is not uncommon. In present case the offender used the metallic iron made belan for assault which is the house hold material in India. In such situation high degree of suspicion and diagnostic modality are helpful to save the golden hour of patient and save the life of patients. General principles of trauma management is really very helpful to save the life threatening conditions. Urgent exploratory laparotomy with control of bleeding and repair of damaged structures are the cornerstone steps to manage such cases. CONCLUSION Assault with iron made belan and its penetration inside vagina is extremely rare mode of injury. Timely intervention, concept of ATLS and definitive surgical interventions are the key steps in managing such patient.
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Affiliation(s)
- Anil Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India.
| | - Shiv Shankar Paswan
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India.
| | - Anita Paswan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, India.
| | - Tushar Anand
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India.
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Chopin J, Beauregard E. Elderly Sexual Abuse: An Examination of the Criminal Event. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:706-726. [PMID: 31010404 DOI: 10.1177/1079063219843899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current study investigates the modus operandi specificities for the sexual abuse against the elderly. A comparison between sex crimes against adult and elderly victims is conducted following the criminal event approach. The comparison is based on the precrime, crime, and postcrime phases of the modus operandi, operationalized through 53 variables. The sample comes from a French national police database including a total of 1,829 cases-including 130 cases of elderly sexual abuse and 1,699 cases of sexual abuse against victims aged between 18 and 45 years. Bivariate and multivariate analyses are performed to examine the differences in the two groups. Several differences are observed between the two modus operandi. Findings indicate that the precrime phase is the most important to explain these differences, and this phase of the criminal event affects the rest of the decisions taken during the crime and postcrime phases. Specifically, we have highlighted that sexual crimes against the elderly are more violent and occur more often in the victim's residence. This study suggests that offenders targeting the elderly use specific crime characteristics, and this allows to highlight practical implications in terms of investigation and offender management.
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Affiliation(s)
- Julien Chopin
- Simon Fraser University, Burnaby, British Columbia, Canada
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9
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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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10
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The effects of skin pigmentation on the detection of genital injury from sexual assault. Am J Emerg Med 2019; 37:974-975. [DOI: 10.1016/j.ajem.2018.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022] Open
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Bows H. Sexual Violence Against Older People: A Review of the Empirical Literature. TRAUMA, VIOLENCE & ABUSE 2018; 19:567-583. [PMID: 29333969 DOI: 10.1177/1524838016683455] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aging and sexual violence are both established areas of research, but little attention has been paid to research into sexual violence against older people. This article presents a critical review of the literature reporting empirical research in three overlapping fields of inquiry: elder abuse, domestic violence, and sexual violence, identifying points of theoretical and methodological similarity and difference across academic disciplines. Using a range of search terms combining age, sexual violence, and elder abuse, the following databases were searched: EBSCOHOST, Ingenta-Ingenta connect, and JSTOR. In total, the databases searches returned 31 relevant articles and an additional 9 relevant articles were found through manual searches of bibliographies and Google searches, which were grouped into three categories: elder abuse, domestic violence in later life, and sexual violence against older people. Four themes common across these fields emerged: prevalence, characteristics of victims and risk factors, impacts and coping strategies, and perpetrator and assault characteristics. The findings in each area are discussed in detail, exposing gaps in knowledge and understandings of sexual violence against older women. The article ends by defining a future research agenda for this underexplored phenomenon that is of increasing importance in a context of global aging.
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Affiliation(s)
- Hannah Bows
- 1 Centre for Research into Violence and Abuse, School of Applied Social Sciences, Durham University, Durham, United Kingdom
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12
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Two cases of hymenal scars occurred by child rape. Obstet Gynecol Sci 2017; 60:612-615. [PMID: 29184873 PMCID: PMC5694739 DOI: 10.5468/ogs.2017.60.6.612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/19/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022] Open
Abstract
Children who have been raped some years back may have hymenal scars. However, medical professionals are not accustomed in assessing these scars because of the lack of experience in performing physical examinations of the external genitalia of children who suffered from rape some years back. Moreover, the importance of physical examination of the victim's external genitalia is sometimes overlooked. Two cases of rape victims with hymenal scars who visited Daegu Child Sexual Abuse Response Center several years after their first sexual abuse along with a literature review are presented here.
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Boukhanni L, Dhibou H, Zilfi W, Housseini KI, Benkeddour YA, Aboulfalah A, Asmouki H, Soummani A. [Postcoital bleeding: 68 case-reports and review of the literature]. Pan Afr Med J 2016; 23:131. [PMID: 27279958 PMCID: PMC4885701 DOI: 10.11604/pamj.2016.23.131.9073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 11/11/2022] Open
Abstract
L'acte sexuel consenti ou imposé, peut être à l'origine des traumatismes. L'hémorragie post coïtale est un symptôme gynécologique commun. Elle peut révéler de sérieux problèmes. Le but de notre travail est d’étudier le profil épidémiologique, diagnostique et thérapeutique ainsi que les moyens préventifs en cas de déchirure post coïtale. Il s'agit d'une étude prospective, étalée sur deux ans, mené au service de gynécologie obstétrique du CHU Med VI de Marrakech. Nous avons colligé 68 patientes. L’âge moyen est de 27 ans, la majorité des patientes étaient des nullipares soit 89,7% des cas. La moitié des patientes avaient un mariage traditionnel. Le rapport était consentent dans 74% des cas. L'hémorragie génitale a constitue le motif de consultation le plus fréquent soit 98% des cas. Les lésions hyménales ont été retrouvées dans 39% des cas et la lésion siégeait dans le cul de sac postérieur chez 35% des cas. La prise en charge thérapeutique a consisté en une suture chirurgicale chez 97% des cas, associé à une transfusion sanguine chez deux patientes et une abstinence sexuelle pendant minimum deux semaines chez toutes nous patientes. Le contexte social ainsi que le manque d’éducation sexuelle sont souvent incriminé d'où l'intérêt d'une prise en charge psychologique pour prévenir aussi bien le retentissement du traumatisme sur la sexualité que les récidives.
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Affiliation(s)
- Lahssen Boukhanni
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hanane Dhibou
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Wafaa Zilfi
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Kawtar Iraki Housseini
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Yasser Ait Benkeddour
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderrahim Aboulfalah
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hamid Asmouki
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderraouf Soummani
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
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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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Thomas L, Scott Tilley D, Esquibel K. Sexual assault: where are mid-life women in the research? Perspect Psychiatr Care 2015; 51:86-97. [PMID: 24628447 DOI: 10.1111/ppc.12067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE There is extensive literature related to the experience of sexual assault of women with a majority focused on younger women, college-aged women, or older women. There is little research about the experience of sexual assault of mid-life women. DESIGN AND METHODS This paper synthesizes the current literature associated with sexual assault by describing the increased number of single women in the population, defining terms associated with sexual assault, examining rape myths, characteristics of the victim, describing the relationship of victim to assailant, extent of victimization experienced by women, common physical injuries, age-related physiological changes, psychological considerations, and post-traumatic stress disorder specific to mid-life women. FINDINGS The population of single women has increased across the life span. Current studies utilize varying definitions of sexual assault, examine results across variable age groups, and include the responses of single women with married women. Characteristics of victims demonstrate similarities by age group, relationship type, living conditions, and physical or mental capabilities that affect the occurrence of sexual assault. PRACTICE IMPLICATIONS There are few studies that examine the sexual assault experiences of single mid-life women. Further research into the experiences of single mid-life women is warranted to provide direction for nursing education programs and clinical practice.
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Affiliation(s)
- Laura Thomas
- Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
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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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Strategic categorization of available research relating to sexual assault and rape facilitates more accurate interpretation of injury data. Am J Forensic Med Pathol 2015; 36:31-5. [PMID: 25581484 DOI: 10.1097/paf.0000000000000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The available research evidence pertaining to anogenital injury in victims of sexual violence presents a very wide range of injury prevalence data. As such, it is extraordinarily challenging for health care practitioners involved in clinical forensic examination of victims of sexual violence to place their examination findings in to context. It is generally accepted that the broad range of existing injury prevalence data is reflective of heterogeneous research study methodologies and clinical practice techniques. Thus, health care practitioners should be encouraged to present their evidence in the context of the prevalence data that are most representative of their clinical practice. Presented herein is a simple categorization of existing prevalence data in accordance with national clinical practice guidelines. The range of anogenital injury prevalence is narrower when presented in this manner than when taken as a whole. This will facilitate health care practitioners in presenting their examination findings in the context of research literature that is most representative of their clinical practice.
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Macroscopically detected female genital injury after consensual and non-consensual vaginal penetration: a prospective comparison study. J Forensic Leg Med 2013; 20:884-901. [PMID: 24112341 DOI: 10.1016/j.jflm.2013.06.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 05/26/2013] [Accepted: 06/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence, type and pattern of macroscopically detected female genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of genital injury resulting from vaginal penetrative sexual intercourse. STUDY DESIGN Two groups of reproductive age women (aged 18-45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal genital sites. Forty one women who presented for forensic examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic genital examination and gynaecological examination of healthy and diseased sexually active women. Data collection and examination protocols were the same for both groups. RESULTS The key finding was a statistically significant difference in genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one genital injury [OR 10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing genital 'infection' were found to be significantly associated with the presence of injury in the univariate analysis after adjusting for consent. Logistic regression demonstrated that women penetrated without consent were 19.5 times more likely to sustain at least one genital injury, than those penetrated consensually [OR 19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely to result in at least one genital injury than penetration without finger involvement [OR 4.25, CI (1.42, 12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalence in the consensual group limited interpretation, results revealed possible differences in genital injury typology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerations were seen after both consensual and non-consensual vaginal penetration, while abrasions and bruises were seen exclusively in the non-consensual group. CONCLUSION This study demonstrated a significant consent group difference in genital injury prevalence and the highest macroscopically detected genital injury prevalence rate resulting from non-consensual vaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increases the likelihood of sex-related injury. The difference in type of injury sustained as a result of non-consensual and consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting genital injury based on consistent injury definitions, examination protocols, and examiner experience and suggest that macroscopic genital examination may be uniquely placed to detect consent group differences in injury typology and pattern if they exist.
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Astrup BS, Ravn P, Thomsen JL, Lauritsen J. Patterned genital injury in cases of rape – A case–control study. J Forensic Leg Med 2013; 20:525-9. [DOI: 10.1016/j.jflm.2013.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 11/12/2012] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
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Boykins AD, Alvanzo AAH, Carson S, Forte J, Leisey M, Plichta SB. Minority women victims of recent sexual violence: disparities in incident history. J Womens Health (Larchmt) 2013; 19:453-61. [PMID: 20156130 DOI: 10.1089/jwh.2009.1484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aims of this descriptive study were to (1) describe assault and care characteristics and (2) determine differences in assault and care characteristics between black women and white women who sought emergency care following sexual violence. METHODS A retrospective, cross-sectional design was used to examine forensic examination data characterizing the incident history reported by women victims of sexual violence at the time of a forensic nurse examination. Examinations occurred at an urban university-affiliated hospital emergency department (ED) over a 2-year period. RESULTS Of the women (n = 173) seeking care in the ED, 58.4% were black and 41.6% were white. When compared with white women, black women were more likely to have weapons used in their assaults (42.6% vs. 16.7%, p < 0.00) and to be assaulted in the city rather than the suburbs (82.8% vs. 56.5%, p < 0.00). In general, substance use prior to the assault was reported to have occurred in 49.1% of the victims and 41% of the assailants; however, differences existed in the type and pattern of substance use by race/ethnicity. Black victims were more likely to report use of illicit drugs (28.7% vs. 12.5%, p = 0.01). White women were more likely than black women to report personal alcohol use prior to their assault, with significant differences for drinking by victims (47.2% vs. 23.8%, p = 0.01) or assailant use of alcohol (47.2% vs. 23.8%, p = 0.00). White women were more likely than black women to report both they and the assailant had used some type of substance (38.9 vs. 21.8, p = 0.01). Black women were more likely to arrive to the ED via EMS services (45.5% vs. 29.2%, p = 0.03). There were no reported differences in care characteristics by race. CONCLUSIONS Findings from this study suggest that differences exist in assault characteristics between black and white women. Use of substances, including alcohol, plays an important role in sexual violence in women and should be a focus of preventive intervention initiatives when conducting a forensic examination. Both coordinated responses and comprehensive, individualized care by specially trained providers are important in the emergency care of minority women who are victims of recent sexual violence.
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Affiliation(s)
- Anita D Boykins
- School of Nursing, University of Southern Mississippi, Hattiesburg, Mississippi 39406-0001, USA.
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21
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White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013; 27:113-30. [DOI: 10.1016/j.bpobgyn.2012.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/03/2012] [Accepted: 08/16/2012] [Indexed: 11/28/2022]
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Fisher BS, Kaplan A, Budescu M, Fargo J, Tiller D, Everett J, Sommers M. The influence of anogenital injury on women's willingness to engage with the criminal justice process after rape. VIOLENCE AND VICTIMS 2013; 28:968-983. [PMID: 24547675 DOI: 10.1891/0886-6708.vv-d-12-00109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical-legal-social science research has documented that nongenital and/or anogenital injuries play a significant role throughout the criminal justice system from victims reporting to judges determining the length of a sentence. What remains an open question is whether the documentation of anogenital injury influences women's willingness to engage in the criminal justice system. A sample of women age 21 years and older residing in an urban area were asked about willingness to report to police, file charges, and work with the courts to prosecute after rape. Questions were framed with a qualifying statement about the forensic examination being able to detect injury related to forced sexual intercourse. Results show that women had a high willingness to act if the examination could detect anogenital injury and women with and without a history of forced sexual intercourse had significant differences in their responses to these questions. Implications for health care, criminal justice system, and future research are discussed.
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Affiliation(s)
- Bonnie Sue Fisher
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH 45221-0389, USA.
| | - Alyssa Kaplan
- New York Presbyterian Weill Cornell Medical Center, USA
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Anderson JC, Sheridan DJ. Female Genital Injury Following Consensual and Nonconsensual Sex: State of the Science. J Emerg Nurs 2012; 38:518-22. [DOI: 10.1016/j.jen.2010.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/12/2010] [Accepted: 10/31/2010] [Indexed: 11/24/2022]
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Ghosh M, Rodriguez-Garcia M, Wira CR. Immunobiology of genital tract trauma: endocrine regulation of HIV acquisition in women following sexual assault or genital tract mutilation. Am J Reprod Immunol 2012; 69 Suppl 1:51-60. [PMID: 23034063 DOI: 10.1111/aji.12027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/07/2012] [Indexed: 01/10/2023] Open
Abstract
Studies on HIV acquisition and transmission in women exposed to sexual trauma throughout their life cycle are lacking, but some findings suggest that rates of HIV acquisition through coercive sex are significantly higher than that seen in consensual sex. Sexual trauma can also occur as a result of female genital mutilation, which makes sex extremely painful and can cause increased abrasions, lacerations, and inflammation, which enhances the risk of HIV acquisition. This review presents an overview of the immune system in the human female reproductive tract (FRT) from adolescence, through puberty to pregnancy and menopause. What is clear is that the foundation of information on immune protection in the FRT throughout the life cycle of women is extremely limited and at some stages such as adolescence and menopause are grossly lacking. Against this backdrop, forced or coercive sexual intercourse as well as genital mutilation further complicates our understanding of the biological risk factors that can result in transmission of HIV and other sexually transmitted infections.
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Affiliation(s)
- Mimi Ghosh
- Department of Epidemiology and Biostatistics, The George Washington University, Washington, DC 20037, USA.
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Sommers MS, Brown KM, Buschur C, Everett JS, Fargo JD, Fisher BS, Hinkle C, Zink TM. Injuries from intimate partner and sexual violence: Significance and classification systems. J Forensic Leg Med 2012; 19:250-63. [PMID: 22687765 DOI: 10.1016/j.jflm.2012.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/05/2012] [Accepted: 02/13/2012] [Indexed: 11/28/2022]
Abstract
UNLABELLED While intimate partner violence (IPV) and sexual violence (SV) are highly associated with injury, the healthcare and legal significance of these injuries is controversial. PURPOSE Herein we propose to explore the significance of injury in IPV and SV and examine the current status of injury classification systems from the perspectives of the healthcare and criminal justice systems. We will review current injury classification systems and suggest a typology of injury that could be tested empirically. FINDINGS Within the published literature, we found that no commonly accepted injury typology exists. While nuanced and controversial issues surround the role of injury detection in the sexual assault forensic examination, enough evidence exists to support the continued pursuance of a scientific approach to injury classification. We propose an injury typology that is measurable, is applicable to the healthcare setting and criminal justice system, and allows us to use uses a matrix approach that includes a severity score, anatomic location, and injury type. We suggest a typology that might be used for further empirical testing on the validity and reliability of IPV and SV injury data. CONCLUSION We recommend that the community of scientists concerned about IPV and SV develop a more rigorous injury classification system that will improve the quality of forensic evidence proffered and decisions made throughout the criminal justice process.
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Affiliation(s)
- Marilyn S Sommers
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, USA.
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Nature, frequency and duration of genital lesions after consensual sexual intercourse--implications for legal proceedings. Forensic Sci Int 2011; 219:50-6. [PMID: 22192579 DOI: 10.1016/j.forsciint.2011.11.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 11/03/2011] [Accepted: 11/29/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to make a normative description of the nature and duration of genital lesions sustained during consensual sexual intercourse, using the three most commonly used techniques; visualisation using the naked eye, colposcopy and toluidine blue dye followed by colposcopy. METHODS Ninety eight women were examined within 48 h of consensual sexual intercourse. Fifty of the women were examined twice again within the following 7 days of sexual abstinence after the first examination. RESULTS The participants had a median age of 22.4 years and 88% were nulliparous. Lesions were frequent; 34% seen with the naked eye, 49% seen with colposcopy and 52% seen with toluidine blue dye and subsequent colposcopy. The lesions lasted for several days; the median survival times for lacerations were 24, 40 and 80 h, respectively. CONCLUSIONS The legal implications of these findings are that genital lesions by themselves do not corroborate a rape complaint. Genital lesions may, however, corroborate specific details of a case and should be documented as carefully as any other lesion in rape complaints.
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27
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28
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Female genital injuries resulting from consensual and non-consensual vaginal intercourse. Forensic Sci Int 2011; 204:27-33. [DOI: 10.1016/j.forsciint.2010.04.049] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 04/19/2010] [Accepted: 04/29/2010] [Indexed: 11/21/2022]
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Assailants' Sexual Dysfunction During Rape: Prevalence and Relationship to Genital Trauma in Female Victims. J Emerg Med 2010; 38:529-35. [DOI: 10.1016/j.jemermed.2008.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 09/17/2008] [Accepted: 09/27/2008] [Indexed: 11/22/2022]
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Jones JS, Rossman L, Diegel R, Van Order P, Wynn BN. Sexual assault in postmenopausal women: epidemiology and patterns of genital injury. Am J Emerg Med 2009; 27:922-9. [DOI: 10.1016/j.ajem.2008.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 07/13/2008] [Accepted: 07/13/2008] [Indexed: 10/20/2022] Open
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Teitelman AM, Seloilwe ES, Campbell JC. Voices from the frontlines: the epidemics of HIV/AIDS and violence among women and girls. Health Care Women Int 2009; 30:184-94. [PMID: 19191112 DOI: 10.1080/07399330902739239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anne M Teitelman
- Center for Health Disparities Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104, USA.
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33
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Poulos CA, Sheridan DJ. Genital injuries in postmenopausal women after sexual assault. J Elder Abuse Negl 2009; 20:323-35. [PMID: 19042660 DOI: 10.1080/08946560802359243] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Physiological and anatomical changes that occur as a result of menopause alter sexual response and sexual function. These changes can result in genital injuries from both consensual sexual intercourse and sexual assault. The purpose of this article is to review the literature examining what is known about postmenopausal women and genital injuries. Only seven research studies were found that examine genital injuries in postmenopausal women after sexual assault. Of the comparative studies, a majority determined that postmenopausal women are more likely to sustain genital injuries after sexual assault than younger women. No literature was found that specifically investigates genital injuries incurred as a result of consensual sexual intercourse versus sexual assault in the postmenopausal population.
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Ingemann-Hansen O, Sabroe S, Brink O, Knudsen M, Charles AV. Characteristics of victims and assaults of sexual violence--improving inquiries and prevention. J Forensic Leg Med 2008; 16:182-8. [PMID: 19329073 DOI: 10.1016/j.jflm.2008.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 06/06/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
The purpose of our study was to provide descriptive data on victim and assault characteristics in sexual violence and to ascertain risk factors in the sequence of the assault events. Retrospective data were collected on all sexual assault victims presented to the sexual referral centre, the police and the Institute of Forensic Medicine in Aarhus, Denmark, during a five-year period. Four hundred and twenty-three victims were included. The annual incidence rate was 14.5 per 100,000 inhabitants aged 12-87 years and the "dark figure" was estimated to be 1.34. Median age was 21 years; 69% of the victims knew the assailant, and penile intercourse was reported in 59% of the cases. Young age and drinking alcohol were risk factors for the assault to take place in a public place. Information to high-risk groups identified by this study should be integrated in approaches of modifying sexual behaviour. Furthermore, the results from this study are useful in supporting staff and police investigators in the guidance of their efforts regarding treatment and inquiries.
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Affiliation(s)
- Ole Ingemann-Hansen
- Institute of Forensic Medicine, Section of Clinical Forensic Medicine, University of Aarhus, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
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Sommers MS, Zink TM, Fargo JD, Baker RB, Buschur C, Shambley-Ebron DZ, Fisher BS. Forensic sexual assault examination and genital injury: is skin color a source of health disparity? Am J Emerg Med 2008; 26:857-66. [PMID: 18926341 PMCID: PMC2587067 DOI: 10.1016/j.ajem.2007.11.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 11/14/2007] [Accepted: 11/14/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination. METHODS A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse. RESULTS Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables--lightness/darkness-, redness/greenness-, and yellowness/blueness-confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable--redness/greenness--was significantly associated with injury occurrence and frequency in the internal genitalia. CONCLUSIONS Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.
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Affiliation(s)
- Marilyn S Sommers
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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Changes in genital injury patterns over time in women after consensual intercourse. J Forensic Leg Med 2008; 15:306-11. [PMID: 18511005 DOI: 10.1016/j.jflm.2007.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 11/08/2007] [Accepted: 12/13/2007] [Indexed: 12/12/2022]
Abstract
To date, there are no studies in the literature addressing whether or not microscopic genital injuries change over time or change in appearance during the 72 h time period following intercourse. In this study, women (n=35) had two evidentiary type pelvic examinations to document injuries after consensual intercourse. At Time 1 (within 48 h of consensual intercourse) a: larger total surface area of injury (p=0.02); larger surface area of injury to the posterior fourchette (p=0.02); larger surface area of abrasions (p=0.04); and larger surface area of redness (p=0.04) were found compared to Time 2 (24 h after Time 1). Since this research is exploratory, larger studies are needed to explore the differences in genital injuries based on the time of examination and in women after non-consensual intercourse.
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Baker RB, Sommers MS. Physical Injury From Intimate Partner Violence: Measurement Strategies and Challenges. J Obstet Gynecol Neonatal Nurs 2008; 37:228-33. [DOI: 10.1111/j.1552-6909.2007.00226.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
The forensic examination following rape has two primary purposes: to provide health care and to collect evidence. Physical injuries need treatment so that they heal without adverse consequences. The pattern of injuries also has a forensic significance in that injuries are linked to the outcome of legal proceedings. This literature review investigates the variables related to genital injury prevalence and location that are reported in a series of retrospective reviews of medical records. The author builds the case that the prevalence and location of genital injury provide only a partial description of the nature of genital trauma associated with sexual assault and suggests a multidimensional definition of genital injury pattern. Several of the cited studies indicate that new avenues of investigation, such as refined measurement strategies for injury severity and skin color, may lead to advancements in health care, forensic, and criminal justice science.
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