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Kane D, Kennedy KM, Eogan M. The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review. Int J Legal Med 2024; 138:997-1010. [PMID: 37971512 DOI: 10.1007/s00414-023-03117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies. AIMS AND OBJECTIVES We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed. METHODS Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms. RESULTS Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized. CONCLUSIONS This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.
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Affiliation(s)
- D Kane
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland.
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland.
| | - K M Kennedy
- School of Medicine, University of Galway, Galway, Ireland
| | - M Eogan
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland
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Majeed-Ariss R, Martin GP, White C. Identifying the prevalence of genital injuries amongst patients attending Saint Mary's sexual assault referral centre following an allegation of digital penetration. J Forensic Leg Med 2024; 102:102656. [PMID: 38387234 DOI: 10.1016/j.jflm.2024.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
This study aimed to (1) add to the limited evidence base regarding genital injury associated with digital vaginal penetration and (2) identify predisposing or protective factors to the identification of a genital injury. Data collection was performed retrospectively on the paper case files of 120 female adult (>18 years) patients alleging digital vaginal penetration with no penile vaginal penetration that had an acute FME at Saint Mary's Sexual Assault Referral Centre (SARC) Manchester. Descriptive statistics were used to investigate differences in the demographics of those reporting digital penetration, with and without injuries. Overall, 18% had genital injuries noted at the time of the FME. Posterior fourchette was the most common location of genital injury and abrasion was the most common injury type. It is worth further noting that all 22 patients where an injury was noted were of white ethnicity, only 12 patients in the sample were not white so caution is needed in interpretating this finding of a non-significant difference. Future research should consider injury and ethnicity more specifically. The findings from this study add to the existing evidence base and should prove useful to expert witnesses when called upon to interpret examination findings of sexual assault complainants as they relate to an allegation of digital penetration.
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Affiliation(s)
- Rabiya Majeed-Ariss
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK.
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Catherine White
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Institute for Addressing Strangulation Sexual Offences, Manchester, UK
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Playfair C, Hunt G, DaCosta C. Developing anti-racist undergraduate nursing education: themes and action. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:736-742. [PMID: 37596088 DOI: 10.12968/bjon.2023.32.15.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
The impact of racism on health is undeniable. However, undergraduate nurse education in the UK is not adequately addressing the racism within the profession. Literature on anti-racist nursing education was reviewed to uncover the most effective strategies for nurse educators to develop this approach. The literature describes a climate of denial and defensiveness among nurse educators. It urges nurse educators to develop racial literacy, and explores nursing curricula, recommending intersectionality as a way to teach about health disparities, with a move away from a culturalist perspective. There is growing recognition that institutions need to address issues around the retention of Black students, and robust reporting systems are required to respond to allegations of racism. Institutions also need to provide evidence-based anti-racist training for staff. The conclusion here is that, without institutional support, there is little nurse educators can do alone to change the culture of racism in nurse education. Thus, this review is a starting point for nurse educators interested in anti-racist nursing education.
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Affiliation(s)
- Catherine Playfair
- Lecturer in Nursing Sciences, School of Health Sciences, University of East Anglia
| | - Garfield Hunt
- Senior Lecturer in Social Work, School of Social Sciences and Humanities, University of Suffolk
| | - Chrissie DaCosta
- Academic Skills Advisor, Centre for Excellence in Learning and Teaching/Department of Library and Learning Services, University of Suffolk
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Mainwaring C, Gabbert F, Scott AJ. A Systematic Review Exploring Variables Related to Bystander Intervention in Sexual Violence Contexts. TRAUMA, VIOLENCE & ABUSE 2023; 24:1727-1742. [PMID: 35343337 DOI: 10.1177/15248380221079660] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article presents a systematic review of the available literature which has investigated the role of key variables in facilitating or inhibiting bystander intervention (including direct intervention, tertiary and secondary prevention) in sexual violence (SV) contexts. Studies exploring the role of individual, situational and contextual variables were grouped to provide a narrative overview of bystanders' personal characteristics as well as the immediate and wider contexts which may be influencing their bystander behaviour. A systematic search of published literature from four electronic databases identified 2526 articles that were screened, of which 85 studies met the inclusion criteria. Most studies focused upon the role of individual variables, in particular gender of bystander. This body of work finds females are more likely to intervene than males; however, not all studies report these differences and in some cases, this is influenced by the type of intervention behaviour being considered. Regarding situational variables, the most commonly researched variable was the presence of other bystanders, although the role of this variable as inhibiting or facilitating was not clear. Finally, the most commonly researched contextual variable was social norms towards intervention, which has consistently shown greater bystander intervention when there is a belief that peers support such behaviour. Very few studies considered the interaction between these variables. Therefore, it is important for future research to consider this gap in the literature so that we can obtain a more well-rounded understanding of variables that can inhibit and facilitate bystander intervention in SV contexts.
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Affiliation(s)
| | - Fiona Gabbert
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Adrian J Scott
- Department of Psychology, Goldsmiths, University of London, London, UK
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Kunst M, Huibers M, van Wingerden S. The Impact of Information From Mental Health Care Providers on Decisions About State Compensation for Violent Crime Victimization. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7510-7529. [PMID: 36583340 DOI: 10.1177/08862605221145714] [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
In the Netherlands, as in many other countries, victims of intentionally committed violent crimes may apply for state compensation if the offender is unknown or unable to pay for the damages of the crime. This state compensation scheme is run by the Dutch Violent Offences Compensation Fund (VOCF). Lawyers who work for this fund need to evaluate applicants´ eligibility for state compensation on the basis of two criteria: (1) the plausibility of the applicant's victimization story and (2) the severity of the injury sustained by the applicant. Whether these criteria are fulfilled is largely left to the discretion of the lawyer who evaluates the application. This discretionary power makes the decision-making process prone to biased outcomes. Inspired by previous research, this study investigated whether information from mental health care providers, such as psychiatrists or clinical psychologists, serves as a potential source of bias. Although this type of information may or should sometimes be used to evaluate an applicant's eligibility for compensation, in most cases it should not affect the outcome of this evaluation because of its potential unreliability. A statistical association between availability of information from mental health care providers and adjudication of state compensation is therefore not to be expected. Analyzing 246 applications submitted to the Dutch VOCF between July 1st 2016 and July 1st 2017, this study tested the empirical validity of this expectation. Results indicated that the availability of information of mental health care providers was associated with adjudication of state compensation. This finding was discussed in view of the literature on heuristic thinking and biased decision making and the study's limitations.
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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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Buswell H, Majeed-Ariss R, Rajai A, White C, Mills H. Identifying the prevalence of genito-anal injuries amongst clients attending St Mary's Sexual Assault Referral Centre following an allegation of anal penetration. J Forensic Leg Med 2022; 90:102392. [DOI: 10.1016/j.jflm.2022.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
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Kaur S, Kaur S, Rawat B, Sharma R. A multidisciplinary approach in pre-pubertal child sexual assault cases - forensic evaluation and suggestions. Leg Med (Tokyo) 2022; 58:102097. [PMID: 35667134 DOI: 10.1016/j.legalmed.2022.102097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Child sexual assault is highly prevalent in India yet a handful cases are reported under POCSO (Protection against child sexual offenses) Act, 2012. Even though the victims' testimony alone is enough to arrest accused as regulated by the Supreme Court but forensic evidence is still critical for sentencing rapists. A systematic evaluation of such cases will estimate impact of Child sexual assault (CSA) and pinpoint important aspects required for progression of prevention strategies and provision of support. METHOD AND OBJECTIVE Present study reviewed cases pertaining pre-pubertal victims (up to 10 years age). Study included simple descriptive analysis of data highlighting significance of different variables in sexual assault cases involving child victims- perpetration, interventions, medical examination and forensic DNA analysis with the aim to improve primary preventive strategies and identify potential setbacks obstructing road to justice. RESULT The strengths and weaknesses of pre-pubertal sexual assault assessment were identified. This study analyzed socio-economic backgrounds, age of alleged accused and whether known to the victim. Frequently reported type of abuse was assessed and total reviewed cases that yielded DNA profile from exhibits of victims and alleged accused were determined. CONCLUSION As emerged in present study, pre-pubertal CSA is a complicated phenomenon grounded in interplay between societal influences, family support, evidence collection, legal delays, and medical hindrances that greatly affect DNA analysis. Prevalence of CSA is evidently alarming and demands stringent measures to be taken to prevent and control it. Joint and multidisciplinary assessment is important for forensic reporting rather than solo assessment.
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Affiliation(s)
- Suminder Kaur
- DNA Fingerprinting Unit, Biology Division, Regional Forensic Science Laboratory, New Delhi, India.
| | - Simarpreet Kaur
- National Council of Educational Research and Training, New Delhi, India
| | - Banita Rawat
- DNA Fingerprinting Unit, Biology Division, Regional Forensic Science Laboratory, New Delhi, India
| | - Rakesh Sharma
- Biology Division, State Forensic Science Laboratory, Jaipur, Rajasthan, India
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Zayed AA, Elbendary RN, Moawad AM. Questioned Virginity Has No Definite Reply. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2369-2372. [PMID: 35414148 PMCID: PMC9192407 DOI: 10.1007/s10508-022-02332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Virginity is the nullity of sexual experience in females. However, the use of virginity testing as proof of previous involvement in sexual relations is dependent on having an intact hymen, which refers to a hymen with no signs of previous penetrating injury. Although the quality of this evidence in questioned virginity is extremely poor and considered a violation of human rights, it still constitutes a major facet in medicolegal investigations of sexual assaults. This work evaluates virginity testing as currently practiced in many countries, including Egypt, in terms of medical and legal considerations.
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Affiliation(s)
- Abeer Ahmed Zayed
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Reham Nafad Elbendary
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt
| | - Asmaa Mohammad Moawad
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, Egypt.
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Klasen CM, Meyer L, Anders S, Lohner L, Ondruschka B, Pinnschmidt H, Püschel K, Schmalfeldt B, Seifert D, Wilmes S, Witzel I. Frequency of Injuries to Women after Sexual Offense - Relevance of a Gynecology Examination. Geburtshilfe Frauenheilkd 2022; 82:420-426. [PMID: 35392069 PMCID: PMC8983108 DOI: 10.1055/a-1769-6613] [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: 10/13/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction
Up to a third of women worldwide report having experienced an act of sexual violence during their lifetime. The emergency gynecology department is often the first port
of call for affected individuals. The aim of the current study was to evaluate the importance of gynecology examinations for women after a sexual offense and to evaluate the pattern of
injuries sustained.
Methods
This study is a retrospective single center analysis of the gynecology and forensic examination reports of all women examined for a suspected sexual offense in the central
emergency department of a university hospital between 2013 and 2017 (n = 692). We evaluated genital and extragenital injury patterns, age, offender profile, time of offense, and substance
use, as well as the administration of post-coital contraception and post-exposure prophylaxis for HIV.
Results
The affected individuals had a mean age of 26 (12 – 91 years). Almost 75% of affected individuals presented within 24 hours of the reported sexual offense. Extragenital
injuries were detected in 78.6% of patients and genital injuries in 28.5%. Overall, 20.1% of the women reported complete memory loss and 18.7% partial memory loss of the actual event. Risk
factors for memory lapse were the consumption of alcohol and/or the (possibly non-consensual) administration of other substances acting on the central nervous system. A history of alcohol
consumption by the victim (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.21 – 3.12, p = 0.006) and younger victims aged between 25 – 49 years (HR 1.75; 95% CI 1.07 – 2.85,
p = 0.025) were associated with the occurrence of extragenital injuries. However, if the perpetrator was someone who was known to the affected individual, fewer extragenital injuries were
sustained (HR 0.60; 95% CI 0.36 – 0.99, p = 0.046). Reports of genital injuries, associated with an older age of affected individuals and indications of anal penetration, resulted in more
frequent administration of post-exposure prophylaxis (29.1% vs. 19.5%, p < 0.012) and hepatitis B (active) vaccination (40% vs. 28.5%, p < 0.028).
Conclusion
Emergency gynecology examinations form a fundamental component of the medical care and the assessment of affected women after a sexual offense, since almost a third of
victims sustain injuries to the genital region. In addition to a detailed complete physical examination and expert forensic documentation of physical and genital injuries, victims should
also be offered psychological support which is easy for them to access.
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Affiliation(s)
- Caroline M Klasen
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Luise Meyer
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel
| | - Sven Anders
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Larissa Lohner
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | | | - Hans Pinnschmidt
- Institut für Medizinische Biometrie & Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Barbara Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Dragana Seifert
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Sandra Wilmes
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Brahim O, Turki E, Chebbi E, Fersi O, Fatnassi R. Sexual Assault of Women in the region of Kairouan, Tunisia: an 8-year retrospective study on epidemiological and medicolegal characteristics. BMC Womens Health 2022; 22:64. [PMID: 35260145 PMCID: PMC8902712 DOI: 10.1186/s12905-022-01647-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the abundance of studies reporting the prevalence of women's sexual abuse all over the world, there is a real lack of such reports in developing countries in general and Arab-Muslim societies in particular. However, due to the little number of published studies in Tunisia, and the absence of a national database, data on female sexual assaults are still underestimated, which is a gap that needs to be filled in order to make specific preventive actions. We aim to identify the pattern of female victims of sexual abuse in the governorate of Kairouan (Tunisia) in order to provide recommendations for prevention. METHODS Retrospective data were collected on all-female sexual assault victims, particularly rape, presented to the Department of Forensic Medicine of the University Hospital Ibn El Jazzar of Kairouan (Tunisia), during an 8-year period, from 2009 to 2016. RESULTS Two hundred and sixteen victims were included. Age ranged from 3 to 82 years with a mean age of 20.4 years. Victims were single in 84.3%, unmarried in 90.7% and they lived in rural areas in the majority of cases. Rape was committed by a single individual in 94.9% of cases, and the assailant was a stranger in only 26.8%. The assault occurred most frequently in the assailant's home (73.6%) or the public places (11.6%). Evidence of recent acute general body trauma was found in 41.2% of the victims, and the most common injuries were located on the thigh, upper arm, and chest. In 28.1% of the cases, injuries were seen in the face and the neck. Genital examination showed that 188 victims (87%) had a tear in the hymenal membrane and only 13% of victims had intact hymenal membrane. A complacent hymen was noted in 2.3%. A recent anal lesion was seen in 8.3% of the cases. Cytology was performed on 78 victims. In 22 cases (28.2%), sperm could be detected in vaginal swabs up to 3 days post-assault, and pregnancy was seen in 7.4% of assault victims. CONCLUSION Sexual abuse represents a human rights and public health problem that is thriving in a culture of silence, particularly in the Arab region. There is a particular need to create a Tunisian national database on female sexual assaults, in order to centralize data and provide holistic follow-up for specific preventive measures. Finally, efficient management of such cases will need, in addition to legislation, a partnership between the various actors involved in taking care of the victims (health care professionals, the police, social specialists, and psychologists). In addition, civil societies are key partners to break the silence, support this issue, and raise awareness.
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Affiliation(s)
- Oumeima Brahim
- Department of Legal Medicine, Faculty of Medicine of Sousse, Ibn El Jazzar Teaching Hospital of Kairouan, 3100 Kairouan, Tunisia
| | - Elyes Turki
- Department of Legal Medicine, Faculty of Medicine of Sousse, Ibn El Jazzar Teaching Hospital of Kairouan, 3100 Kairouan, Tunisia
| | - Elaa Chebbi
- Department of Legal Medicine, Faculty of Medicine of Sousse, Ibn El Jazzar Teaching Hospital of Kairouan, 3100 Kairouan, Tunisia
| | - Oumayma Fersi
- Department of Obstetrics and Gynaecology, Faculty of Medicine of Sousse, Ibn El Jazzar Teaching Hospital of Kairouan, 3100 Kairouan, Tunisia
| | - Ridha Fatnassi
- Department of Obstetrics and Gynaecology, Faculty of Medicine of Sousse, Ibn El Jazzar Teaching Hospital of Kairouan, 3100 Kairouan, Tunisia
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Lohner L, Nigbur L, Klasen C, Witzel I, Garland J, Ondruschka B, Anders S. Vaginal injuries after consensual sexual intercourse - a survey among office-based gynecologists in Hamburg, Germany. Forensic Sci Med Pathol 2022; 18:352-358. [PMID: 35716294 PMCID: PMC9587115 DOI: 10.1007/s12024-022-00488-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
Studies on the occurrence of injuries following consensual sexual intercourse (CSI) among patients treated by office-based gynecologists are lacking. This survey aimed to assess the presence and medical relevance of vaginal injuries after CSI in gynecological office-based practice, associated risk factors, and their significance for forensic medical assessment practice. All office-based gynecologists in Hamburg, Germany (n = 316), were asked to fill in a one-page questionnaire via a fax survey. The questionnaire covered various aspects such as having observed CSI-related injuries, injury severity, risk factors, and concomitant factors (bleeding, need for surgical care, hospitalization). Response rate was 43.2% (n = 115). Overall, 83.5% of office-based gynecologists reported having observed vaginal injuries after CSI at least once and 59.1% repeatedly. Regarding maximum injury severity, 52.1% observed mucosal erosions, 32.3% mucosa penetrating injuries, and 14.6% injuries penetrating the vagina. Having observed bleeding was reported by 56.3%, 28.1% had to perform surgical suture care, and hospital admission was initiated by 20.8%. Menopause (37.5%), use of objects (19.8%), alcohol, and/or drug use (16.7%) were reported as the most frequently observed associated risk factors. Vaginal injuries after CSI have been observed by the majority of office-based gynecologists in Hamburg involving a wide spectrum of severity, including the necessity of surgical care and hospital admission. Complementing published work in clinical and emergency medicine, these findings are highly relevant to the forensic evaluation of injuries in an allegation of sexual assault, as the severity of a vaginal injury in this setting does not necessarily support a conclusion on the issue of consent.
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Affiliation(s)
- L. Lohner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - L. Nigbur
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - C. Klasen
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I. Witzel
- grid.13648.380000 0001 2180 3484Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Garland
- Forensic and Scientific Services, Coopers Plains, Brisbane, Australia
| | - B. Ondruschka
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - S. Anders
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
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Kaur S, Kaur S, Rawat B. Medico-legal evidence collection in child sexual assault cases: a forensic significance. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2021. [DOI: 10.1186/s41935-021-00258-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Every year, millions of children face sexual exploitation worldwide. In India, 109 children (National Crime Records Bureau2018) were sexually abused everyday (22% jump from the previous year). Even with advanced DNA techniques, the conviction rate remains low. The methods used for forensic DNA evidence analysis vary around the world, but the primary step of biological evidence collection plays the most vital role. Proper and timely evidence collection from the victim by a trained medical professional is important.
Main body
Dynamics of child sexual assault being massively different from an adult rape demands altogether different approach of evidence collection. A standard sexual kit employed for evidence collection needs urgent modifications considering genital development of pre- and post-pubertal victims. In the present study, parameters including systemic collection and evaluation of forensic evidences, medico-legal examination, and developmental consequences of sexual assault on pre-pubertal victims were assessed. Further suggestions for separate evidence collection kit during medico-legal examination were given for pre-pubertal victims and alleged accused in sexual assault cases in order to streamline and for better evaluation of DNA analysis in forensic laboratories.
Conclusion
The importance of expert medical practitioners plays a significant role in collection of appropriate information and evidences from the victim of sexual assault. General guidelines for evidence collection in sexual assault cases are not well suited for pre-pubertal victims. Appropriate reforms pertaining to the age and genital development of victims are required. Securing clothing as forensic evidence is essential in most cases as it turned out to be the exclusive evidence bearing material. The purpose of this article is to bring awareness about the thorough medical examination and modified sexual assault kit for pre-pubertal victims and alleged accused for a better approach in evidence collection and conviction rate.
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Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA. Sexual health difficulties among service women: the influence of posttraumatic stress disorder. J Affect Disord 2021; 292:678-686. [PMID: 34157663 DOI: 10.1016/j.jad.2021.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.
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Affiliation(s)
- Claire A Kolaja
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
| | - Ashley C Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - Jean A Orman
- University of Texas Health at San Antonio, TX, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Jaiswani AK, Kumar NB, Jaiswani K, Kukde HG, Dere RC. The pattern of genito-anal injuries in female sexual assault cases in Mumbai, India. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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McNair SM, Boisvert L. Prevalence of Adult Female Genital Trauma After Acute Sexual Assault: The Need for a Universal Definition of Genital Trauma. JOURNAL OF FORENSIC NURSING 2021; 17:140-145. [PMID: 34091536 DOI: 10.1097/jfn.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Examination of the adult female genitalia after an acute sexual assault may reveal findings interpreted by the examiner as injuries, which may be linked to later legal outcomes. There is no consistent definition in the literature regarding what findings constitute genital trauma after sexual assault. We studied how the prevalence of genital trauma is impacted by the inclusion/exclusion of various genital findings reported in the literature. METHODS A retrospective descriptive chart review of the sexual assault forensic records from a provincial regional sexual assault treatment center was conducted over a 4-year period and included 67 female patients, 12 years old and over, who reported being sexually assaulted in the previous 72 hours and received a complete forensic examination. We studied the prevalence of genital trauma, using eight definitions of trauma, as well as the percentage of each type of genital finding within this population. RESULTS The prevalence of genital trauma in this population ranged from 52%, the majority, to 31% of women, depending on the definition of trauma utilized. Forty-one percent of the findings, the greatest number overall, were redness. Bruises, abrasions, and tears (lacerations), the components of blunt force trauma, accounted for 4%, 15%, and 14% of the findings, respectively. INTERPRETATION A universal definition of what findings constitute genital trauma after acute sexual assault is required if the examiner, as expert witness, is to compare findings in a given case with the broader literature and assist the court in ensuring an informed process of decision making.
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Affiliation(s)
| | - Leslie Boisvert
- Division of Paediatric Emergency Medicine, London Health Sciences Centre
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18
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Reported child maltreatment in the Riyadh region of Saudi Arabia: A retrospective study. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2020. [DOI: 10.1016/j.fsir.2020.100125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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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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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Wood LCN. Child modern slavery, trafficking and health: a practical review of factors contributing to children's vulnerability and the potential impacts of severe exploitation on health. BMJ Paediatr Open 2020; 4:e000327. [PMID: 32537521 PMCID: PMC7264998 DOI: 10.1136/bmjpo-2018-000327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 12/26/2022] Open
Abstract
Child trafficking is a form of modern slavery, a rapidly growing, mutating and multifaceted system of severe human exploitation, violence against children, child abuse and child rights violations. Modern slavery and human trafficking (MSHT) represents a major global public health concern with victims exposed to profound short-term and long-term physical, mental, psychological, developmental and even generational risks to health. Children with increased vulnerability to MSHT, victims (in active exploitation) and survivors (post-MSHT exploitation) are attending healthcare settings, presenting critical windows of opportunity for safeguarding and health intervention. Recognition of child modern slavery victims can be very challenging. Healthcare providers benefit from understanding the diversity of potential physical, mental, behavioural and developmental health presentations, and the complexity of children's responses to threat, fear, manipulation, deception and abuse. Healthcare professionals are also encouraged to have influence, where possible, beyond the care of individual patients. Research, health insights, advocacy and promotion of MSHT survivor input enhances the collaborative development of evidence-based approaches to prevention, intervention and aftercare of affected children and families.
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Affiliation(s)
- Laura C N Wood
- Centre for Child & Family Justice Research, Lancaster University Department of Sociology, Lancaster, UK
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Kunst MJJ, Schiltkamp SAC. Sympathy for the applicant: investigating its role in decisions about state compensation for violent crime victimization. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2019; 27:26-43. [PMID: 32284778 PMCID: PMC7144196 DOI: 10.1080/13218719.2019.1664278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In the Netherlands, as in many other Western countries, state compensation for violent crime victimization is only to be granted if the applicant provides a plausible victimization story and did not contribute to the crime. However, due to the discretion left to those who decide upon requests for state compensation, decisions about state compensation may be subject to the influence of legally irrelevant factors. This study investigated the potential influence of one such legally irrelevant factor: feelings of sympathy for the applicant. Forty-seven lawyers who work for the Dutch Violent Offences Compensation Fund (VOCF) were presented five vignettes about a fictitious act of violent crime and asked to rate their feelings of sympathy for the victims and to indicate how they would decide about the victims' requests for state compensation. Results indicate that feelings of sympathy may indeed play a role in the decision-making process.
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Affiliation(s)
- M. J. J. Kunst
- Faculty of Law, Institute for Criminal Law & Criminology, Leiden University, Leiden, The Netherlands
| | - S. A. C. Schiltkamp
- Faculty of Law, Institute for Criminal Law & Criminology, Leiden University, Leiden, The Netherlands
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Bunzel L, Koelzer SC, Zedler B, Verhoff MA, Parzeller M. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019; 16:1547-1556. [PMID: 31447384 DOI: 10.1016/j.jsxm.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/24/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Non-natural deaths associated with sexual activity may occur either with or without the involvement of other persons. AIM The present study provides an overview of cases of non-natural death related to sexual activities as well as recommendations of how to handle these cases and to identify potentially dangerous pleasure-enhancing techniques. METHODS This medicolegal, postmortem, retrospective, and prospective study is based on data of autopsies performed at the Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany. MAIN OUTCOME MEASURE Identification of circumstances, sexual practices, and gender distribution of cases of non-natural death in this context. RESULTS Between 1993 and 2017 (25 years), 16,437 medicolegal autopsies were performed, of which 74 cases (43 males, 31 females) of non-natural death were found to relate to sexual activities (0.45%). One female and 21 males had died in the course of autoerotic practices (group I, n = 22). Nine males and 14 females had performed sexual practices with mutual consent (group II, n = 23), and 13 males and 16 females without mutual consent (group III, n = 29). The average age in group I was 45.4 years; in group II, 40.6 years; and in group III, 39.2 years. Most of the deceased were found in their own apartments. Forms of stimulation included vaginal, anal, and oral intercourse; insertion of foreign bodies; use of chemical substances; and tools for respiratory depression/hypoxia. Three cases of death occurred during sexual activities involving bondage and discipline, sadism, and masochism (BDSM). Death due to strangulation was the main cause in group I, whereas intoxications were predominant in group II. Sharp force (eg, knife) was mainly responsible for death in group III. Anogenital injuries were documented in all groups in approximately equal percentages. CLINICAL IMPLICATIONS The cases presented show a high variety of circumstances in which non-natural death connected to sexual activity may occur. STRENGTHS & LIMITATIONS This study presents a large postmortem collection of non-natural death cases with associated sexual activity. As the main limiting factor, it must be stated that mutual consent for a sexual practice or consumption of substances was presumed based on the information provided and a lack of evidence against this assumption. CONCLUSION In cases of death associated with sexual activity, medical staff should perform thorough unbiased examinations and documentations. Strangulation and the consumption of stimulants should be classified as life-threatening, pleasure-enhancing techniques. Patients and young people should be informed about these risks. Bunzel L, Koelzer SC, Zedler B, et al. Non-Natural Death Associated with Sexual Activity: Results of a 25-Year Medicolegal Postmortem Study. J Sex Med 2019;16:1547-1556.
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Affiliation(s)
- Lena Bunzel
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany.
| | - Sarah C Koelzer
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
| | - Barbara Zedler
- Institute of Legal Medicine, Justus Liebig University of Gießen, Gießen, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
| | - Markus Parzeller
- Institute of Legal Medicine at University Hospital, Goethe University, Frankfurt, Germany
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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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Rossman L, Solis S, Stevens J, Wynn B, Jones JS. Effect of menstrual bleeding on the detection of anogenital injuries in sexual assault victims. Am J Emerg Med 2019; 37:1203-1204. [DOI: 10.1016/j.ajem.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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Morse J. Legal mobilization in medicine: Nurses, rape kits, and the emergence of forensic nursing in the United States since the 1970s. Soc Sci Med 2019; 222:323-334. [DOI: 10.1016/j.socscimed.2018.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
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Rogers A, McIntyre SL, Rossman L, Solis S, Bacon-Baguley TA, Jones J. The forensic rape examination: Is colposcopy really necessary? Am J Emerg Med 2018; 37:999-1000. [PMID: 30337089 DOI: 10.1016/j.ajem.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abby Rogers
- College of Health Professions, Grand Valley State University, Grand Rapids, MI, United States of America
| | - Sarah L McIntyre
- College of Health Professions, Grand Valley State University, Grand Rapids, MI, United States of America
| | - Linda Rossman
- YWCA West Central Michigan Nurse Examiner Program, Grand Rapids, MI, United States of America
| | - Stephanie Solis
- YWCA West Central Michigan Nurse Examiner Program, Grand Rapids, MI, United States of America
| | - Theresa A Bacon-Baguley
- College of Health Professions, Grand Valley State University, Grand Rapids, MI, United States of America
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Hospitals, Grand Rapids, MI, United States of America.
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Ohayi SR, Ezugwu EC. Prevalence and pattern of genital injuries among adolescent rape victims attending Enugu State University Teaching Hospital, South East Nigeria. J OBSTET GYNAECOL 2018; 39:190-194. [PMID: 30257575 DOI: 10.1080/01443615.2018.1474189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The study aimed to determine the prevalence and pattern of genital injuries among the female adolescents alleged to have been raped that presented at the Enugu State University Teaching Hospital (ESUTH) from January 1 2013 to August 31 2014. All of the adolescents alleged to have been raped that presented within the study period were studied, and the relevant data were extracted from their records. The data were analysed using the Epi info statistical software, Version 7. There were 78 adolescents alleged to have been raped within the study period. They were all female, with a mean age of 14.12 ± 5.6 years. The majority of them were virgins (n = 47, 60.3%). Five of them (6.4%) had multiple perpetrators. The prevalence of genital injuries was 44.9%, while the genital injury frequency rate was 1.2. Laceration was the commonest injury type, while the hymen was the most affected site (n = 15; 35.7%). Being a virgin at the time of the rape was significantly associated with the presence of genital injury (p < .001). This suggests that the absence of genital injury is not sufficient evidence to rule out the possibility of rape. Impact Statement What is already known on this subject? Rape is a global problem with a severe negative impact on the victim. Apart from the associated psychological and emotional trauma, a genital injury could result. However, it appears that so much emphasis are usually placed on the presence of a genital injury in establishing an incident of rape in the developing world. Genital injuries seem to be the main substantive evidence of rape in the developing world including Nigeria. Convicting the perpetrator of rape in law court is usually difficult in the absence of genital injuries after medical examination. What the results of this study add? The result of this study shows that a genital injury is not be found in all cases of an alleged rape, especially among the adolescents. In fact, more than half of the rape survivors had no genital injury. What the implications are of these findings for clinical practice and/or further research? The absence of a genital injury does not exclude the possibility of a rape, neither does its presence confirm a rape, as genital injuries can occur even in consensual sex. Adopting a modern method of establishing a rape case is very important for the provision of concrete evidence in court that will enable the proper and sound dispensation of justice.
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Affiliation(s)
- Samuel Robsam Ohayi
- a Department of Pathology , Enugu State University Teaching Hospital , Enugu , Nigeria
| | - Euzebus Chinonye Ezugwu
- b Department of Obstetrics and Gynaecology, Faculty of Medical Sciences College of Medicine , University of Nigeria , Enugu , Nigeria
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Zerbo S, Milone L, Scalici E, Procaccianti S, Nardello R, Ventura Spagnolo E, Piscionieri D, Argo A. Medico legal procedures related to sexual assault: a 10-year retrospective experience of a Daphne protocol application. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0039-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Song SH, Fernandes JR. Comparison of Injury Patterns in Consensual and Nonconsensual Sex: Is It Possible to Determine if Consent was Given? Acad Forensic Pathol 2017; 7:619-631. [PMID: 31240011 DOI: 10.23907/2017.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/27/2017] [Accepted: 09/08/2017] [Indexed: 11/12/2022]
Abstract
Matters of sexual consent and sexual assault are hotly debated issues among professionals and laypersons alike. A widespread misconception of sexual assault is that most victims of sexual assault sustain significant physical trauma. It is the purpose of this review article to compare the patterns of physical injury (both genital and extragenital) in victims of sexual assault and participants of consensual sex to conclude if physical injury alone can indicate whether consent was given. Interpretations of injury have great forensic significance as it can influence the outcome of sexual assault cases. Several articles indicate that extragenital injuries are commonly found in sexual assault victims (46%-82%) and that most of such injuries are deemed minor. Articles report a wide range of genital injury detection rates in both sexual assault victims (6%-87%) and consensual sex participants (6%-73%). Usage of different examination techniques may partly explain the wide range of detection rates reported. Out of all those who sustained genital injuries, only a small portion of people required hospitalization. In both consensual and sexual assault cases, genital injuries in the 6 o'clock position were most common. Studies of genital injury lacked standardization of factors that significantly influence the results, such as time to examination after sex, examination techniques, and injury severity scales. Therefore, medicolegal personnel should be aware that sexual assault victims can present with a wide range of physical trauma and should avoid relying on physical trauma alone to conclude whether consent was present.
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Affiliation(s)
- Sung Hoon Song
- McMaster University Faculty of Health Sciences - Health Sciences
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Abstract
Sexual assault is characterized by any sexual contact or behavior that occurs without explicit consent. Classifications vary based on the status of the perpetrator's relationship to the victim (eg, stranger, acquaintance) and characteristics of the victim herself (eg, child, elder adult, mentally disabled adult). Regardless of the classification, sexual assault is a significant individual as well as public health issue affecting women of all ages. While the majority of sexual assault cases are not initially reported to law enforcement, the best available data suggest the lifetime prevalence of sexual assault in the United States is approximately 20% among adult women. With such a significant proportion of women affected by sexual assault, women's health care providers in both ambulatory and emergency care settings play key roles in the evaluation, management, and advocacy of these victims. Establishing standard protocols based on state laws and on victim-centered practices to avoid revictimization of the patient is critical. The primary goals of care include the assessment and treatment of physical injuries, psychological assessment and support, pregnancy assessment and prevention, and therapy for prevention of sexually transmitted infections. In addition, evidentiary collection is a critical component of the sexual assault evaluation and subsequent legal proceedings. This report focuses specifically on the immediate evaluation and management of adult female victims of sexual assault. Best practices include the utility of the Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner programs, as well as standardized treatment protocols.
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Exploring Genitoanal Injury and HIV Risk Among Women: Menstrual Phase, Hormonal Birth Control, and Injury Frequency and Prevalence. J Acquir Immune Defic Syndr 2016; 71:207-12. [PMID: 26334741 DOI: 10.1097/qai.0000000000000824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Genital, anal, and oral injuries sustained from sexual intercourse may explain HIV transmission among women. We determined the variability in genitoanal injury frequency and prevalence in women after consensual sexual intercourse, exploring the role of menstrual phase and hormonal birth control. METHODS We used a longitudinal observational design with a convenience sample of 393 women aged 21 years and older. Participants had a baseline interview with gynecological examination, followed by consensual sexual intercourse with a male partner and a second gynecological examination. We analyzed injury prevalence with logistic regression and injury frequency with negative binomial regression among women who were (1) menstrual, not using hormonal birth control, (2) menstrual, using hormonal birth control, or (3) menopausal. We also compared injury among menstrual women in the follicular, ovulatory, and luteal phases. FINDINGS Women using hormonal birth control had 38% more external genitalia injuries [adjusted rate ratio (ARR) = 1.38, P = 0.030] and more than twice the anal injuries (ARR = 2.67, P = 0.005) as the nonhormonal birth control menstruating group. Menopausal women had more than 3 times the anal injuries (ARR = 3.36, P = 0.020) than those in the nonhormonal menstrual group. Among menstrual women, those in the follicular phase had a greater prevalence and frequency of external genitalia injuries than those in other phases. INTERPRETATION Increased rates of postcoital genitoanal injuries are noted among women using hormonal birth control and/or in the follicular phase of menstruation. Biological factors that influence women's risk for HIV warrant further investigation.
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Boukhanni L, Dhibou H, Zilfi W, Housseini KI, Benkeddour YA, Aboulfalah A, Asmouki H, Soummani A. [Postcoital bleeding: 68 case-reports and review of the literature]. Pan Afr Med J 2016; 23:131. [PMID: 27279958 PMCID: PMC4885701 DOI: 10.11604/pamj.2016.23.131.9073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/18/2016] [Indexed: 11/11/2022] Open
Abstract
L'acte sexuel consenti ou imposé, peut être à l'origine des traumatismes. L'hémorragie post coïtale est un symptôme gynécologique commun. Elle peut révéler de sérieux problèmes. Le but de notre travail est d’étudier le profil épidémiologique, diagnostique et thérapeutique ainsi que les moyens préventifs en cas de déchirure post coïtale. Il s'agit d'une étude prospective, étalée sur deux ans, mené au service de gynécologie obstétrique du CHU Med VI de Marrakech. Nous avons colligé 68 patientes. L’âge moyen est de 27 ans, la majorité des patientes étaient des nullipares soit 89,7% des cas. La moitié des patientes avaient un mariage traditionnel. Le rapport était consentent dans 74% des cas. L'hémorragie génitale a constitue le motif de consultation le plus fréquent soit 98% des cas. Les lésions hyménales ont été retrouvées dans 39% des cas et la lésion siégeait dans le cul de sac postérieur chez 35% des cas. La prise en charge thérapeutique a consisté en une suture chirurgicale chez 97% des cas, associé à une transfusion sanguine chez deux patientes et une abstinence sexuelle pendant minimum deux semaines chez toutes nous patientes. Le contexte social ainsi que le manque d’éducation sexuelle sont souvent incriminé d'où l'intérêt d'une prise en charge psychologique pour prévenir aussi bien le retentissement du traumatisme sur la sexualité que les récidives.
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Affiliation(s)
- Lahssen Boukhanni
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hanane Dhibou
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Wafaa Zilfi
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Kawtar Iraki Housseini
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Yasser Ait Benkeddour
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderrahim Aboulfalah
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Hamid Asmouki
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
| | - Abderraouf Soummani
- Service de Gynécologie Obstétrique, Pôle Mère et Enfant, CHU Mohamed VI, Marrakech, Maroc
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Abraham M, Kondis J, Merritt DF. Case Series: Vaginal Rupture Injuries after Sexual Assault in Children and Adolescents. J Pediatr Adolesc Gynecol 2016; 29:e49-52. [PMID: 26746636 DOI: 10.1016/j.jpag.2015.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/05/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vaginal rupture after sexual assault is a rare but life-threatening occurrence requiring prompt recognition and treatment. Herein, we describe four such cases in children. Our purposes are to increase clinicians' awareness of the physical trauma that a sexual abuse victim can suffer and increase recognition that these victims require immediate trauma services. CASES Each patient had obvious hymenal and vaginal lacerations with a vaginal apical rupture injury and secondary acute blood loss. None of the four victims sustained infectious sequelae. SUMMARY AND CONCLUSION Providers should have a low threshold for managing sexual abuse victims as trauma cases when they have obvious hymenal and vaginal lacerations and genital bleeding, proceeding expeditiously to examination using general anesthesia when appropriate.
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Affiliation(s)
- Margaret Abraham
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri.
| | - Jamie Kondis
- Child Abuse Pediatrics, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Diane F Merritt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
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Nonoccupational Postexposure Human Immunodeficiency Virus Prophylaxis: Acceptance Following Sexual Assault. Nurs Res 2016; 65:47-54. [PMID: 26657480 DOI: 10.1097/nnr.0000000000000122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonoccupational postexposure prophylaxis (nPEP) for HIV following sexual assault may decrease the likelihood of HIV transmission. OBJECTIVE The purpose of this exploratory chart review study was to examine factors associated with patients accepting post-sexual assault nPEP at three forensic nurse examiner programs in urban settings. METHODS Forensic nursing charts of patients presenting for acute sexual assault care were reviewed as part of a mixed-methods study. RESULTS Patients assaulted by more than one or an unknown number of assailants were over 12 times more likely to accept the offer of nPEP (adjusted odds ratio [aOR] = 12.66, 95% CI [2.77, 57.82]). In cases where no condom was used (aOR = 8.57, 95% CI [1.59, 46.10]) or when any injury to the anus or genitalia was noted (aOR = 4.10, 95% CI [1.57, 10.75]), patients were more likely to accept nPEP. Patients with any injury to the face or head were less likely to initiate nPEP (aOR = 0.32, 95% CI [0.11, 0.97]). DISCUSSION This study is an important first step in understanding factors associated with nPEP acceptance after sexual assault.
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Eskandari A, Mukherjee A, McHugh J. Transarterial embolization for management of severe postcoital bleeding. SAGE Open Med Case Rep 2016; 4:2050313X16662803. [PMID: 27551425 PMCID: PMC4976789 DOI: 10.1177/2050313x16662803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.
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Affiliation(s)
- Armen Eskandari
- Internal Medicine Program, Riverside County Regional Medical Center, Department of Internal Medicine, University of California Riverside School of Medicine, Moreno Valley, CA, USA
| | - Ashis Mukherjee
- Department of Cardiovascular Medicine, St. Bernardine Medical Center and University of California Riverside School of Medicine, San Bernardino, CA, USA
| | - John McHugh
- Department of Obstetrics and Gynecology, St. Bernardine Medical Center, San Bernardino, CA, USA
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Brew-Graves E, Morgan L. Injuries and allegations of oral rape: A retrospective review of patients presenting to a London sexual assault referral centre. J Forensic Leg Med 2015; 34:155-8. [PMID: 26165676 DOI: 10.1016/j.jflm.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
A retrospective review was carried out of patients seen at the Haven sexual assault referral centre in South East London between January 2009 and September 2010 to determine the frequency and nature of oral injuries found in people reporting oral rape. Ninety five eligible patients were identified and relevant information was extracted from standardised Haven forms completed during forensic medical examination. The main outcome measures were prevalence, type and location of oral injury. Eighteen (19%) were found to have sustained an oral injury. The most common injury was abrasions, followed by bruising and petechiae. The lips were the most common site of injury followed by the soft palate and the inside of the cheeks. It was concluded that injuries in the mouth were not common after an allegation of oral rape. Injuries were minor and did not require treatment.
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Affiliation(s)
- Emmeline Brew-Graves
- Haven Camberwell, King's College Hospital NHS Foundation Trust, 13-14 Caldecot Road, London SE5 9RS, UK
| | - Louise Morgan
- Haven Camberwell, King's College Hospital NHS Foundation Trust, 13-14 Caldecot Road, London SE5 9RS, UK.
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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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Edinburgh L, Pape-Blabolil J, Harpin SB, Saewyc E. Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases. CHILD ABUSE & NEGLECT 2014; 38:1540-1551. [PMID: 24933707 PMCID: PMC4760763 DOI: 10.1016/j.chiabu.2014.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/30/2014] [Accepted: 05/12/2014] [Indexed: 05/30/2023]
Abstract
The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims.
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Affiliation(s)
- Laurel Edinburgh
- Midwest Children's Resource Center, Children's Hospital and Clinics of Minnesota, St. Paul, MN, USA
| | - Julie Pape-Blabolil
- Midwest Children's Resource Center, Children's Hospital and Clinics of Minnesota, St. Paul, MN, USA
| | - Scott B Harpin
- University of Colorado College of Nursing, Aurora, CO, USA
| | - Elizabeth Saewyc
- University of British Columbia School of Nursing, Vancouver, Canada
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Joki-Erkkilä M, Rainio J, Huhtala H, Salonen A, Karhunen PJ. Evaluation of anogenital injuries using white and UV-light among adult volunteers following consensual sexual intercourse. Forensic Sci Int 2014; 242:293-298. [PMID: 25161122 DOI: 10.1016/j.forsciint.2014.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/20/2013] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES New clinical forensic examination techniques for sexual assaults have not been introduced over the last few decades. We evaluated the benefit of ultraviolet light compared to white light for detecting minor anogenital injuries and scars, following consensual sexual intercourse among adult volunteers. DESIGN A prospective study comparing female genital findings utilising white and ultraviolet light. A colposcopy with photographic documentation was used. SETTING Personal invitation to healthcare students, hospital employees or acquaintances to volunteer for a gynecological examination, with a focus on clinical forensic aspects. PARTICIPANTS Eighty-eight adult female volunteers were recruited for the study. The examination was performed after consensual intercourse. Age ranged from 20 to 52 years (median 26.5 years). MAIN OUTCOME MEASURES Presence of acute findings and scars in the genital area using white and UV-light. RESULTS Acute genital injury rate was 14.8% under white light colposcopy and 23.0% using UV light. Submucosal hemorrhages in the genital area were documented significantly better under UV-light than white light (14.9% vs. 6.8%; p=0.016), whereas petechiaes (4.5%) and abrasions (2.3%) were detected using either method. UV-light revealed significantly more often delivery-associated genital scars compared to white light (39.8% vs. 31.8%; p=0.016). Furthermore, 10 out of 31 (33.3%) women had no residual anogenital skin or mucosal surface findings, despite a prior episiotomy or rupture of the vaginal outlet wall during delivery, supporting its enormous ability to heal even after major trauma. CONCLUSIONS UV-light may provide additional value for the evaluation of physical findings in clinical forensic examinations after sexual assault, and is especially useful in detecting otherwise invisible early submucosal hemorrhages and scars.
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Affiliation(s)
- Minna Joki-Erkkilä
- Departments of Gynecology and Obstetrics and Forensic Child Psychiatry, Tampere University Hospital, Finland.
| | - Juha Rainio
- Department of Forensic Medicine, School of Medicine, University of Tampere, and Institute for Health and Welfare, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Finland
| | - Aki Salonen
- Crime Scene Investigation Unit, Pirkanmaa Police Department, Tampere, Finland
| | - Pekka J Karhunen
- Department of Forensic Medicine, School of Medicine, University of Tampere and Fimlab Laboratories, Tampere University Hospital Region, Finland
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Draughon JE, Hauda WE, Price B, Rotolo S, Austin KW, Sheridan DJ. Factors Associated With Forensic Nurses Offering HIV nPEP Status Post Sexual Assault. West J Nurs Res 2014; 37:1194-213. [PMID: 24733232 DOI: 10.1177/0193945914530192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nonoccupational, postexposure prophylaxis (nPEP) for human immunodeficiency virus (HIV) is offered inconsistently to patients who have been sexually assaulted. This may be due to Forensic Nurse Examiner (FNE) programs utilizing diverse nPEP protocols and HIV risk assessment algorithms. This study examines factors associated with FNEs offering nPEP to patients following sexual assault at two FNE programs in urban settings. Offering nPEP is mostly driven by site-specific protocol. At Site 1, in addition to open anal or open genital wounds, the presence of injury to the head or face was associated with FNEs offering nPEP (adjusted odds ratio [AOR] 64.15, 95% confidence interval [CI] = [2.12, 1942.37]). At Site 2, patients assaulted by someone of Other race/ethnicity (non-White, non-African American) were 86% less likely to be offered nPEP (AOR 0.14, 95% CI = [.03, .72]) than patients assaulted by Whites. In addition to following site-specific protocols, future research should further explore the mechanisms influencing clinician decision making.
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Affiliation(s)
| | | | - Bonnie Price
- Bon Secours St. Mary's Hospital, Richmond, VA, USA
| | - Sue Rotolo
- Dr. Rotolo Forensic Consulting, Leesburg, VA, USA
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Choong KA, Barrett M. Forensic physicians and written evidence: witness statements v. expert reports. J Forensic Leg Med 2014; 22:93-8. [PMID: 24485431 DOI: 10.1016/j.jflm.2013.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/20/2013] [Accepted: 12/07/2013] [Indexed: 11/16/2022]
Abstract
When assisting the courts in criminal proceedings, the work of forensic physicians are leaning more towards the preparation of written evidence rather than the giving of oral evidence in person. For this, they may be asked to serve either as professional witnesses or expert witnesses. These 2 roles have nevertheless been a constant source of confusion among forensic physicians. In view of this, the article aims to highlight the similarities and differences between these 2 roles particularly in relation to the preparation of written evidence. It will take a close look at the forms of written evidence which forensic physicians are expected to produce in those distinct capacities and the attending duties, evidentiary rules and legal liabilities. Through this, the work aspires to assist forensic physicians undertake those responsibilities on a more informed footing.
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Affiliation(s)
- Kartina A Choong
- Lancashire Law School, Harris Building, University of Central Lancashire, Preston PR1 2HE, United Kingdom.
| | - Martin Barrett
- St Peter's Surgery, La Rue De L'Eglise, St Peter, Jersey JE3 7AG, United Kingdom.
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Factors That Influence the Variability in Findings of Anogenital Injury in Adolescent/Adult Sexual Assault Victims. Am J Forensic Med Pathol 2013; 34:286-94. [DOI: 10.1097/paf.0b013e31829a0f46] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Southern PJ. Missing out on the biology of heterosexual HIV-1 transmission. Trends Microbiol 2013; 21:245-52. [DOI: 10.1016/j.tim.2013.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/03/2013] [Accepted: 02/06/2013] [Indexed: 11/16/2022]
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46
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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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Abstract
OBJECTIVE To describe the mechanism, injury pattern and management of women who present to the ED with non-obstetric vulval trauma. METHODS A retrospective, single-institution case series was carried out. Data were sourced from medical records of women who presented to the ED and Royal Brisbane and Women's Hospital between 2007 and 2011. Records of possible injuries to the vulva were assessed to determine incidence, age, site, type of injury, mechanism of injury and whether urinary retention required treatment. This information was analysed using the computer software Statistical Package for the Social Sciences 11.0. RESULTS Vulval non-obstetric trauma was found in 19 of 519 cases, resulting in haematoma formation, lacerations, tears or a combination of the three in 16 of the 19 cases. Injuries were due to falling astride a firm object, consensual coitus, sexual assault, cold waxing and tight clothing. Urinary retention occurred in three cases. Site of injury, whether anterior or posterior, was evenly distributed irrespective of the mechanism of injury. Haematomas were treated conservatively and bleeding lacerations sutured. None required resuscitation. CONCLUSIONS Non-obstetric vulval injuries are uncommon (incidence 3.7%). All cases require assessment for vaginal, urethral, anal and bony pelvis injuries. This might require examination under anaesthesia. Conservative management of haematomas in the absence of acute haematoma expansion is favoured. The need to screen for sexually transmissible infections and pregnancy is important. Social worker and psychological support is important to reduce the incidence of long-term psychological problems.
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Affiliation(s)
- Ian S C Jones
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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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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Ingemann-Hansen O, Charles AV. Forensic medical examination of adolescent and adult victims of sexual violence. Best Pract Res Clin Obstet Gynaecol 2012; 27:91-102. [PMID: 23036587 DOI: 10.1016/j.bpobgyn.2012.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/14/2012] [Accepted: 08/19/2012] [Indexed: 10/27/2022]
Abstract
The acute care and examination of a victim of sexual violence must be carried out by a competent forensic examiner in a setting appropriate for crisis intervention, forensic evidence collection, and medical follow up. The aim of forensic evidence and biological material collection is to document an alleged physical or sexual contact between individuals and to corroborate the victim's and the assailant's history. This is why the forensic examiner is expected to be objective and in possession of specialised technical and scientific skills. These skills are addressed and recommendations are made on how to carry out a forensic examination. This includes medical and assault history, top-to-toe examination, biological material collection, and documenting injuries while obtaining the chain of custody. Yet, consensus on time limitations for forensic evidence collection is lacking. Available forensic evidence has been shown to benefit prosecution. To meet the legal system's needs, an interpretation of the findings in a written legal report is mandatory.
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Affiliation(s)
- Ole Ingemann-Hansen
- Department of Forensic Medicine, Section of Forensic Pathology and Clinical Forensic Medicine, University of Aarhus, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
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