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Purpose-The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination.Methods-A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse.Results-Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables-lightness/darkness-, redness/greenness-, and yellowness/blueness-confounded the original relationship between race/ ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variableredness/greenness -was significantly associated with injury occurrence and frequency in the internal genitalia.⋆ The study was designed and data were collected when the principal investigator (Marilyn Sommers) was a faculty member at the University of Cincinnati. Previous presentation: Injury prevalence preliminary data on a sub-sample and a review of injury detection methods were presented at a podium presentation at the State of the Science Congress in Washington, DC, in October, 2004 Conclusions-Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed. NIH Public Access

Objective-The purpose of this report is to compare consensual intercourse related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy and 3) toluidine-blue contrast application.Methods-Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling).Results-Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p <.05). More tears were identified on the anus following toluidine-blue as compared to direct visualization (p <.05), but not colposcopy. Fewer ecchymoses were identified on the internal genitalia and fewer areas of redness were identified on both the external and internal genitalia when toluidine-blue was used as compared to either direct visualization or colposcopy (p <.05).Conclusions-The scientific community needs to continue to build information about anogenital injury prevalence following consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic

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