Sexual Assault Forensic Examination in adult and child cases: Is Colposcopy Really Necessary?

Abstract

Sexual assault is a complex situation with medical, psychological, and legal aspects. Victims should be examined by a specially trained medico-legal examiner to collect evidence and avoid multiple examinations. The use of colposcopy in child and adult sexual assault cases is becoming increasingly more widespread however; it is still not a routine aspect of all examinations in most countries. The present study aimed to evaluate the importance of using the colposcope in the examination of the sexual assault cases admitted to the violence against women and child clinic in the Forensic Medicine Authority in Egypt. The study included (150) cases, divided into two groups according to age: Group A (1 to 18 years) (124) male and female children and Group B (19-40 years) (26) females. -General, then local examination with the naked eye and colposcopy had been performed. Internal genitalia was examined by using disposable plastic Casco in adult non-virgin victims only. -Vaginal and anal swabs were collected for the detection of seminal stains. The results of the colposcopic examination revealed a significant difference in both negative and positive results when compared to the other methods of examination (naked eye, swabs, and clothes examination). Colposcopic magnification power with high resolution and illumination light permits to discover microtrauma which may not be discovered with a normal examination by naked eyes. Colposcope seems to be an important noninvasive tool for the examination of children and adults when sexual abuse is suspected. Its documentation could allow for supervision, teaching, and second opinions in an ethically difficult setting. The colposcopic examination should be introduced to all forensic departments in Egypt to be used as a routine aspect of all sexual assault examinations. Future studies are recommended to be conducted on a national scale. Keywords: Sexual assault; Colposcope; Toluidine blue dye; Examination

Pattern of Injuries in Cases of Sexual Assault and Role of Colposcopy in Detection of Hidden Injuries

“…The results of present study are consistent with the research of Alaa El-Din et al (2019), who reported that colposcopy skipped some positive data. Sommers (2007) and González (2017) had how the timing of the colposcopic examination, the healing of the microtrauma or friction mark, and the disappearance of the redness in the genitalia during external friction without penetration could be responsible for the positive results of clothes examinations and exchanges in sexual assault victims, even though the colposcopic examination produced negative results.…”

“…Similar findings were reported by the study of Alaa El-Din et al (2019). Sena et al (2015) and Thackeray et al (2011) who discussed the significance of tangible proof in establishing the commission of sexual assault and in identifying the attackers in such circumstances.…”

“…These results are aligning with Yung (2015) and Alaa El-Din et al (2019) who demonstrated that colposcope improves finding genital injury in cases of sexual assault compared to naked eye examination alone. Similarly, a study performed by Rogers et al (2019) deduced that in the detection of microtrauma following rape or sexual assault, colposcopy was superior to gross visual inspection.…”

“…Such results are going with the work of Alaa El-Din et al (2019), that revealed that the major common form of sexual assault penetration in cases aged below 18 years was penile-anal followed by penile-vaginal penetration, whereas in the older age category (above 18), the most common type was penile-vaginal followed by penile-anal penetration. They, in match with the findings of present study, also found that no significant difference between both sexes in the prevalence of penetration, and that the prevalence decreased in the older age group.…”