Validation Set Correlates of Anogenital Injury after Sexual Assault

Abstract

Objectives: Forensic investigators remain unsure exactly why some sexual assault victims display acute injury while others do not. This investigation explores potential reasons for these differential findings among female victims.Methods: This cross-sectional analysis examined data from consecutive female sexual assault victims, at least 12 years old, who agreed to a forensic exam between November 1, 2002, and November 30, 2006. Exams utilized colposcopy, anoscopy, macrodigital imaging, and toluidine blue dye to delineate anogenital injury (AGI), which was defined as the presence of recorded anogenital abrasions, tears, or ecchymosis. Demographic variables of the victim, including sexual experience and reproductive parity, and assault characteristics were recorded in the database for bivariate and multivariate analysis with AGI.Results: Forty-nine percent of the initial 3,356 patients displayed AGI. Of this total, 2,879 cases included complete data for all variables and were included in the multivariate logistic regression model. A statistically significant increased risk for AGI was noted with: educational status (odds ratio [OR] 1.53, 95% CI = 1.25 to 1.87); vaginal or attempted penetration using penis (OR 2.29, 95% CI = 1.74 to 3.01), finger (OR 1.61, 95% CI = 1.88 to 1.94), or object (OR 3.19, 95% CI = 1.52 to 6.68); anal-penile penetration (OR 2.00, 95% CI = 1.57 to 2.54); alcohol involvement (OR 1.25, 95% CI = 1.04 to 1.50); and virgin status of victim (OR 1.38, 95% CI = 1.11 to 1.71). Victims were less likely to display AGI with a longer postcoital interval (OR 0.50, 95% CI = 0.39 to 0.65) and increased parity (OR 0.76, 95% CI = 0.57 to 0.99). Conclusions:Approximately half the patients displayed AGI. This rate is higher than earlier studies, but consistent with current investigations utilizing similar injury detection methods. The correlates of injury found reinforce the findings of prior studies, while prompting questions for future study.ACADEMIC EMERGENCY MEDICINE 2008; 15:231-238 ª

Correlates of Anogenital Injuries in Adolescent Females

“…Contrasting the findings of Sachs et al in an estrogenized female population and Drocton et al in an adult population, our data showed increase injury in patients reporting penetrating assault in multiple positions versus the back only position (OR 1.41, 95% CI = 1.05 to 1.91) [3,4]. McLean et al did not find an association for position in their adult population [10].…”

“…We further explored correlates of AGIs with a logistic regression model choosing independent variables based on prior work and plausible association with injury [3,4].…”

Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims

“…10 Although visible injury may be present, it is not unusual to have a normal or nonspecific anogenital examination. 41 Injuries that do occur typically heal quickly, within days to a few weeks, and scarring is very unusual. 42 With the patient's assent, a sexual assault evidence kit may be obtained if the assault has occurred within the past 72 hours (up to 96 hours in some jurisdictions).…”

Female Genital Injury Following Consensual and Nonconsensual Sex: State of the Science

“…Some reports classified injuries by type and location, 13,14,19,20 whereas others simply noted the presence or absence of genital injury. 15,21 Redness and swelling were not defined as injuries in 2 of the studies because of inconsistent identification, poor inter-rater reliability, and limitations associated with photographing these findings. 19,20 Increased injury frequency was documented in patients reporting virgin status prior to the incident 14,15 and in survivors whose examinations were completed within 24 hours of nonconsensual intercourse.…”

“…Only one study specifically documented injury rates for different penetration types. 15 Likewise, no consistent method of injury documentation was used between studies. A commonly used clinical approach to genital injury documentation is the Tears, Ecchymoses, Abrasions, Redness, and Swelling (TEARS) mnemonic.…”