Abstract
BACKGROUND: The literature on sexual assault has not directly addressed the question of genital injuries in women without prior sexual intercourse experience. Given the paucity of research and the current importance of physical evidence in the criminal justice system, this study was designed to document the type and site of genital injuries from sexual assault in women without and with prior sexual intercourse experience. METHODS: The charts were reviewed of 132 women who had been sexually assaulted and had sought medical treatment at the Sexual Assault Care Centre (SACC), Women's College Hospital, Toronto, within 10 days after the assault. Half (66) of the women reported that, at the time of the assault, they had no prior sexual intercourse experience. The Sexual Assault Evidence Kit in each patient's file was reviewed to ascertain the type and location of genital injuries. Types of injuries were classified into 3 categories (nonperforating soft-tissue injuries, lacerations or current bleeding) and locations into 6 categories (labia majora and minora, posterior fourchette and introitus, hymen, vagina, cervix, and anus). RESULTS: Significantly more women without than with prior sexual intercourse experience had visible genital injuries (65.2% v. 25.8%, p < 0.01). However, of the women without prior experience, only 9.1% had hymenal perforation. Analyses of the data for only women with genital injuries indicated no difference between those without and those with prior sexual intercourse experience in the overall mean number of injured sites (1.65 and 1.47 respectively) or in the mean number of sites with nonperforating soft-tissue injuries (0.349 and 0.706), lacerations (0.953 and 0.471) and bleeding (0.279 and 0.294). INTERPRETATION: The results suggest that genital injuries are more common in women without prior sexual intercourse experience but that substantial proportions of all women, regardless of their prior sexual experience at the time of assault, will not have visible genital injuries. Emergency department staff and members of the criminal justice system need to be aware of the variable presentation of genital trauma related to sexual assault in women with and without prior sexual intercourse experience.
Full Text
The Full Text of this article is available as a PDF (164.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cartwright P. S. Factors that correlate with injury sustained by survivors of sexual assault. Obstet Gynecol. 1987 Jul;70(1):44–46. [PubMed] [Google Scholar]
- Cartwright P. S., Moore R. A., Anderson J. R., Brown D. H. Genital injury and implied consent to alleged rape. J Reprod Med. 1986 Nov;31(11):1043–1044. [PubMed] [Google Scholar]
- Elam A. L., Ray V. G. Sexually related trauma: a review. Ann Emerg Med. 1986 May;15(5):576–584. doi: 10.1016/s0196-0644(86)80996-9. [DOI] [PubMed] [Google Scholar]
- Emans S. J., Woods E. R., Allred E. N., Grace E. Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr. 1994 Jul;125(1):153–160. doi: 10.1016/s0022-3476(94)70144-x. [DOI] [PubMed] [Google Scholar]
- Everett R. B., Jimerson G. K. The rape victim: a review of 117 consecutive cases. Obstet Gynecol. 1977 Jul;50(1):88–90. [PubMed] [Google Scholar]
- FISH S. A. Vaginal injury due to coitus. Am J Obstet Gynecol. 1956 Sep;72(3):544–548. doi: 10.1016/0002-9378(56)90378-7. [DOI] [PubMed] [Google Scholar]
- Geist R. F. Sexually related trauma. Emerg Med Clin North Am. 1988 Aug;6(3):439–466. [PubMed] [Google Scholar]
- Herman-Giddens M. E., Frothingham T. E. Prepubertal female genitalia: examination for evidence of sexual abuse. Pediatrics. 1987 Aug;80(2):203–208. [PubMed] [Google Scholar]
- Hicks D. J. Rape: sexual assault. Am J Obstet Gynecol. 1980 Aug 15;137(8):931–935. doi: 10.1016/s0002-9378(16)32834-4. [DOI] [PubMed] [Google Scholar]
- Hobbs C. J., Wynne J. M., Thomas A. J. Colposcopic genital findings in prepubertal girls assessed for sexual abuse. Arch Dis Child. 1995 Nov;73(5):465–471. doi: 10.1136/adc.73.5.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kerns D. L., Ritter M. L., Thomas R. G. Concave hymenal variations in suspected child sexual abuse victims. Pediatrics. 1992 Aug;90(2 Pt 1):265–272. [PubMed] [Google Scholar]
- Massey J. B., García C. R., Emich J. P., Jr Management of sexually assaulted females. Obstet Gynecol. 1971 Jul;38(1):29–36. [PubMed] [Google Scholar]
- McCann J., Voris J., Simon M. Genital injuries resulting from sexual abuse: a longitudinal study. Pediatrics. 1992 Feb;89(2):307–317. [PubMed] [Google Scholar]
- McCauley J., Guzinski G., Welch R., Gorman R., Osmers F. Toluidine blue in the corroboration of rape in the adult victim. Am J Emerg Med. 1987 Mar;5(2):105–108. doi: 10.1016/0735-6757(87)90084-2. [DOI] [PubMed] [Google Scholar]
- Muram D. Child sexual abuse--genital tract findings in prepubertal girls. I. The unaided medical examination. Am J Obstet Gynecol. 1989 Feb;160(2):328–333. doi: 10.1016/0002-9378(89)90436-5. [DOI] [PubMed] [Google Scholar]
- Norvell M. K., Benrubi G. I., Thompson R. J. Investigation of microtrauma after sexual intercourse. J Reprod Med. 1984 Apr;29(4):269–271. [PubMed] [Google Scholar]
- Penttilä A., Karhumen P. J. Medicolegal findings among rape victims. Med Law. 1990;9(1):725–737. [PubMed] [Google Scholar]
- Rambow B., Adkinson C., Frost T. H., Peterson G. F. Female sexual assault: medical and legal implications. Ann Emerg Med. 1992 Jun;21(6):727–731. doi: 10.1016/s0196-0644(05)82788-x. [DOI] [PubMed] [Google Scholar]
- Ramin S. M., Satin A. J., Stone I. C., Jr, Wendel G. D., Jr Sexual assault in postmenopausal women. Obstet Gynecol. 1992 Nov;80(5):860–864. [PubMed] [Google Scholar]
- Raudrant D., Landrivon G., Frappart L., De Haas P., Champion F., Ecochard R. Comparison of the effects of different menstrual tampons on the vaginal epithelium: a randomised clinical trial. Eur J Obstet Gynecol Reprod Biol. 1995 Jan;58(1):41–46. doi: 10.1016/0028-2243(94)01977-f. [DOI] [PubMed] [Google Scholar]
- Sill P. R. Non-obstetric female genital tract trauma in Port Moresby, Papua New Guinea. Aust N Z J Obstet Gynaecol. 1987 May;27(2):164–165. doi: 10.1111/j.1479-828x.1987.tb00973.x. [DOI] [PubMed] [Google Scholar]
- Slaughter L., Brown C. R. Cervical findings in rape victims. Am J Obstet Gynecol. 1991 Feb;164(2):528–529. doi: 10.1016/s0002-9378(11)80013-x. [DOI] [PubMed] [Google Scholar]
- Soules M. R., Pollard A. A., Brown K. M., Verma M. The forensic laboratory evaluation of evidence in alleged rape. Am J Obstet Gynecol. 1978 Jan 15;130(2):142–147. doi: 10.1016/0002-9378(78)90356-3. [DOI] [PubMed] [Google Scholar]
- Soules M. R., Stewart S. K., Brown K. M., Pollard A. A. The spectrum of alleged rape. J Reprod Med. 1978 Jan;20(1):33–39. [PubMed] [Google Scholar]
- Stermac L. E., Du Mont J. A., Kalemba V. Comparison of sexual assaults by strangers and known assailants in an urban population of women. CMAJ. 1995 Oct 15;153(8):1089–1094. [PMC free article] [PubMed] [Google Scholar]
- Teixeira W. R. Hymenal colposcopic examination in sexual offenses. Am J Forensic Med Pathol. 1981 Sep;2(3):209–215. doi: 10.1097/00000433-198109000-00004. [DOI] [PubMed] [Google Scholar]
- Underhill R. A., Dewhurst J. The doctor cannot always tell. Medical examination of the "intact" hymen. Lancet. 1978 Feb 18;1(8060):375–376. doi: 10.1016/s0140-6736(78)91094-2. [DOI] [PubMed] [Google Scholar]
- Wilson F., Swartz D. P. Coital injuries of the vagina. Obstet Gynecol. 1972 Feb;39(2):182–184. [PubMed] [Google Scholar]