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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Women's Health 1/2015

Genito-anal injury patterns and associated factors in rape survivors in an urban province of South Africa: a cross-sectional study

BMC Women's Health > Ausgabe 1/2015
Ruxana Jina, Rachel Jewkes, Lisa Vetten, Nicola Christofides, Romi Sigsworth, Lizle Loots
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

RJ, LV and NC were involved in the conceptualization of the study design and, with RS, the development of the tools. All were involved in the training of fieldworkers and RJ assisted with this. RS and LL oversaw and managed the collection and capturing of the data. RJ, NC and RJ coded the data from the original forms. RJ and RJ drafted the manuscript after analyzing the relevant data. All of the authors were involved in the final manuscript and approved it before submission.

Authors’ information

RuxanaJ is a specialist at School of Public Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital. RuxanaJ has a special interest in maternal and child health and violence against women. RachelJ is a Director the Medical Research Council’s Gender and Health Unit and the Secretary of the Sexual Violence Research Initiative. She is an experienced qualitative researcher, epidemiologist and public health specialist. NC has worked in the field of gender-based violence for more than 10 years. She currently coordinates the Masters of Public Health programmes at the School of Public Health, University of the Witwatersrand. LL has a Masters Degree in Sociology and is registering for a PhD. She is a researcher at the Sexual Violence Research Initiative, RS has a Masters Degree in Women’s Studies and is the Gender Specialist at the Institute for Security Studies. LV has worked in the field of gender-based violence for more than 20 years and is an honorary research associate at the Wits Institute for Social and Economic Research. She holds a Master’s degree in Political Studies and is currently a PhD candidate in the same discipline.



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.


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.


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.


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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