Short reportPatterned genital injury in cases of rape – A case–control study
Introduction
The existence of a pattern of genital injury distinguishing trauma seen in rape cases and trauma seen following consensual sexual intercourse has been a matter of debate. Typical different patterns was suggested by Slaughter et al. in 1997 i.e. multiple genital lesions at multiple locations seen in rape victims as opposed to single lesions in the posterior forchette following consensual sexual intercourse.1 This pattern has to some degree been confirmed in adults2 and adolescents,3 whereas a third study could not confirm such a pattern.4 A more detailed description of a pattern would aid the medico-legal expert when giving evidence based testimony in court proceedings.
This study aimed to describe the pattern of injury in a prospective, controlled setting using the three most commonly used objective measures worldwide – the naked eye, colposcopy and toluidine blue dye followed by colposcopy.5, 6
Section snippets
Methods
The present study was part of a larger study conducted at the Southern Denmark Sexual Assault Referral Centre (SDSARC) as collaboration between the Institute of Forensic Medicine, University of Southern Denmark and the Department of Gynaecology and Obstetrics, Odense University Hospital. Data and results regarding the control group has been published in detail.6 The SDSARC is a 24 h service that receives victims of sexual assault of both sexes, ≥15 years of age, with or without prior police
Study population
A total of 71 women were seen by a forensic physician at SDSARC in the inclusion period. Of these, 32 were excluded: 12 did not wish to participate, 9 were minors accompanied by other than a legal guardian, 8 were excluded due to psychological issues such as psychiatric disease, mental retardation or severe intoxication, and 3 cases due to technical problems. All cases, including minors, had previous sexual experience. After inclusion it was revealed, that 12 of the 110 controls did not fulfil
Discussion
This study is, to our knowledge, the first prospective, case-control study of female genital lesions seen after sexual intercourse. It is also the first study to report results using all three investigative methods in common use around the globe, making the results useful in all settings. We confirmed the differences in genital lesions seen following rape and consensual sexual intercourse proposed in earlier papers.1, 2, 4, 5 The overall frequency of having one or more lesion of any kind was
Conclusion
In this prospective case-control study of genital lesions following non-consensual and consensual sexual intercourse, we have confirmed different patterns of lesions. A single laceration at the 6 o'clock position is the most common finding in both groups, but any other positive finding was more common in the case group. Cases had more complex lesions with a higher frequency of abrasions, haematomas and multiple lesions and a higher frequency of lesion in other locations than the 6 o'clock
Ethical approval
The study was approved by the Medical Research Ethics Committee of Southern Denmark.
Funding
None declared.
Conflict of interest
The authors of this paper hereby declare that we have no conflict of interest regarding the present study.
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Cited by (27)
Acute concomitant injury and intoxication in complainants of recent sexual assault: A review
2022, Journal of Forensic and Legal MedicineThe pattern of genito-anal injuries in female sexual assault cases in Mumbai, India
2021, Forensic Science International: ReportsCitation Excerpt :Injuries were more in those victims who were virgins [1,15,26]. It has been reported that genito-anal injuries are possible after vigorous consensual sex [27,28]. As in most of the cases genito-anal injuries are absent, there is a possibility that the police and court might presume that rape has not occurred [25].
Comment to the article: Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females
2021, Journal of Forensic and Legal MedicineAnal/anogenital lesion revealing child sexual abuse: A case series of an unusual situation in a black African setting
2020, International Journal of Surgery Case ReportsCitation Excerpt :According to WHO, child sexual abuse (CSA) is the involvement of a child in sexual activity that he/she does not fully understand and/or is unable to give informed consent [1,2]. Globally, the prevalence of genito-anal injuries after sexual abuse is estimated between 9% and 87% depending on the ages of the survivors in the sample, method of examination and the type of injuries included [3–5]. The earliest study of CSA in Africa dates back in 1984 by Westcott et al., who described 18 cases at a Cape Town hospital [6].
Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault
2017, Forensic Science InternationalCitation Excerpt :Of these six, only three [4,19,20] in addition to the Australian study conducted by Lincoln et al. [8] excluded redness and swelling as injuries and therefore are suitable for comparison of genital injury frequency following completed vaginal penetration with our study. A further four more recent studies not reviewed by Lincoln, have significant methodological differences to our study precluding comparisons with our findings [24–27]. Of the four comparable genital injury studies, the earliest study (1992) reported a 9% prevalence of genital injury [4], much lower than our overall prevalence of 22%.