Colposcopy and rape

Genitoanal Injury in Sexually Assaulted Adult Women: Six-Year Retrospective in Bangkok

Sexual assault persists as a global problem. Even when sexual assault does not result in obvious visible wounds, genitoanal injury must be evaluated because it is often pertinent for legal outcomes. Macroscopic ("naked eye") examination is valuable when colposcope is not available or when patients do not consent. This study reviewed the genitoanal injuries of 117 sexually assaulted adult women evaluated macroscopically. Genitoanal injury prevalence was 47%, and nongenitoanal injury prevalence was at 44%. The most common injury type was abrasion, and the most common site was posterior fourchette. Most injury patterns were singular. The number of women who did not report a history of sexual intercourse in the sample and usage of fingers/palm during assault may have affected pattern and/or injury type. There was a significant relationship between hymenal old tear below the 3- to 9-o'clock area and prior sexual intercourse. Factors related to genitoanal injury were prior sexual intercourse, vaginal delivery, and spermatozoa detection. In conclusion, all sexually assaulted women should be encouraged to have a pelvic examination: nothing overtly visible does not mean that nothing happened.

Current issues in the use of colposcopy for examination of sexual assault victims

Colposcopic examination is considered the gold standard in child sexual abuse evaluations in Australia. However, there remain contentious issues with its use, especially in adult victims, which we sought to address by a review of the literature. Colposcopy has been shown to be a sensitive and acceptable tool for detection of anogenital abnormalities in children. The significance of some genital findings remains controversial, especially when images are interpreted by inexperienced clinicians. Its use in adult assessments is hampered by a lack of comparative studies on colposcopically detected genital injuries in adults following consensual v. non-consensual sexual intercourse. Further research is urgently needed before the use of colposcopy can be routinely recommended for adult victims.

Using colposcopy in the rape exam: health care, forensic, and criminal justice issues

In the setting of a forensic examination following rape, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped. The role of colposcopic findings as evidence in court testimony, however, remains controversial. This paper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape.

A case of suspected child sexual abuse

Cases of suspected child sexual abuse are notoriously difficult in respect of investigation, management, diagnosis and aftercare. This specialised area of forensic medicine is what might be regarded as a "dynamic science" in that our understanding and knowledge of the subject is incomplete. Recent research continues apace and while this undoubtedly assists in our understanding of the complexities involved, we may be obliged to re-examine our medical opinion on the basis of emerging validated scientific research. Particularly difficult is the problem of educating non-medical professionals that the majority of children who have been the victims of child sexual abuse show no clinical evidence that abuse has occurred. These highly emotive cases may be made yet more difficult by any variation in medical opinion, not specifically limited to that between prosecution and defence "experts". Consequently it behoves us to follow clearly defined guidelines and practices in our investigation and management of these cases such that we might provide the children involved with the best care for their immediate and future health and safety.

Injury in Women Who Are Raped

Sexual assault is considered the silent, violent epidemic. However, many critical care nurses are unaware of the injury patterns that may indicate that their patient has been sexually assaulted. In addition, critical care nurses are often uncertain how to proceed when caring for someone with a suspected sexual assault. This article provides both background information about sexual assault and guidance to critical care nurses on how to manage this difficult situation.

Sexual assault forensic medical examination: is evidence related to successful prosecution?

STUDY OBJECTIVE

We describe the medical-legal findings in a population of adult sexual assault cases assessed in an emergency department setting and reported to the police, document the law enforcement and legal disposition of cases seen over the study period, and determine whether medical-legal findings are associated with filing of charges and conviction after adjusting for demographic factors and assault characteristics.

METHODS

This was a retrospective chart review of all police-reported cases seen from January 1993 to December 1997 at the British Columbia Women's Sexual Assault Service, a 24-hour hospital-based emergency service. Information on patient demographics, assault characteristics, and medical-legal findings was merged with data extracted from police and court files on the cases' legal outcomes and sperm-semen test results of collected forensic evidence. Cases were assigned a clinical injury extent score reflecting the degree of documented genital and extragenital injury. The association of medical-legal variables, patient demographics, and assault characteristics with filing of charges (among the subset of cases in which a suspect was identified by police) and conviction (among the subset of cases in which charge were filed) was examined by using logistic regression.

RESULTS

Charges were filed in 151 (32.7%) and a conviction secured in 51 (11.0%) of the 462 cases examined in this study. Genital injury was observed in 193 (41.8%), and sperm-semen-positive forensic results were obtained in 100 (38.2%) of the 262 samples tested. A gradient association was found for injury extent score and charge filing in the following categories: mild injury (odds ratio [OR] 2.85; 95% confidence interval [CI] 1.09 to 7.45); moderate injury (OR 4.00; 95% CI 1.63 to 9.84); and severe injury (OR 12.29; 95% CI 3.04 to 49.65). Documentation on the police file of receipt of forensic samples collected by the Sexual Assault Service examiner was also significantly associated with charges being filed (OR 3.45; 95% CI 1.82 to 6.56). Injury extent score defined as severe was the only variable significantly associated with conviction (OR 6.51; 95% CI 1.31 to 32.32).

CONCLUSION

The finding that documented injury extent had a significant positive association with both filing of charges and conviction is an important step in confirming the value of injury documentation in the forensic examination of sexual assault victims.

Female victims of rape and their genital injuries

OBJECTIVE

A minority (some report < 10%) of women report sexual assault. Of those that negotiate the police process, only a minority will come to a court hearing. It is thought that the courts still rely upon medical evidence, in particular evidence of genital injury to 'prove' the rape. This study aimed to ascertain the incidence of genital injury in victims of alleged rape.

DESIGN

Retrospective review of case records of women who reported they had had been raped, provided by women doctors on the Northumbrian Police Doctors scheme.

SAMPLE

Case records from Newcastle, North and South Tyneside, Sunderland and Northumbria.

METHODS

Analysis of records in the standardised booklet used by police surgeons to examine women reporting rape.

MAIN OUTCOME MEASURES

Presence of genital injury, presence of other physical injuries.

RESULTS

A minority of women had genital injuries (22/83); the majority had some form of physical injury (68/83), although most of these were minor.

CONCLUSION

The study shows that only a minority of women examined by specifically trained police doctors show evidence of genital injury. The absence of genital injury does not exclude rape.