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

The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review

BACKGROUND

Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies.

AIMS AND OBJECTIVES

We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed.

METHODS

Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms.

RESULTS

Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized.

CONCLUSIONS

This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.

Identifying the prevalence of genital injuries amongst patients attending Saint Mary's sexual assault referral centre following an allegation of digital penetration

This study aimed to (1) add to the limited evidence base regarding genital injury associated with digital vaginal penetration and (2) identify predisposing or protective factors to the identification of a genital injury. Data collection was performed retrospectively on the paper case files of 120 female adult (>18 years) patients alleging digital vaginal penetration with no penile vaginal penetration that had an acute FME at Saint Mary's Sexual Assault Referral Centre (SARC) Manchester. Descriptive statistics were used to investigate differences in the demographics of those reporting digital penetration, with and without injuries. Overall, 18% had genital injuries noted at the time of the FME. Posterior fourchette was the most common location of genital injury and abrasion was the most common injury type. It is worth further noting that all 22 patients where an injury was noted were of white ethnicity, only 12 patients in the sample were not white so caution is needed in interpretating this finding of a non-significant difference. Future research should consider injury and ethnicity more specifically. The findings from this study add to the existing evidence base and should prove useful to expert witnesses when called upon to interpret examination findings of sexual assault complainants as they relate to an allegation of digital penetration.

Consequences of the lack of clinical forensic medicine in emergency departments

Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.

Comparison of the quality of clinical forensic examination of victims of physical violence conducted by clinicians and forensic examiners

INTRODUCTION

The Istanbul Convention calls for comprehensive care for victims of violence while maintaining forensic standards. After violent crimes, court usable documentation of injuries and securing of evidence is essential to avoid disadvantages for those affected in criminal prosecution.

MATERIAL AND METHODS

This retrospective study compares forensic relevant aspects in clinical forensic examination of victims of physical and sexual violence conducted by clinicians and forensic examiners. Forensic medical reports based on clinical documentation of individuals of all ages in the period from 2015 to 2018 (n = 132) were evaluated in comparison to a control group of examinations conducted by forensic specialists. A comparative statistical evaluation was performed.

RESULTS

The study revealed statistically significant differences in forensically relevant aspects. In the clinical examinations, full-body examination was performed in only 37.9%, and concealed body sites were examined in 9.8%. Photo documentation was often incomplete (62.4%), without scale (59.1%), blurred (39.7%), or poorly exposed (31.2%). Information on size, color, shape, and texture of injuries was often missing. In about every third examination, the findings were not described purely objective. A body scheme was used only in 8.3% of the clinical cases.

DISCUSSION

In order to establish nationwide care structures and the forensic standard required in criminal proceedings, intensive involvement of forensic medicine is essential. Standardized examination materials, regular training of medical staff, and telemedical approaches can improve the care for victims of violence regarding criminal prosecution.

Characteristics of acute sexual assault care in New England emergency departments

Objective

Interventions such as written protocols and sexual assault nurse examiner programs improve outcomes for patients who have experienced acute sexual assault. How widely and in what ways such interventions have been implemented is largely unknown. We sought to characterize the current state of acute sexual assault care in New England.

Methods

We conducted a cross-sectional survey of individuals acute with knowledge of emergency department (ED) operations in relation to sexual assault care at New England adult EDs. Our primary outcomes included the availability and coverage of dedicated and non-dedicated sexual assault forensic examiners in EDs. Secondary outcomes included frequency of and reasons for patient transfer; treatment before transfer; availability of written sexual assault protocols; characteristics and scope of practice of dedicated and non-dedicated sexual assault forensic examiners (SAFEs), provision of care in SAFEs' absence; availability, coverage, and characteristics of victim advocacy and follow-up resources; and barriers to and facilitators of care.

Results

We approached all 186 distinct adult EDs in New England to recruit participants; 92 (49.5%) individuals participated, most commonly physician medical directors (n = 34, 44.1%). Two thirds of participants reported they at times have access to a dedicated (n = 52, 65%, 95% confidence interval [CI], 54.5%-75.5%) or non-dedicated (n = 50, 64.1%; 95% CI, 53.5%-74.7%) SAFE, but fewer reported always having this access (n = 9, 17.3%; 95% CI, 7%-27.6%; n = 13, 26%; 95% CI, 13.8%-38.2%). We describe in detail findings related to our secondary outcomes.

Conclusions

Although SAFEs are recognized as a strategy to provide high-quality acute sexual assault care, their availability and coverage is limited.

Evaluating the effectiveness of a mobile application to improve the quality, collection, and usability of forensic documentation of sexual violence

BACKGROUND

Survivors of sexual violence deserve timely and high-quality forensic examination, evidence collection, and documentation as part of comprehensive care. However, in many countries, the quality of medical-legal documentation is severely limited. MediCapt is an innovative digital application that enables clinicians to document forensic medical evidence as well as capture and securely store forensic photographs of injuries. This study evaluated the effectiveness and usability of MediCapt to document forensic medical evidence of sexual violence.

METHODS

This mixed-methods evaluation involved key-informant interviews, usability questionnaires, and forensic record reviews. Participants included clinicians, medical records personnel, information technology personnel, and health facility administrators, as well as law enforcement and legal professionals in Kenya.

RESULTS

The Physicians for Human Rights (PHR) data quality checklist found that using MediCapt led to significantly higher data-quality scores compared to paper-based forms. MediCapt forms scored higher on 23 of 26 checklist items. While a wide difference in quality was seen among paper-based forms, MediCapt appeared to both standardize and improve quality of documentation across sites. MediCapt strengths included data security and confidentiality, accuracy and efficiency, and supplemental documentation with photography. Weaknesses included infrastructure challenges, required technological proficiencies, and time to learn the new system. Although it is early to assess the impact of MediCapt on prosecutions, providers and law and justice sector professionals were optimistic about its usefulness. They identified MediCapt as appropriate for use with survivors of sexual violence and reported MediCapt's legibility and photography features had already been commended by the court.

CONCLUSION

MediCapt was well-received across all sectors, its use was perceived as feasible and sustainable, and it significantly improved the quality of collected forensic data. It is anticipated this improvement in forensic documentation will increase successful prosecutions, strengthen accountability for perpetrators, and improve justice for survivors.

Population-Level Trends in Emergency Department Encounters for Sexual Assault Preceding and During the COVID-19 Pandemic Across Ontario, Canada

IMPORTANCE

Lockdown measures and the stress of the COVID-19 pandemic are factors associated with increased risk of violence, yet there is limited information on trends in emergency department (ED) encounters for sexual assault.

OBJECTIVE

To compare changes in ED encounters for sexual assault during the COVID-19 pandemic vs prepandemic estimates.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, population-based cohort study used linked health administrative data from 197 EDs across Ontario, Canada, representing more than 15 million residents. Participants included all patients who presented to an ED in Ontario from January 11, 2019, to September 10, 2021. Male and female individuals of all ages were included. Data analysis was performed from March to October 2022.

EXPOSURES

Sexual assault, defined through 27 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, procedure and diagnoses codes.

MAIN OUTCOMES AND MEASURES

Ten bimonthly time periods were used to compare differences in the frequency and rates of ED encounters for sexual assault between 2020 to 2021 (during the pandemic) compared with baseline prepandemic rates in 2019. Rate differences (RDs) and age adjusted rate ratios (aRRs) and Wald 95% CIs were calculated using Poisson regression.

RESULTS

From January 11, 2019, to September 10, 2021, there were 14 476 656 ED encounters, including 10 523 for sexual assault (9304 [88.4%] among female individuals). The median (IQR) age was 23 (17-33) years for female individuals and 15 (4-29) years for male individuals. Two months before the pandemic, ED encounters increased for sexual assault among female individuals (8.4 vs 6.9 cases per 100 000; RD, 1.51 [95% CI, 1.06 to 1.96]; aRR, 1.22 [95% CI, 1.09 to 1.38]) and male individuals (1.2 vs 1.0 cases per 100 000; RD, 0.19 [95% CI, 0.05 to 0.36]; aRR, 1.19 [95% CI, 0.87 to 1.64]). During the first 2 months of the pandemic, the rates decreased for female individuals (4.2 vs 8.3 cases per 100 000; RD, -4.07 [95% CI, -4.48 to -3.67]; aRR, 0.51 [95% CI, 0.44 to 0.58]) and male individuals (0.5 vs 1.2 cases per 100 000; RD, -0.72 [95% CI, -0.86 to -0.57]; aRR, 0.39 [95% CI, 0.26 to 0.58]). For the remainder of the study period, the rates of sexual assault oscillated, returning to prepandemic levels during the summer months and between COVID-19 waves.

CONCLUSIONS AND RELEVANCE

These findings suggest that lockdown protocols should evaluate the impact of limited care for sexual assault. Survivors should still present to EDs, especially when clinical care or legal interventions are needed.

Beyond Forensic Evidence: Examining Sexual Assault Medical Forensic Exam Mechanisms that Influence Sexual Assault Case Outcomes

Despite the widespread use of sexual assault medical forensic exams (SAMFEs), practitioners and researchers continue to debate the role of SAMFEs and the evidence they provide in the investigation and prosecution of sexual assault cases. Using data from a review of sexual assault cases reported to police between 2015 and 2017 in two jurisdictions (n = 534), we use logistic regression examine whether the presence of a SAMFE predicts the likelihood of achieving criminal case processing outcomes and whether the relationship of the SAMFE with criminal case processing outcomes is moderated by other legal and extralegal case characteristics. We did not find evidence that the presence of a SAMFE in a case significantly predicts whether a suspect will be identified, arrested, or convicted overall, but we did find evidence of the SAMFE's injury documentation value for arrest. Researchers and practitioners should account for the multiple ways SAMFEs can influence decision-making in future research and policymaking.

Factors Associated With Law Enforcement Reporting in Patients Presenting for Medical Forensic Examinations

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011-2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p = .001). Patients who were not students were more likely to report than students (OR = 3.24; p = .002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p = .007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p = .008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p = .056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting.

Development and validation of a data quality index for forensic documentation of sexual and gender-based violence in Kenya

Introduction

High-quality forensic documentation can improve justice outcomes for survivors of sexual and gender-based violence, but there are limited tools to assess documentation data quality. This study aimed to develop and validate a data quality assessment index to objectively assess clinician documentation across the 26 key elements of the standardized forensic evidence forms used in Kenya.

Methods

Informed by prior quality assessment tools, an initial draft of the index was developed. Feedback from Kenya- and U.S.-based clinicians and human rights experts was solicited and incorporated into the draft index in an iterative fashion. Two raters independently employed the finalized Physicians for Human Rights Data Quality Index to assess and score the quality of documentation across 31 clinician-completed forms. Inter-rater reliability was determined using Cohen kappa (к) coefficients.

Results

The Index was found to have substantial overall reliability. Of the 26 documentation items, the Index had a perfect (к = 1.0) and almost perfect (к = 0.81–0.99) level of inter-rater agreement across 17 (65.4%) and 5 (19.2%) items, respectively. On a low-to-high documentation quality scale of 0 to 2, the majority of items (n = 19, 73.1%) had a mean documentation quality score >1.5–2.

Conclusion

Quality assurance of forensic documentation is an essential component of post-sexual assault care. To our knowledge, this is the first validated quality-assessment tool in the peer-reviewed literature for sexual assault documentation and may be a promising strategy to enhance the quality of sexual assault documentation in other settings, locally, regionally, and internationally.

Rechtsmedizinische Modelle der Versorgung von gewaltbetroffenen Personen in Deutschland

Hintergrund

In Deutschland bestehen keine einheitlichen Strukturen für die Versorgung von Gewaltbetroffenen. Aktuellen politischen Bestrebungen zufolge soll eine Beweissicherung auch ohne Strafanzeige flächendeckend in Deutschland ermöglicht werden. Die Rechtsmedizin verfügt über die notwendige Expertise, um eine gerichtsverwertbare Befunderhebung niederschwellig durchzuführen und den Aufbau eines solchen Angebotes zu begleiten.

Material und Methoden

Durch die Arbeitsgemeinschaft Klinische Rechtsmedizin der Deutschen Gesellschaft für Rechtsmedizin erfolgte eine Umfrage an rechtsmedizinischen Instituten in Deutschland zu aktuellen Modellen der Versorgung von Gewaltbetroffenen. Ausgewertet wurden Angaben zur Projektstruktur, zum Leistungsangebot und zum Versorgungsgebiet, zur Finanzierung sowie zu Vor- und Nachteilen der Projekte.

Ergebnisse

Es wurden 16 Projekte aus 14 Bundesländern rückgemeldet, die körperliche Untersuchungen an eigenen und peripheren Standorten, Beratungen, Lagerungen von Asservaten sowie Fortbildungen beinhalten. In etwa der Hälfte der Projekte haben die rechtsmedizinischen Institute zusätzlich koordinierende Funktion, wobei Kooperationspartner die Untersuchungen durchführen. Der Großteil der Projekte wird über öffentliche Mittel finanziert; in 7 Projekten müssen zusätzlich eigene oder sonstige Mittel aufgebracht werden. Elf Projekte sind befristet oder Modellprojekte.

Diskussion

Rechtsmedizinische Institute verfügen über die notwendige Expertise und bieten ein umfassendes niederschwelliges Angebot für Gewaltbetroffene. Die Finanzierungsmodelle sind heterogen, häufig befristet und nicht auskömmlich. Um die politisch geforderte, flächendeckende Versorgung zu etablieren, sind eine bundesweite Einbeziehung der Rechtsmedizin und auskömmliche Finanzierung dringend notwendig.

Comparative prevalence of anogenital injury following sexual assault in women who have had recent consensual sexual contact

OBJECTIVE

The purpose of this study was to compare the frequency and types of anogenital trauma in rape victims as a function of the time interval between the assault and recent (72 h) consensual sexual intercourse.

METHODS

This retrospective cohort trial evaluated consecutive female patients, age 13 years or older, presenting to a community-based nurse examiner clinic (NEC) during a 5-year study period. The NEC facility is staffed by forensic nurses trained to perform medical-legal examinations using colposcopy with nuclear staining and digital imaging. Eligible patients were classified into five different groups based on the time interval from the last consensual intercourse to the forensic examination (none, 0-24 h, 25-48 h, 49-72 h, 73-96 h). Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system.

RESULTS

A total of 947 cases of sexual assault met the inclusion criteria and were divided into five groups. The age range was 13 to 87 years (mean, 23.9 years); 78% were examined within 24 h following sexual assault. The five study groups were comparable in terms of demographics, assault history, and incidence of non-genital injuries. The overall frequency, type, or location of anogenital injury did not vary significantly between groups (p > 0.5).

CONCLUSION

This is the first clinical study to systematically compare the prevalence and typology of anogenital injuries in sexual assault victims who have had consensual intercourse within four days before a forensic exam. The frequency, type or location of anogenital trauma did not vary significantly based on the time interval from last consensual intercourse to the forensic examination.

The legal impact of forensic medical life-threatening danger assessment conclusions in cases of violent offense

OBJECTIVE

The aim of this study was to examine the association between the legal outcome for suspected perpetrators and the forensic life-threatening danger assessments conducted as part of the clinical forensic medical examinations of victims with penetrating injuries.

METHOD

From the Danish Central Crime Register, we retrieved the legal outcomes for suspected perpetrators linked to victims with penetrating injuries in a six-year period and compared the proportional distribution of forensic life-threatening danger assessment conclusions - no life-threatening danger (NLD), could have been in life-threatening danger (CLD), and life-threatening danger (LD) - with the legal outcomes.

RESULTS

326 victims were related to at least one identified suspected perpetrator with a legal outcome. When the forensic life-threatening danger assessments were more severe, an increased proportion of cases resulted in formal charges and, subsequently, conviction, than when the forensic life-threatening danger assessments were less severe. The percentage point differences between NLD, CLD, and LD were almost equal.

CONCLUSION

Our results indicate that the forensic life-threatening danger assessments are associated with the legal outcome, as both the proportion of cases with formal charges and the proportion of cases with a conviction increased with the severity of the forensic life-threatening danger assessment conclusions.

Sexual Assault Against Women: A Retrospective Study of 292 Cases in Fujian Province, China

INTRODUCTION

In China, rape is defined as forced sexual intercourse against a woman's will by violence, coercion, or any other means or intentionally having sexual intercourse with a girl under the age of 14 years who is legally incompetent of giving consent.

METHOD

A retrospective study of 292 cases of rape in Fujian Province, China, between the years 2014 and 2017 was conducted. Sociodemographic characteristics of victims and perpetrators, perpetration patterns of rape, and associated factors were reviewed and analyzed.

RESULTS

Over a quarter of rape victims were under the age of 18 years. In over half of cases, the perpetrators were known to the victims, which was more frequent in minors than in adult victims. Over half of perpetrators were within the age range of 18-30 years. Most perpetrators had received a low level of education and were from low-income populations. Nighttime has the highest occurrence of rapes: 39.9% of rapes occurred during late night; and 24.6%, during early night. Victim perpetrator relationship and the location were significantly related (χ2 = 23.667; df = 3, 266; p < 0.001). Risk evaluation showed that 30.8% and 28.1% of cases occurred under medium- and high-risk settings, respectively. Sexual motivation was present in over 95% of cases. Physical force was used in almost half of cases. Less than half of victims received forensic clinical examination after perpetration.

CONCLUSIONS

The findings provide population-based data to contribute to the future development of prevention strategies and to raise awareness of the urgent need for victim assistance services.

Prosecutors' Perspectives on Biological Evidence and Injury Evidence in Sexual Assault Cases

Little prior research has explored how prosecutors perceive and utilize biological and injury evidences in sexual assault cases. In this qualitative study, semistructured interviews were conducted with assistant district attorneys (ADAs) working in an urban district attorney's office in the northeastern United States. ADAs were asked to describe how biological and injury evidences could be probative and their strategies for using this evidence. The interviews suggest that prosecutors perceive the probative value of biological and injury evidences on a continuum, varying based on case characteristics. Prosecutors felt that undergoing a forensic medical examination in itself supported victims' credibility. Biological evidence bolstered victims' credibility if it matched the victim's account better than the defendant's. They perceived DNA evidence as helpful when it identified unknown suspects, confirmed identification of suspects by other means, or rebutted defendants' denial of sexual contact. DNA evidence was also helpful when victims were incapacitated, too traumatized to recall or talk about the assault, or too young to identify assailants, and when police used the information in interrogating suspects. The biggest limitation to biological evidence prosecutors cited was overcoming the consent defense. The ADAs reported they used DNA evidence even when it was not particularly probative, because it confirms the correct person is being prosecuted, it communicates the victim's and prosecution's seriousness, and it meets jury expectations in trials. Prosecutors found injury evidence useful because it corroborated victims' accounts and helped refute defendant claims of consensual sex. The findings may assist in educating others about biological and injury evidences in these cases, and could inspire professionals and advocates to work to develop and support a broad range of investigative methods.

Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females

BACKGROUND

Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases.

OBJECTIVES

To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables.

METHODS

We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted.

RESULTS

We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears.

CONCLUSION

External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.

Forensic photo-documentation in adult sexual assault- what do patients think?

Historically, some forensic practitioners and policy makers have viewed the use of photography in forensic documentation for adult victims of sexual assault as controversial. Some argue that diagrams and verbal descriptions of injury are sufficient, suggesting that sexual assault victims are so traumatised at time of examination that they are not able to provide valid consent, that the imaging process itself is humiliating, and that any decision to have photographs taken might be later regretted. Objectively, a patient capable of consenting to a forensic examination has an equal capacity to consent for forensic imaging, even when this involves sensitive areas of the body, and the process of forensic photography is not inherently problematic. Literature on forensic photography is sparse, particularly from the patient perspective. Our Forensic Medical Unit is in an excellent position to investigate this issue, as it is one of the few services in Australia that routinely offers sexual assault forensic photography, including genital, as part of its standard procedures for injury documentation. Photographs, in adult sexual assault cases, are not routinely taken of normal anatomy nor are they ever taken without patient consent. This study explores the immediate and short-term experiential impacts of forensic photography from the victims' perspective. Capacity to consent was assessed using a trauma informed, evidence-based interviewing tool at the start of their forensic assessment. Participants also completed questionnaires at the conclusion of their examination and on follow-up. Results show that victims not only have the capacity to provide informed consent but also found forensic photography, and the reasons for it, quite acceptable. A majority [80%; n = 87/108] indicated the photographic process had either been not at all or only a little embarrassing. When asked how they felt about having photographs taken, the majority 93.4% [n = 99/106) indicated that as well as having no regrets they were also happy with the way the images had been taken. 4.7% [n = 5] expressed some doubt about whether they had made the right decision. A similar pattern of responses was observed at follow-up which occurred, on average, seven weeks post examination. 72% [n = 26/36] said they did not think about the photographs at all or did so rarely. While 14% [n = 5/36] said they thought about them a fair bit or a lot of the time, most stated they had no concerns regarding the images that had been taken. Given its evidentiary salience and other benefits, such as its potential to promote greater transparency in the provision of forensic opinions and its usefulness in teaching, this study supports the case for the routine use of forensic photography in adult Sexual Assault Units more broadly.

Sexually assaulted women: Results of a retrospective analysis of 850 women in Germany

OBJECTIVE

According to prevalence studies, at least 5-6 % of women in Europe experience rape in their lives. The initial treatment after a sexual assault can influence the individual healing process positively. In Germany, there are hardly any studies that investigate larger collection of cases of sexual assault treated in hospitals. However, knowledge about characteristics of cases of sexual assault is a prerequisite for the optimal processing of primary care.

STUDY DESIGN

For this study, the retrospective collection of data on cases of suspected sexual assault of patients presented for treatment at the Charité was carried out. Standardized findings sheets as part of a rape kit used in all cases were evaluated. Overall, 850 cases from the period between 01.01.2011 and 30.06.2016 were analyzed. The statistical evaluation was descriptive.

RESULTS

The median age of patient was 26 years (range 16-92). Penetration (vaginal/anal/oral) occurred in 75 % of cases. The suspect was unknown to 48,4 % of those affected, 26 % came from a circle of friends or acquaintances. 15,5 % were partners or expartners. 2/3 of the sexual assaults took place in private rooms, especially in the apartments of the victims. More than 2/3 of the women had drunk alcohol in temporal proximity to the crime. Extragenital injuries were present in 61,4 % of those affected and anogenital injuries in 25,4 %. Extragenital injuries were predominantly classified as mild (92,9 % in general physical examination and 62,4 % in eyes-nose-throat-examination). 42,1 % of the assaults took place on the weekend. 74,8 % of the patients presented themselves within 24 h of the suspected offence.

CONCLUSION

To our knowledge, this is the largest analysis of cases of sexually assaulted women treated at a hospital in Germany. The results point to important components of primary care, e.g. standardized injury recording and alcohol measurement, as these can serve as evidence in subsequent court proceedings. The structures of the first care of victims after sexual assault should consider that the majority of those affected present themselves at the weekend.

Three groups of suspects in police reported rape cases: First-time suspects, recidivists and unidentified suspects. A comparative study

BACKGROUND

Previous studies show that reported suspects in adult rape cases often have a criminal record, and that many are rape recidivists. Annual numbers of police reported rapes have dramatically increased but the proportion of rapes being prosecuted and numbers of convictions are low. To increase knowledge about the suspects in cases of police reported rapes; whether they have committed the crime before or not may inform preventive measures.

AIMS

To compare suspect, victim, and assault related characteristics among different groups of police-reported rape suspects (first-time suspects, recidivist suspects and unidentified suspects).

METHODS

Retrospective, descriptive study of suspects in cases of rape or attempted rape reported by women ≥16 years of age in the Sør-Trøndelag police district, Norway, from 2003 to 2010.

RESULTS

Among the 356 suspects included, 207 (58%) were first-time suspects, 75 (21%) were recidivists and 74 (21%) were unidentified. Being a first-time suspect was significantly associated with victim being <18 years, recidivist suspect was significantly associated with victim being a partner, both suspect- and victim unemployment, and suspect reporting intake of other drugs than alcohol. When suspects were unidentified, victims were more likely to have consumed alcohol prior to assault, and reporting the suspect being of non-Western origin. Also, the reporting of a public venue was more frequent when unidentified suspect.

CONCLUSIONS

The study shows different patterns in groups of suspects as to victim and assault characteristics. Detection and description of such differences can provide valuable information for future prevention programs, police investigation methods and health care guidelines.

Funneled Through or Filtered Out: An Examination of Police and Prosecutorial Decision-Making in Adult Sexual Assault Cases

To improve criminal justice responses to sexual assault, it is vital to understand the factors that influence decisions made by police and prosecutors and how these decisions overlap. Although decisions made at the prosecutorial stage are largely reliant on the actions of the police, the prosecutors' charging decisions often differ from how the police classify incidents. Guided by the focal concerns perspective, this study examined 231 cases of adult sexual assault incidents reported to the police to identify which factors were predictive of congruent charging decisions and arrest. The results supported the focal concerns perspective and revealed that legal and extralegal factors were influential at both of these points. Legally relevant factors that focused on the collection of evidence were paramount in decisions at both stages; however, extralegal variables such as timely reporting and whether the victim physically resisted were also significantly related to decisions at each stage. Implications arising from the results are discussed.

Psychosocial Vulnerability Among Patients Contacting a Norwegian Sexual Assault Center

In this study, the objective was to assess the occurrence of specific vulnerability factors among adult and adolescent females attending a Norwegian sexual assault center (SAC). We also explored assault characteristics and investigated whether these characteristics differed between the group of patients with vulnerability factors compared with the group without such factors. We conducted a retrospective descriptive study of 573 women ≥ 12 years of age attending the SAC at St. Olavs Hospital, Trondheim, Norway, between July 1, 2003 and December 31, 2010. A patient was considered vulnerable if at least one of the following features was present: intellectual or physical disability; history of present/former mental health problems; history of present/former alcohol/substance abuse; or former sexual assault. At least one vulnerability factor was present in 59% of the cases. More than one vulnerability factor was present in 29%. Reporting at least one vulnerability factor was associated with a higher patient age, unemployment, a higher frequency of reported light/moderate physical violence, and the documentation of minor body injury. In contrast, those without vulnerability more often were students assaulted during night time, by a casual or stranger assailant and reporting a higher intake of alcohol prior to the assault. There are obvious patterns of differences in the nature of sexual assaults reported among victims with specific vulnerability factors compared with victims without these factors. Future research should address these differences and possible solutions for better protection of especially vulnerable individuals against sexual offenses, such as those with mental health and substance abuse difficulties.

The Effects of Legislation Mandating DNA Testing in Sexual Assault Cases: Results in Texas

Many cities and states have taken steps to identify and process all untested sexual assault kits (SAKs). Texas was one of the first states to enact such legislation-SB 1636-which created a time line for a statewide audit and mandatory testing of SAKs. A mixed-methods approach was used to assess the effects of SB 1636 at both state and local levels. The study did not detect any effect of SB 1636 on reporting, arrests, or convictions. The legislation did have a significant effect on criminal justice workloads, particularly crime laboratories.

The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends

OBJECTIVE

The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape.

METHODS

All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included.

RESULTS

The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015.

CONCLUSION

The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault

In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.

Legal decision-making in child sexual abuse investigations: A mixed-methods study of factors that influence prosecution

Prosecution of child sexual abuse cases is an important aspect of a community's response for holding perpetrators accountable and protecting children. Differences in charging rates across jurisdictions may reflect considerations made in prosecutors' decision-making process. This mixed-methods, multiphase study used data from a Children's Advocacy Center in a suburban county in the Southern United States to explore the factors associated with child sexual abuse cases that are accepted for prosecution and the process followed by prosecutors. Data were sequentially linked in three phases (qualitative-quantitative-qualitative), incorporating 1) prosecutor perceptions about what case characteristics affect charging potential, 2) 100 case records and forensic interviews, and 3) in-depth reviews of cases prosecuted. Content analysis was used to identify influential case elements, logistic regression modeling was used to determine factors associated with a decision to prosecute, and framework analysis was used to further confirm and expand upon case factors. Overall, findings indicate that prosecution is most strongly predicted by caregiver support and the availability of other evidence. The decision to prosecute was found to include a process of ongoing evaluation of the evidence and determination of a balanced approach to justice. The decision to prosecute a case can be influenced by strong and supportive investigative practices. An important implication is that interaction among multidisciplinary professionals promotes communication and efforts, further enhancing discretion about potential legal actions.

A retrospective study of sexual offences in Zambia

Zambia has recently reported high incidences of sexual abuse against women and children. Zambian law categorises sexual offences into rape, defilement, incest and others, with defilement constituting the majority of the reported cases (>89%). Between 2010 and 2012, convictions of defilement cases were achieved in only 13% of cases reported to the police. DNA evidence has shown prominence in resolving crimes, specifically as an identification tool in sexual offences. Currently there is no empirical evidence describing the role of forensic evidence in sexual crimes in Zambia; as such a retrospective study was conducted to evaluate this between 2007 and 2014 (n = 1154). Only 14 (0.1%) of the cases had forensic samples collected in the form of a vaginal swab for semen analysis. In all cases where a suspect was identified (60%), identification was based on the witness/victim testimonies, and in no case, was forensic DNA evidence used to assist in identification or corroborate the testimonies. Overall, 28.1% of cases were taken to court and the conviction rate was 12.4%. These findings support the use of employing DNA evidence in sexual offence cases to aid the identification of suspects, which is hypothesised to increase the number of cases prosecuted in Zambia.

Factors associated with trace evidence analyses and DNA findings among police reported cases of rape

OBJECTIVE

The aim of this study was to examine the association between victim, suspect and assault characteristics and (1) forensic analysis of trace evidence, (2) detection of spermatozoa and (3) DNA match in police-reported cases of rape/attempted rape. In addition, we explored whether DNA findings were associated with legal outcome.

METHODS

We conducted a retrospective, descriptive study based on police-reported rapes and attempted rapes of women  ≥16 years of age in Sør-Trøndelag Police District throughout 1997-2010. Police data were merged with information from the Sexual Assault Centre (SAC) at St. Olavs University Hospital, Trondheim, Norway. We used binary and multivariable logistic regression for the comparisons.

RESULTS

We identified 324 victims (mean age 24 years). The police requested analysis in 135 (45%) of the 299 collected victim samples. The police decision to analyze was after adjustment associated with the victim being employed or under education, and a public venue, but not with interval from assault to sampling. Spermatozoa were detected in 79 (61%) of the analyzed cases, of which 71 were collected from victims within 24h. Interval from assault being <24h and reporting a penetrative assault remained associated with the findings of spermatozoa after adjustments. Forensic analyses of trace evidence collected from victim, suspect and/or venue disclosed matching DNA profiles in 57 (40%) of a total of 143 analyzed cases. Matching DNA profiles were associated with suspect being known to the victim and with the venue being private. A higher proportion of cases with a DNA match were prosecuted in court: 20 of the 29 cases prosecuted. However, despite a DNA match 35 cases were anyway dismissed because of insufficient evidence.

CONCLUSIONS

Although many of the associations in our study were expected, it is still important to report the actual numbers to gain insight into the importance of a DNA match in legal proceedings. A substantial proportion of cases with DNA match was dismissed because of insufficient evidence. To strengthen the justice response to sexual assault, it is essential to generate knowledge about the role of medico-legal evidence in such cases, and there are obviously other non-medical factors influencing the legal decisions.

Comparison of Injury Patterns in Consensual and Nonconsensual Sex: Is It Possible to Determine if Consent was Given?

Matters of sexual consent and sexual assault are hotly debated issues among professionals and laypersons alike. A widespread misconception of sexual assault is that most victims of sexual assault sustain significant physical trauma. It is the purpose of this review article to compare the patterns of physical injury (both genital and extragenital) in victims of sexual assault and participants of consensual sex to conclude if physical injury alone can indicate whether consent was given. Interpretations of injury have great forensic significance as it can influence the outcome of sexual assault cases. Several articles indicate that extragenital injuries are commonly found in sexual assault victims (46%-82%) and that most of such injuries are deemed minor. Articles report a wide range of genital injury detection rates in both sexual assault victims (6%-87%) and consensual sex participants (6%-73%). Usage of different examination techniques may partly explain the wide range of detection rates reported. Out of all those who sustained genital injuries, only a small portion of people required hospitalization. In both consensual and sexual assault cases, genital injuries in the 6 o'clock position were most common. Studies of genital injury lacked standardization of factors that significantly influence the results, such as time to examination after sex, examination techniques, and injury severity scales. Therefore, medicolegal personnel should be aware that sexual assault victims can present with a wide range of physical trauma and should avoid relying on physical trauma alone to conclude whether consent was present.

Sexual assault and general body injuries: A detailed cross-sectional Australian study of 1163 women

OBJECTIVES

To describe the frequency and severity of general body injury in women alleging recent sexual assault and then identify demographic and assault characteristics associated with injury severity.

DESIGN

Cross-sectional study.

SETTING

Sexual Assault Resource Centre (SARC), Western Australia.

PARTICIPANTS

Total of 1163 women attending SARC from Jan-2009 to Mar-2015.

METHODS

Women underwent a standardised medical examination and data collection by forensically trained doctors. Multivariate ordinal logistic regression analyses were performed. An algorithm was used to classify general body injuries as mild, moderate or severe.

RESULTS

General body injury was observed in 71% of women; 52%, 17% and 2% were classified as having respectively, mild, moderate and severe injuries. Moderate or severe injury was observed in 30.4% of women assaulted by intimate partners, 16.4% of women assaulted by strangers and 14.9% of women assaulted by friends/acquaintances. In regression analysis, an interaction between mental illness and assailant type existed after adjusting for age, intellectual disability, time-to-examination, number of assailants and location. Mental illness was an independent predictor for lower injury severity (adjusted odds ratio=0.5, 95% CI 0.3, 0.9) in women assaulted by strangers and higher injury severity in women assaulted by a friend/acquaintance (adjusted odds ratio=2.4, 95% CI 1.6, 3.6). While women assaulted by intimate partners had more frequent moderate-to-severe injuries than other women their current mental illness status was not associated with risk of injury severity.

CONCLUSION

This study highlights the increased injury severity in women assaulted by intimate partners. The risk of moderate/severe injury for women with mental illness assaulted by their acquaintances was unexpected and requires further investigation.

[Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes]

OBJECTIVES

To describe the medical and legal characteristics of sexual assault victims and to highlight which aspects of the medical examination may be associated with a conviction of the alleged offender.

METHODS

This study included all women who consulted to the center for the victims of sexual assault in Nancy between 2008 and 2012 and who filed a complaint. Associations were evaluated with a logistic regression trying to explain the presence of a conviction at the end of the legal proceeding.

RESULTS

Three hundred seventy-six victims were included. Following aspects were associated with a reduced probability of conviction: the use of psychoactive substances, the prescription of an antiretroviral therapy and the presence of more than one assailant. The prescription of pain killers were contrarily related to the conviction of an assailant.

CONCLUSION

A detailed description, an interpretation of the physical injuries and the prescription of toxicological tests if needed are decisive in the outcome of the legal proceedings of victims of sexual assault. The education of populations at risk and the accompanying of the victims can reduce the delay of care and optimize the collection of evidence.

Increasing the Accessibility of Sexual Assault Forensic Examinations: Evaluation of Texas Law SB 1191

INTRODUCTION

Texas SB 1191 was enacted in 2013 with the intent of increasing access to medical forensic examinations for sexual assault victims by requiring every hospital with an emergency department to be prepared to provide a medical forensic examination if requested by a sexual assault victim. To realize that goal, the law also required basic forensic training for medical professionals before conducting a medical forensic examination as well as a requirement that hospitals develop a "plan to train personnel on sexual assault forensic evidence collection."

METHODS

Interviews were conducted in 18 healthcare facilities (five with sexual assault nurse examiner [SANE] programs and 13 without SANE programs) in Dallas, Lubbock, and Austin to determine their awareness and compliance with SB 1191.

RESULTS

The data suggest that the law had a little effect on actual practice, and sexual assault survivors still sought a SANE program for a medical forensic examination.

DISCUSSION

Although SB 1191 is an important state level effort to make forensic examinations more readily available, it did not fully account for the challenges faced by smaller hospitals that do not see enough sexual assault victims to justify training staff to SANE standards and did not adequately address the training required by medical professionals to feel prepared to conduct a medical forensic examination.

Qualitative Analysis of Prosecutors' Perspectives on Sexual Assault Nurse Examiners and the Criminal Justice Response to Sexual Assault

OBJECTIVE

The aim of this study was to understand prosecutors' perspectives on the contribution of Sexual Assault Nurse Examiners (SANEs) to evidence collection and trials in sexual assault cases.

BACKGROUND

Several studies have suggested that a sexual assault case is more likely to progress in the criminal justice system when a SANE conducts the forensic medical examination. However, little is known about how prosecutors perceive SANEs and what they value about SANEs versus other medical professionals.

METHOD

Semistructured interviews, conducted in one jurisdiction with eight assistant district attorneys who prosecute sexual assault cases, included questions about the value of SANEs in evidence collection and trials. Interview transcripts were analyzed to identify common themes and variability among prosecutors.

RESULTS

Most prosecutors identified advantages for SANEs in evidence collection, trial preparation, and testimony. Specific advantages cited by one or more prosecutors included superior documentation, thoroughness of the physical examination, better identification of injuries, quality of relationships with patients, professionalism, skill in trial preparation and testifying, and credibility with jurors.

DISCUSSION

These findings help validate SANEs' contribution to the criminal justice response to sexual assault, despite the study's limitations in sample size and inclusion of only one jurisdiction. The study also suggests the value of further education about SANEs for prosecutors who may not have the opportunity to learn about the range of skills SANEs possess.

Validation of alternate light sources for detection of bruises in non-embalmed and embalmed cadavers

Bruising is frequently documented in cases of violence for use as forensic evidence. However, bruises can be overlooked if they are not visible to the naked eye. Alternate light sources such as ultraviolet, narrow band, and infrared have been used in an attempt to reveal the presence of bruising that is not otherwise apparent. However, there is a significant gap in knowledge surrounding this technique as it has not been validated against histology to confirm that bruising is genuinely being enhanced. A recent study evaluated the ability of alternate light sources to enhance visibility of bruises using a pigskin model. However, histological confirmation of bruising in humans using these light sources has not yet been performed. In this study, embalmed and non-embalmed human cadavers were used. Bodies were surveyed with alternate light sources, and enhanced regions that were unapparent under white light were photographed with the alternate light sources and sampled for histological assessment. Immunohistochemical staining for the red blood cell surface protein glycophorin was used determine if the enhanced area was a bruise (defined by the presence of extravasated erythrocytes). Photographs of areas confirmed to be bruises were analyzed using the program Fiji to measure enhancement, which was defined as an increase in the measured transverse diameter. In the non-embalmed and the embalmed cadavers violet alternate light produced the greatest enhancement of histologically confirmed bruises, followed by blue (both p < 0.0001). Regions that were not confirmed as bruises also enhanced, indicating that light sources may not be specific. This suggests that the use of light sources to enhance the visibility of bruising should be undertaken with caution and further studies are required.

The Use of Forensic Evidence in Sexual Assault Investigations

Despite the potential value of DNA evidence for criminal investigations and prosecution, we have a limited understanding of the way forensic evidence is used and its impact on case outcomes. This study uses qualitative data to describe the way investigators from the Houston Police Department use DNA evidence during investigations of sexual assaults. Results show DNA evidence has limited influence during investigations, and the value of DNA evidence is shaped by other evidentiary factors. The findings provide insight into the utility of DNA evidence, instances when DNA evidence is least and most useful, the importance of DNA evidence in comparison with other evidence, and the likely aggregate impact of DNA evidence across sexual assault cases.

The Role of “Real Rape” and “Real Victim” Stereotypes in the Police Reporting Practices of Sexually Assaulted Women

Some feminists have argued that rape myths constrain women’s reporting of sexual assault to the police. The authors investigated whether myth-associated characteristics of sexual assaults play a role in police reporting behaviors of women. A sample of 186 sexual assault cases seen at a hospital-based sexual assault care center in 1994 was analyzed using logistic regression. A positive association was found between reporting a sexual assault to the police and two overtly violent components of the “real rape” myth: the use of physical force and the occurrence of physical injury.

Comparative study of spermatozoa detection using the genital swab versus bedside smear slide technique in sexual assault patients

BACKGROUND

Specimen collection from sexual assault victims is an essential part of practice in forensic medicine. Semen analysis is a forensic test used to confirm sexual contact. Two methods of specimen collection were compared in this study: the genital swab and bedside slide smear.

MATERIALS AND METHODS

A retrospective chart review was performed in the Division of Clinical Forensic Medicine, Siriraj Hospital, Thailand. Data were collected on microscopic spermatozoa detection in the external and internal genitalia, the time interval from assault to visit, and the history of condom use and genital cleansing. McNemar's test was used for comparison between the genital swab and bedside slide smear techniques.

RESULTS

In total, 724 case files from 2009 to 2013 were reviewed. The genital swab technique yielded a higher detection rate than did the bedside slide smear technique in both the external genitalia (37.0% vs. 31.8%, respectively) and internal genitalia (40.8% vs. 34.1%, respectively). Collection of a genital swab only missed positive cases in 4%-6% of negative swabs. When considering both the external and internal genitalia, the genital swab still yielded a higher rate of positive results than did the slide smear (45.9% vs. 39.0%, respectively). Examination of the victim within the first 3 days produced the highest spermatozoa detection rate (46.3%).

CONCLUSIONS

The genital swab is the preferred specimen collection method for spermatozoa detection in adult sexual assault victims. However, collection of both a swab and slide specimen may be considered in some cases. Collection of specimens later than 3 days after the assault greatly decreases the rate of spermatozoa detection.

The (in)significance of genital injury in rape and sexual assault

The forensic significance of genital injury following rape and sexual assault has been the subject of considerable academic and research interest, in terms of the contribution it may provide to the body of evidence in criminal proceedings. This essay takes a critical look at such research, in the context of modern understandings of what actually constitutes rape and sexual assault. Written from the author's perspective as a forensic physician practising in Scotland, it illustrates the fascinating interface between medical evidence and the legal system.

Intimate partner violence against women in Spain: A medico-legal and criminological study

Intimate partner violence (IPV) is a significant worldwide problem whose magnitude and risk factors vary across different settings and cultures. Nowadays, it is a priority to improve the knowledge on this issue in order to formulate better evidence-based policy responses. This study aims to contribute to a better understanding of non-fatal IPV against women in Spain. A retrospective analysis of IPV cases with a final judicial decision was carried out. The period under study extended from January 2005 to December 2012, with a total of 582 files included in the investigation. Most IPV victims were young adult women of Spanish origin, either married or single, with children, unemployed and with a low family income level. The majority of alleged perpetrators were young adults, employed, with a middle-low income level, a history of alcohol consumption/abuse, but no criminal records. Most victims had previous history of IPV, were engaged in a long-term relationship with their abuser and lived with him at the time of assault. The combination of psychological and physical abuse was the most frequent form of violence. The most common mechanisms of assault consisted in minor acts of physical violence, which resulted in mild injuries, most of them in the upper limbs and face. Nearly half of women sought medical care, but physician's injury report was only made in about a quarter of these cases, even though it is mandatory for health professionals. The majority of criminal proceedings were initiated by the victim's report and ended in conviction, most of them being considered occasional mistreatment. This study confirms the heterogeneity of the phenomenon of intimate partner violence. The importance of adopting standard IPV concepts and promoting the recognition and assessment of this form of violence amongst health care professionals, criminal investigators and forensic personnel is emphasized.