Sexual assault: a descriptive study of 2500 female victims over a 10-year period

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.

The impact of COVID-19 restrictions on sexual assault in Western Denmark

This study sets out to investigate whether the 15-month nationwide COVID-19 lockdown in Denmark had an impact on the victim demographics, location of sexual assaults, and relationship between victim and perpetrator in the Western part of Denmark compared to the 15 months prior to the lockdown initiatives. This study is a retrospective study including a total of 596 cases. Cases were identified in the database of the Department of Forensic Medicine Aarhus, including cases labeled "rape," "attempted rape," and "later reported." 315 cases were found between March 11th 2020 and June 10th 2021 (lockdown) and 281 cases were found between December 11th 2018 and March 10th 2020(pre-lockdown). Fewer victims were in the age group 15-24 during lockdown (58.4%) than pre-lockdown (71.7%). Fewer stranger rapes occurred during lockdown (11%) than pre-lockdown (19.7%). During lockdown, more sexual assault occurred at a private site (80.1%) than pre-lockdown (60%); correspondingly, fewer public sexual assaults occurred during lockdown (10.3%) than pre-lockdown (26%). No statistically significant difference was observed regarding police reporting of the assault or alcohol intake in the victim prior to assault. We found an overall change in demographics regarding sexual assaults during the lockdown period indicating the restrictions during the lockdown could have affected the patterns of sexual assault in Denmark.

Factors Related to Police Reporting in Sexual Assault Care Centers: Are We Underestimating the Role of Support Persons?

Few victims of sexual assault (SA) report to the police. Research on the role of support persons in victims' reporting is sparse. We address this gap by examining the association of victim, assailant, victimization incident, and support characteristics with reporting rates among victims attending sexual assault care centers (SACCs). Logistic regression results show that type of SA, delay between SA and presentation at SACC, and presence of an informal support person at SACC and SACC site are significantly associated with police reporting. These findings reveal the importance of targeting victims' support persons to alter reporting behavior among SA victims.

Modified prolonged exposure therapy as Early Intervention after Rape (The EIR-study): study protocol for a multicenter randomized add-on superiority trial

BACKGROUND

Sexual assault and rape are the traumatic life events with the highest probability for posttraumatic stress disorder (PTSD), which can have devastating consequences for those afflicted by the condition. Studies indicate that modified prolonged exposure (mPE) therapy may be effective in preventing the development of PTSD in recently traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such interventions as part of routine care.

METHODS/DESIGN

This is a multicenter randomized controlled add-on superiority trial that enrolls patients attending sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms 3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difficulties, pelvic floor hyperactivity, and sexual dysfunction. The first 22 subjects will constitute an internal pilot trial to test acceptance of the intervention and feasibility of the assessment battery.

DISCUSSION

This study will guide further research and clinical initiatives for implementing strategies for preventing post-traumatic stress symptoms after rape and provide new knowledge about which women may benefit the most from such initiatives and for revising existing treatment guidelines within this area.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05489133. Registered on 3 August 2022.

Acute alcohol intoxication and alcohol expectancy effects on women's memory for consensual and non-consensual sexual activity

Objective

To test whether acute alcohol intoxication and alcohol expectancy affects how accurately women remember consensual and non-consensual sexual activity that occurred during an interactive hypothetical dating scenario.

Design

A balanced placebo randomized study that varied alcohol dose (mean Breath Alcohol Content; BrAC = 0.06%) and alcohol expectancy prior to participants encoding a hypothetical interactive rape scenario was implemented. Participants could elect to consent to sexual activity with a male partner in the hypothetical scenario. If they stopped consenting, non-consensual sexual intercourse (i.e., rape) was described. Seven days later, participants' memory for consensual and non-consensual sexual activity in the scenario was tested.

Main outcome measures

Memory accuracy, confidence, and feelings of intoxication.

Results

A total of 90 females (M age = 20.5, SD = 2.2) were tested regarding their memory accuracy for the consensual and non-consensual sexual activities in the scenario. A multi-level logistic regression predicting memory accuracy for the perpetrator's behaviors during the rape indicated no effect of alcohol intoxication. However, a main effect of alcohol expectancy was found, whereby participants who expected to consume alcohol, compared to those who did not, recalled the perpetrator's behaviors during the rape more accurately. A second regression predicting memory accuracy for consensual sexual activity found no main effects for alcohol intoxication or alcohol expectancy. Participants recalled consensual sexual activity with a high degree of accuracy. Calibration analyses indicated that accuracy increased with confidence level, regardless of intoxication level or alcohol expectancy condition, but that women tended to be overconfident in general.

Conclusion

This study provides an important test of how accurately women remember consensual and non-consensual sexual activities. The accuracy of this information is important for forensic medical examinations and police investigations following an allegation of sexual assault. Increased memory accuracy was found for offence details when participants expected to consume alcohol, suggesting there may be important differences in attentional processes (e.g., hypervigilance) depending on whether threat is present. Further research is necessary to investigate memory for sexual violence in real-world settings and to test methods for ascertaining the most complete and reliable accounts.

Serious Mental Illness and Sexual Offending in Forensic Psychiatric Patients

The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999-2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them.

Feasibility of using breath sampling of non-volatiles to estimate the prevalence of illicit drug use among nightlife attendees

The prevalence of drug use among nightlife attendees needs to be accurately estimated to, for example, evaluate preventive interventions. This study tested the feasibility of using a breath-sampling device to estimate the prevalence of drug use among nightlife attendees. The study was conducted at five nightclubs and a large music festival in Stockholm, Sweden. Participants were invited to participate and microparticles in exhaled breath were sampled and analyzed for 47 compounds using a state-of-the-art analytic method that follows forensic standards. In addition, participants' breath alcohol concentration was measured and they were interviewed about demographics, drinking habits, and drug use. Of the people invited, 73.7% (n = 1223) agreed to participate, and breath samples were collected from 1204 participants. Breath sampling was fast and well-accepted by participants. 13 percent of participants tested positive for an illicit drug, but only 4.3% self-reported drug use during the last 48 h. The most common substances detected were cocaine, amphetamine, and MDMA. There was no agreement between self-reported and measured use of any drug. Breath sampling is a convenient method to test illicit drug use among a large number of participants at events, and can be used as an estimate of drug use prevalence.

Sexual Harassments Related to Alcohol and Drugs Intake: The Experience of the Rape Centre of Turin

A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the "Centro Soccorso Violenza Sessuale" (SVS) of the Sant'Anna Hospital in Turin between 1 January 2008, and 31 December 2017. Two hundred twenty-two patients were enrolled, 25 of which were minors, 141 were Italians, and most of them knew their aggressor and were raped in a private home. One hundred and fifty-five of them declared to the healthcare personnel to have taken alcoholic substances and/or drugs in conjunction with the event (86 reported having drunk alcohol, 36 having taken drugs and 33 disclosed both alcohol and drug abuse). If the woman knew her abuser, alcohol consumption was described as voluntary in more than 80% of cases, while in relation to drugs the consumption was equally voluntary or fraudulent. About 73% of women who reported having drunk alcohol just had amnesia or amnesia related to other symptoms, while amnesia was present in about 63% of women who reported only drug use. Physicians observed physical injuries on 156 women. Patients who reported to have assumed alcohol presented a significantly higher risk to suffer any physical injury and have a significantly increased risk to suffer injuries to their head and/or neck. The results obtained underline how even in Northern Italy alcohol intake represents the most widespread psychoactive substance in case of drug-facilitated sexual assault. There is therefore a need to promote education and prevention campaigns among citizens, especially among the youngest.

Cinsel Saldırı - İstismar Olguları Üzerine Retrospektif Bir Çalışma

Objective: In this study; it is aimed to analyze the sexual attack-abuse cases that occurred in Bolu province and were judged by the High Criminal Court. Methods: A total of 148 cases of sexual assault - abuse decided by the Bolu High Criminal Court between 2007 and 2016 were analyzed retrospectively. Results: This study included 148 cases: 131 (88.5%) cases were female and 17 (11.5%) were male. The mean age was 18.6 ± 11.6 (min:4, max:83). The highest number of cases was in the 13-15 age group (n=52, 35.2%). Sexual abuse most frequently occurred through vaginal penetration (n=72: 48.6%). The most common psychiatric diagnosis was acute stress disorder (n:12, 10.8%) and post-traumatic stress disorder (n:12, 10.8%). Physical violence was found to be statistically effective (p = 0.008) in the occurrence of mental disorders after the event. The victim recognized 81.8% of the attacker. Conclusion: We think that more effective sexual attack-abuse prevention strategies can be developed at the national level by determining the risk factors of sexual assault-abuse in our country through wider research to be conducted across the country.

The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study

OBJECTIVES

Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims.

METHODS

This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed.

RESULTS

Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old.

CONCLUSIONS

Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

Characteristics of Sexual Violence Against Adolescent Girls: A 10 Years' Retrospective Study of 731 Sexually Abused Adolescents

Introduction

Sexual violence against young girls is a pervasive multifaceted phenomenon which embraces several different forced sexual acts, including attempted and/or completed rape, sexual coercion and harassment, and sexual contact with force or threat of force. The aim of this study is to evaluate the characteristics of sexual violence in adolescent girls, by a retrospective analysis of 731 consecutive cases of sexually abused girls.

Materials and Methods

We analyzed demographic characteristics, risk factors for rape, and the eventual subsequent presence and type of ano-genital lesions.

Results

We found that sexual violence with penetration was perpetrated in 591 (80%) cases. Vulnerability factors related with a major risk of rape were age >17 years old and consumption of alcohol and/or other drugs. About 196 (55%) victims had at a least one genital lesion.

Conclusion

A prompt identification of red flags of sexual violence may help physicians in suspecting and managing cases of sexual assault in adolescent girls, even in the absence of typical lesions.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up

OBJECTIVE

 To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided.

METHODS

 A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%.

RESULTS

 The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups.

CONCLUSION

 The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Assaults in schools: Findings using a national data base

BACKGROUND

Assaults can occur at schools/educational facilities involving students, teachers and other school employees. It was the purpose of this study to correlate injury patterns with patient demographics in school assault victims. Understanding injury patterns with their associated demographics will not only be useful for health care providers but can also assist in proposing prevention strategies for both students and school employees.

METHODS

Emergency department data from the National Electronic Injury Surveillance System All Injury Program data for the years 2005 through 2015 were used in this study. Statistical analyses were performed with SUDAAN software to account for the weighted, stratified nature of the data.

RESULTS

There were an estimated 852,822 ED visits for school assaults. The median age was 13.8 years with 81.3% between 5 and 19 years old; 64.4% were male. After age 4, the number of females proportionately increased with increasing age. The most common diagnosis was a contusion/abrasion (38.6%). The injuries occurred in the head/neck (63.9%), upper extremity (19.0%), upper trunk (6.6%), lower trunk (5.5%), and lower extremity (4.9%). Firearm violence accounted for 0.1% of the assaults. Human bites occurred in 3.7%. Sexual assault was rare and proportionally the highest in those ≤4 years of age. Internal organ injuries were more common in females (13.1% vs 3.55) and for those admitted to the hospital (29.9% vs 19.9%). The incidence of ED visits for school assault decreased 50% from 2005 to 2015.

CONCLUSIONS

This study analyzed ED visits due to assaults occurring in schools. Firearm violence accounted for only 0.1% of the injuries, in contrast to media coverage regarding school assaults. The most common injury location was the head/neck (63.9%) and the most common diagnosis was a contusion/abrasion. This data can also serve as a baseline for further studies and the impact of potential reduction strategies.

Development of multidisciplinary sexual assault centres in the Netherlands

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.

Care of women and girls after sexual assault in Geneva: A descriptive study between 2005 and 2014

BACKGROUND AND PURPOSE

We aimed to examine epidemiological data and identify risk factors for sexual assault. This study included women seeking care at the Geneva University Hospitals emergency obstetrics and gynaecological unit.

METHOD

Retrospective, sociodemographic, and clinical data were collected from the medical reports.

RESULTS

We reviewed 836 medical charts and registered 92.8 women and girls per year who consulted the emergency department after sexual assault. The average age was 26 (±12) years, with a median of 23 years. Body lesions were reported in 525 patients (63%) and genital traumatic lesions were reported in 230 (28%) patients. Sexual assault by a stranger was reported in 436 cases (52%). Thirty percent of patients knew their aggressor. Aggressions were predominantly committed on the weekend, accounting for 367 cases (46%), with nearly two-thirds (65%, n = 474) occurring between 10 pm and 6 am. In total, 399 (48%) patients who were sexually assaulted reported having consumed alcohol and 102 (12%) reported having taken drugs prior to the aggression; 80 (10%) patients had consumed both and 286 (34%) had amnesia. Half of the sample sought and received medical care within 24 h from the time the aggression took place.

CONCLUSION

Sexual assault risk factors in our study population in Geneva included use of drugs and alcohol, with amnesia. Future prevention and education interventions should target these areas.

Police reporting in cases of sexual assault - a 10-year study of reported cases, unreported cases, and cases with delayed reporting

The aim of this study was to identify characteristics of reported, later-reported and unreported cases of sexual assault. All cases with female complainants (> 15 years) of sexual assault, who had been examined at the Centre for Victims of Sexual Assault (CVSA) in the Region of Southern Denmark in a 10-year period, were included. Retrospective data were collected from medico-legal examination reports and police reports. Descriptive bivariate analysis and logistic analysis were performed. Forensic pathologists examined 850 complainants of sexual assault in 2009-2018, of which 753 cases were included in this study. Of these, 191 cases (25%) were initially not reported to the police, but 53 women (7%) filed a police report, days, weeks or months later. There was a higher relative risk (RR) of not-reporting for young adults, for single women, if the accused was well known to the complainant, if the complainant experienced amnesia, or if there had been some degree of consensual physical interaction at time of the incident but before the assault. The non-reporters also showed a higher degree of delayed examination. The later-reporters only differed from the non-reporters in one parameter - they had a higher degree of partial amnesia. Interestingly, injuries (ano-genital or other) or verbal/physical resistance was not associated with reporting tendency, reflecting the modus of the local judicial system. The opportunity of a reflection period after a high-quality forensic examination, which is not dependent of police involvement, is essential for sexual assault complainants. Furthermore, education and guidance of victims and of the police and judicial system on the unique nature of sexual assault cases is important.

Forensic Nursing Research: The Basics Explained

As a growing profession, forensic nursing requires research to establish best practice guidelines leading to evidence-based practice. In addition, forensic nursing quality improvement projects are necessary to evaluate and improve practices and policies. The purpose of this article is to provide step-by-step guidelines on research and quality improvement projects to encourage all forensic nurses to actively contribute to and utilize research in practice. Research will expand our forensic nursing science and knowledge base. Ultimately, forensic nursing research will benefit our patients and communities by establishing enhanced, evidence-based care.

Similarity and Differences in Sexual Violence Against Adolescents and Adult Women: The Need to Focus on Adolescent Victims

STUDY OBJECTIVE

To explore whether there are differences in characteristics, clinical findings and management in cases of sexual violence in adolescent and adult women.

DESIGN

Retrospective study.

SETTING

SVSeD-Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

PARTICIPANTS

Female victims of sexual violence aged 10 years and older. Two study groups were analysed: an adolescent group and an adult group.

INTERVENTIONS

None; this was an observational study.

MAIN OUTCOME MEASURES

Characteristics of the perpetrator, time spent between the episode of sexual violence and the access to SVSeD, presence of genital and/or extragenital injuries; tests for sexually transmitted diseases, spermatozoa research; and toxicological screening; RESULTS: Adolescent victims of sexual violence requested help later than the adult victims. The majority of the perpetrators were well known to the victims in both groups. In both groups, we observed genital injuries in 1 of 3 patients. We found a strong association between the presence of genital injuries and a positive screening test for sexually transmitted diseases, in particular with regard to the adolescent victims.

CONCLUSION

Adolescents' delayed disclosure of sexual violence may affect the ability to properly manage these crimes. Prevention programs and public awareness campaigns should be implemented to highlight the importance of a prompt disclosure after sexual assault has occurred. Gynecologists should be made increasingly aware of this delicate issue, to better assist victims of sexual violence, especially adolescent victims.

Stranger rape; distinctions between the typical rape type and other types of rape. A study based on data from Center for Victims of Sexual Assault

OBJECTIVE

The aim of this descriptive cohort study was to characterize stranger rape compared to other types of rape.

METHOD & MATERIALS

All cases of women aged 12 years or older, who contacted a Center for Victims of Sexual Assault in the region of Southern Denmark and underwent a forensic examination in 2018, were collected and analyzed. Descriptive frequencies, Pearson's χ²-test and Fisher's exact-test were performed.

RESULTS

Compared to other types of rape, stranger rape were reported to the police more frequently, earlier and more frequently independently, without contact to family, friends or other authorities. In cases of stranger rape women were exposed to threats and violence more often, and clinical findings were found to coincide with the women's report more frequently. Regarding the offenders' level of planning, it was not possible to find significant differences between stranger rape and other rape types by comparing frequencies of the offenders' use of condoms and weapons and/or other remedies as surrogate markers for degree of planning.

CONCLUSION

There were several significant characteristic differences between stranger rape and other types of rape. Characterizing the 'archetypical rape' in opposition to other and more frequent types of rape, may give the public, the police, the courts and aid organizations the background needed to understand the importance of rape typologies when handling cases of sexual assault.

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study

Introduction

Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as “alleged.”

Methods

This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample.

Results

Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault.

Conclusion

Implications of this coding are discussed.

Piloting sexual assault care centres in Belgium: who do they reach and what care is offered?

BACKGROUND

Sexual assault (SA) is highly prevalent in Belgium. In order to mitigate the negative consequences for victims of acute SA, Sexual Assault Care Centres (SACCs) were piloted from October 2017 to October 2018 in three Belgian hospitals. SACCs offer medical and psychological care, forensic examination and the possibility to report to the police at the SACC.

OBJECTIVE

Aiming to improve SACC services, we quantitatively assessed the number and characteristics of victims attending the SACC, the SA they experienced, and the care they received over 12 months upon admission.

METHOD

Data on victims presenting at the SACC were routinely collected in electronic patient files by the SACC personnel between 25 October 2017 and 31 October 2019. These data were analysed in IBM SPSS Statistics 25.

RESULTS

Within the first year 931 victims attended the SACCs. Mean age was 24.5 years (SD = 12.8), and one-third were under 18. The majority were female (90.5%) and 63.1% presented for rape. About one-third of the victims were considered vulnerable due to previous SA (35.6%), prior psychiatric consultation (38.7%) or disability (8.5%). The assailant was known to the victim in 59.2% of the cases. Of all SACC presentations, 35.2% self-referred to the SACC while 40.9% were referred by the police. Two out of three victims attended the SACC within 72 h post-assault. Respectively 74.7% of victims received medical care, 60.6% a forensic examination, 50.2% psychological care, and 68.7% reported to the police.

CONCLUSION

Despite the absence of promotion campaigns, the SACCs received a high number of victims during the pilot year. Use of acute and follow-up services was high, although new approaches to offer more accessible psychological support should be explored. The big proportion of vulnerable victims warrants careful monitoring and adaptation of care pathways.

Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study

BACKGROUND

Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault.

METHODS

Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey.

RESULTS

Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged.

CONCLUSION

Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.

Injury Patterns and Demographics in Child and Adolescent Assault Victims Presenting to US Emergency Departments

Objective

To correlate injury patterns with patient demographics in child and adolescent assault victims.

Methods

The National Electronic Injury Surveillance System-All Injury Program data for the years 2005 through 2015 was used. Injuries due to assault were identified and analyzed with SUDAAN 11.0.01™ software to account for the weighted, stratified nature of the data.

Results

There were an estimated 4,407,009 ED visits for assault in patients ≤ 19 years of age. With increasing age, the percentage of females decreased. Sexual assaults were more common in females (87.4%), and robbery/burglary was more common in males (79.8%). When the perpetrator was a spouse/partner, the assault victim was most commonly female (88.8%), and when a stranger, the assault victim was most commonly male (71.5%). With increasing age, the percentage of sexual assaults decreased while the reason for the assault being unknown increased. The assault occurred in the home in 59.6% of those ≤ 4 years of age, decreasing to 18.7% in those 15 to 19 years of age. The anatomic location was the head/neck in 32.8% of those ≤ 4 years of age, increasing to 60.6% in those 15-19 years old. Those ≤ 4 years old had the highest hospital admission rate (8.3%). The main diagnoses were concussion (3.0%), contusion/abrasion (33.3%), fracture (11.5%), laceration (11.5%), internal organ injury (11.5%), puncture (2.8%), and strain/sprain (20.7%). The number of assaults from 2005 to 2015 decreased for all age groups except for those ≤ 4 years old.

Conclusions

These data provide a comprehensive overview of child and adolescent assault victims presenting to the ED in the USA and can be used as background data for further study. The decreasing numbers of assaults over the 11 years of the study are encouraging, and challenges still exist in decreasing the number for those ≤ 4 years old.

Reporting after sexual violence: The influence of victim, assault and perpetrator characteristics

Sexual violence is a worldwide public health concern. Care for victims has improved with the development of sexual assault centres, which have served to professionalise and tailor care and to get different services to improve collaboration. Nonetheless, reporting rates remain low, causing perpetrators to walk free without prosecution. We aimed to investigate, firstly, the influence of victim, perpetrator and assault characteristics on the reporting rate, and, secondly, the reasons why victims did not report to the police. Data of a Dutch sexual assault centre was used in this cross-sectional study. All victims who attended the centre between January 2016 and January 2019 were included. Logistic regression analysis was used to assess the relation of certain characteristics with reporting. Forty per cent of the victims reported to the police. Age and injuries were significantly related to reporting. Victims of 26 years or over were less likely to report than victims under 18 years old. Victims with objectified injuries reported to the police more often. Contrary to previous research, no relation between the perpetrator being well-known to the victim and a lower reporting rate was found. Victims mainly refrained from reporting as they experienced conflicting emotions, followed by their feeling discouraged by the police. Other reasons were fear of the perpetrator and defamation, wanting to move on with their life and wanting to spare the perpetrator. Our findings will serve to further optimise care for victims of sexual violence and increase reporting rates.

Epidemiological Profile of the Victims of Sexual Violence Treated at a Referral Center in Southern Brazil

OBJECTIVE

 To characterize the sociodemographic profile of women victims of sexual violence treated at a university hospital in southern Brazil.

METHOD

 The present cross-sectional study included all female victims of sexual violence who attended the sexual violence unit at the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) from April 18, 2000 to December 31, 2017. Data were extracted from the electronic record of the patients and stored in a standardized questionnaire database with epidemiological aspects of the victim, the perpetrators and the type of aggression. Statistical analysis was performed using the chi-squared test for trend and descriptive statistics with 95% confidence interval (CI).

RESULTS

 During the length of the study, 711 women victims of sexual violence were treated. The mean age of the patients was 24.4 (±10) years old (range from 11 to 69 years old) and most of the victims were white (77.4%), single (75.9%) and sought care at the unit within 72 hours after the occurrence (80.7%). In most cases, violence was exerted by a single perpetrator (87.1%), who was unknown in 67.2% of cases. Victims < 19 years old showed a higher risk of not using contraception (relative risk [RR] = 2.7; 95% CI = 1.9-3.6).

CONCLUSION

 Most victims of sexual violence were treated within 72 hours of the occurrence. The majority of these victims were white and young, and those < 19 years old had a higher risk of not using contraception and to know the sexual perpetrator.

Increasing awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault: A new viewpoint

The victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts was studied in this work by applying a novel approximation. A multifocal analytical strategy based on an intersectional gender-sensitive approach was used to analyse the evidence coming from both forensic case studies and contextual studies about sexual interrelation and drug use. The process of victimization comprises social changes affecting consumption patterns and sexual interaction, intersecting in the hegemonic recreational nightlife model. However, victims experience a range of situations that make it difficult for them to self-acknowledge themselves as such. Widespread myths about the victimization process add to the social questioning faced by victims, stemming from gender-based double standards which condition the expected female behaviors regarding the use of drugs and sexual interaction. The victims usually experience amnesia, lack of injuries and emotional harm, which make difficult the self-acknowledgement as a victim of sexual assault and the reporting of the episode suffered. Consequently, it is an urgent public health need to implement a new viewpoint about the victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts, able to increase awareness of the severity of this form of sexual violence. Society must recognize the existence of this problem within itself to help victims to acknowledge themselves as such, lodge a complaint and seek adequate help. The lack of this social support feeds the perpetuation of the victimization process, which exacerbates the risk of locking victims into spirals of cyclical re-victimization and favors both the underreporting as well as inadequate coping strategies. In addition to focusing on the need to increase awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault in leisure contexts, other recommendations include the use of the term "take advantage", the development of specific criminal approaches, and the in-depth knowledge of the phenomenon via victimization surveys. These steps are necessary for developing well-targeted and evidence-based preventive measures consistent-with-reality.

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.

Characteristics and trends of sexual assaults in Israel - A large cohort study of 3941 victims

INTRODUCTION

To improve care for victims of sexual assault, specialized assault centers have been developed globally, providing medical, psychological and legal care in one place. Our assault center serves a large population in the center of Israel. In 2010, we initiated a program aimed to prevent assaults among minors and to encourage early referral of victims to the center. The goal of the current study was to assess the impact of this program by comparing the characteristics of sexual assaults before and after the program's initiation.

MATERIAL AND METHODS

We conducted a historic cohort study of all victims of sexual assaults who were treated in our center between October 2000 and November 2017. A comparison was performed between victims treated before and after January 2010 (early vs. late study period), when the prevention program was initiated. The program mainly included lectures in middle and high schools, and workshops for police investigators.

RESULTS

Overall, 3941 victims of sexual assault were treated in our center during the study period. Most victims were females (90.5%). Mean age was 23.0 ± 11.0 years. Most victims were single (93.1%), and approximately half knew their perpetrator before the assault. Compared with the early study period, in the late study period we observed a decrease in the rate of minor victims (31.9% vs. 24.7%, respectively, P < .001) and an increase in the rate of victims who arrived to the center within 3 days of the assault (P = .001). However, we observed higher rates of multiple-perpetrator assaults (16.7% vs. 21.9%, respectively, P < .001), alcohol use (29.2% vs. 40.1%, respectively, P < .001), and drug use (7.2% vs. 9.0%, respectively, P = .04). Moreover, in the late study period, fewer victims were willing to press charges (79.5% vs. 64.4%, respectively, P < .001).

CONCLUSION

Our prevention program might have contributed to reducing the rate of sexual assaults among minors and shortened the time interval between the assault and victim's arrival to the center. Nonetheless, more efforts should be taken to reduce the involvement of alcohol and drugs in sexual assaults and to encourage victims to press charges.

Surgical repair of genital injuries after sexual abuse

Introduction: Genital injuries occur in half of cases of sexual assault through digital or penile penetration as well as the use of objects. Women aged >45 years are more likely to have physical injury and anogenital lesions, transmission of STI and HIV. This review focuses on the evidence about surgical reconstruction of the pelvic floor anatomy of adolescents and adult women sexually assaulted during adolescence or adulthood.

Method: A systematic literature search was performed in PubMed and Orbis plus for articles published in English and German from June 2008 to June 2018. The literature search was performed in October 2018 by topic combining the following Medical Subject Headings: genital trauma, genital injuries, sexual assault, rape, surgical repair, treatment.

Results: 34 records of descriptive studies were identified and 16 full-text articles were included in the present review. Due to the limited number of articles retrieved, articles were not excluded based on methodological design. Superficial genital lesions are common and usually left untreated. For deep vaginal or anal lacerations, intraperitoneal bleeding is usually assessed by means of and additional CT scan or diagnostic colposcopy, cystoscopy, rectoscopy and laparoscopy. Complete reconstruction of the injured is done after. To prevent rectovaginal fistula and uncomplicated primary wound healing a temporary colostomy can be performed.

Conclusion: Although most of genital injuries due to sexual assault do not require any major surgical intervention, there is a lack of good quality evidence regarding the best diagnostic and surgical approach to restore deep lesions of genital organs as well lack evidence on contributors to poor wound healing. Therefore, clinical protocols that standardize examination as well as surgical management are encouraged to be developed.

Predictors of Adherence to HIV Post-Exposure Prophylaxis and Retention in Care After an Episode of Sexual Violence in Brazil

Adherence to nonoccupational post-exposure prophylaxis (nPEP) among sexual violence (SV) victims and their retention in care after SV represent significant challenges. This study aimed at identifying predictors of adherence to nPEP and retention in clinical-laboratory follow-up among SV victims in São Paulo, Brazil. We conducted a retrospective cohort study of SV victims admitted to care and follow-up at the SV unit of the main reference hospital in São Paulo within 72 h following the SV episode. Eligible patients were submitted to a standardized protocol that included nPEP, screening, and management for other sexually transmitted infection as well as emergency contraception. Predictors of adherence to nPEP for 28 days and retention in care until discharge at 180 days after admission were analyzed. A total of 199 SV episodes in 197 victims were recorded from January 2001 to December 2013 (156 months). Of those episodes, 167 were eligible to receive nPEP and 160 (96%) actually received a prescription. Overall 104/160 [65%, 95% confidence interval (CI) 57-72] SV victims, who received nPEP, were fully adherent to nPEP up to 28 days, whereas 89/199 (45%, 95% CI 38-52) were retained in care for 180 days following admission. In multi-variate analysis, patients undergoing at least one psychological consultation (n = 126) were more likely to adhere to nPEP [adjusted odds ratio (adjOR) 8.32; 95% CI 3.0-23.3] and be retained in care for 6 months (adjOR 40.33; 95% CI 8.33-195.30) compared to patients not receiving psychological support. In contrast, study outcomes were not associated with victims' age and sex and with type of perpetrator. In our cohort, provision of psychological care was shown to be associated with enhanced adherence to nPEP and retention in care.

High levels of alcohol intoxication and strong support for restrictive alcohol policies among music festival visitors

Background

Alcohol intoxication is associated with problems such as violence, injuries, drunk driving and sexual risk-taking, and music festivals are considered a high-risk setting for high levels of alcohol consumption. This study investigates intoxication levels, drinking habits, and opinions on alcohol use and alcohol policies among visitors at one of the largest music festivals in Sweden in 2017.

Methods

A cross-sectional study assessing alcohol intoxication levels was conducted at a music festival (~ 50,000 attendees). Two research teams collected data at the two festival entrances during two nights, from approximately 6:00 pm to 01:30 am. Blood alcohol concentration (BAC) levels were measured using breath analyzers. A face-to-face questionnaire was used to interview attendees about their alcohol use in the past 12 months using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), as well as about their personal opinions on alcohol use and alcohol policies (statement). BAC levels were compared between categories of various factors using Mann-Whitney U test and Kruskal-Wallis test. The distributions of BAC, AUDIT-C and statement category across gender was analyzed using Pearson’s Chi-square tests. Associations of BAC levels with different factors were analyzed using Spearman rank correlation and multinomial logistic regression.

Results

A total of 1663 attendees were randomly selected and invited to participate, and 1410 consented (63.7% men, 34.9% women, age 16–64 years). The proportion of drinkers was 81%. Among the drinkers, the median BAC level was 0.082%. Thirty-one percent of the participants had a BAC level above 0.10%. Forty-two percent of the participants reported binge drinking monthly, and 20% said that they binge drank weekly. Sixty-three percent of participants reported risky drinking habits. A self-reported risky alcohol habit increased the risk of a high alcohol intoxication level at the festival. Respondents were supportive of restrictive alcohol policies. Men had significantly higher BAC levels, reported more often risky alcohol habits and were less supportive of restrictive alcohol policies than women.

Conclusions

The results indicate that participants at music festivals in Sweden have high levels of alcohol intoxication and largely support restrictive alcohol policies. Thus, there is both a need and support for the implementation of alcohol prevention strategies at festivals.

Towards a more integrated and gender-sensitive care delivery for victims of sexual assault: key findings and recommendations from the Belgian sexual assault care centre feasibility study

BACKGROUND

Sexual assault remains a major threat to public health, affecting every gender, gender identity and sexual orientation. Following the Belgian ratification of the Istanbul Convention in 2016, the feasibility of a Belgian sexual assault centre model was investigated, aiming to provide more integrated and patient-centred health and judiciary services to victims of sexual assault. By actively involving health professionals, police and judiciary system representatives, as well as victims themselves, this feasibility study eventually fed into the Belgian Sexual Assault Care Centre model. In this process, this paper assessed current Belgian health services and the degree to which the implementation of this model could contribute to both a more integrated and gender-sensitive care delivery. Findings from this study and the subsequent recommendations aim to contribute to similar reforms in other countries that have already taken or are about to take steps towards an integrated, multi-agency support framework for victims of sexual assault.

METHODS

A qualitative, descriptive analysis of the survey response of 60 key health professionals (N = 60) representing 15 major Belgian hospitals was first conducted. Comparing their approach with the international guidelines and standards, a Strengths Weaknesses Opportunities and Threats analysis of the current sexual assault health services and their potential transition to the Sexual Assault Care Centre model was then executed.

RESULTS

Despite adequate equipment, the clear fragmentation of health services and limited follow-up hamper an integrated care delivery in most hospitals. Only three hospitals differentiated their sexual assault care protocol based on the victim's gender, gender identity and sexual orientation. A striking unawareness among health professionals of sexual assault in male victims, as well as in gender and sexual minorities further hampers a gender-sensitive care delivery.

CONCLUSIONS

The Sexual Assault Care Centre model aims to counter most of the current sexual assault health services' weaknesses and threats hampering an integrated care for victims of sexual assault. Further research and training of health professionals are however required in order to tune this integrated form of care to sexuality and gender-based differences in victims' already multi-faceted healthcare needs.

"What Will My Friends Think?" Social Consequences for Danish Victims of Sexual Assaults in Peer Groups

Being exposed to sexual assaults has numerous psychological and social consequences, which may interfere with the adolescent's still-ongoing development. This article focuses on social consequences for adolescents exposed to sexual assault by someone from their peer group. Participants were 148 in number and 15-18 year olds (M = 16.34 years, 90.5% female) from Centre for Victims of Sexual Assault's "Youth Programme." A mixed methods design combined extensive survey data collected from the 148 adolescents and five case stories. Almost half of the assaults (47.4%) were committed by someone from the victim's social circle who was not a family member. Only 30.5% of these victims reported the assault to the police. Fear of social consequences was the main reason for not reporting. The majority of the participants described failure to thrive in school in the aftermath of the assault, for example, because the assailant attended the same school. Result furthermore showed how social relations can be complicated due to an assault and subsequent reactions, which can result in isolation for the victim and exclusion from their peer group. Sexual assaults in peer groups have great impact on the victim's well-being. Understanding and support from peers is of the utmost importance. Implications for practice are discussed.

[Forensic medical examination of adolescent and adult victims of sexual assault or intimate partner violence who do not complain to the police - An observational study in Seine-Saint-Denis, France]

OBJECTIVES

to identify characteristics of victims of sexual assault or domestic violence who consulted in a Department of Forensic Medicine without a formal complaint to the police.

METHODS

observational study (03/01/2014-08/31/2015) of individuals (age>15years) consulting in a Department of Forensic Medicine near Paris, France, after a sexual assault or domestic violence. Among the individuals who were examined in the department of Forensic Medicine, we compared the individuals who had not complained to the police to those who had complained to the police.

RESULTS

A hundred and nine individuals have consulted without a prior complaint to the police, including 73 persons after domestic violence (i.e. 4% of all persons examined with or without a complaint to the police) and 36 persons after a sexual assault (i.e. 8% of all persons examined). Regarding domestic violence, the proportion of persons presenting recent traumatic injuries was lower among those who did not complain to the police than among those who did (64% vs. 78%, P=0.008). Regarding sexual violence, the persons who did not complain to the police were more frequently uncertain about the assault (42% vs. 13%, P<0.001), reported more frequently a recent alcohol or drug intake (42% vs. 26%, P=0.039) and less frequently showed extragenital traumatic injuries than the persons who did complain to the police (22% vs. 43%, P=0.016).

CONCLUSION

the persons examined who had not complained to the police accounted for less than one in 20. The extension of the activity of a Department of Forensic Medicine to persons who do not want to be involved in a judicial process is not sufficient for the majority of victims to consult a forensic physician.

Vulnerability and revictimization: Victim characteristics in a Dutch assault center

Sexual and family violence are highly prevalent problems with numerous negative health consequences. Assault centres, such as the Centre for Sexual and Family Violence (CSFV) in the Netherlands, have been set up to provide optimal care to victims. We wanted to gain insight into characteristics of the population that presented to the Centre in order to customize care to their needs. File analysis was conducted of victims who attended the CSFV between 2013 and 2016. Data were analyzed in SPSS. A total of 121 victims entered the Centre, 93% of them being female. Forty-two per cent were adult victims of sexual violence, 28% minor victims of sexual violence and 30% adult victims of family violence. One-third of sexual and two-third of family violence victims had experienced prior abuse. Current use of psychosocial services and psychiatric medication was high, and a cognitive disability was present in 18% of the sexual violence victims. Half the victims reported, but when the perpetrator was a recent contact, e.g., someone met at a party, reporting rates went down. Sexual and family violence victims share characteristics that indicate vulnerability, suggesting that care for both groups might best be combined in one single assault centre. In this way, victims can make use of the same services and knowledge of gender-based violence. One of the major aims of assault centres is to provide psychosocial follow-up care and facilities for reporting. The victims' needs in these matters deserve further research.

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

Background

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.

Methods

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.

Results

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.

Conclusions

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.