Audit of Genito-Anal Injuries in male and femal sexual abuse cases - A retrospective study.
Keywords:genital injury, anal injury, sexual assault, vaginal intercourse, sodomy
Background: Sexual assault is a global issue wherein timely examination of sexual assault victims by medico-legal officers and an understanding of the characteristics and factors influencing their injuries have a crucial impact on medico-legal evidence collection and its use in the court. Genital injury findings improve the level of justice for victims, but the lack of injury does not negate the possibility of sexual violence incurred on the victim. The following study describes in great detail the different factors associated with injury characteristics and the medico-legal importance of all these factors. Methodology: It was a retrospective descriptive study conducted at the Forensic Medicine Department of King Edward Medical University, Lahore, Pakistan. All the cases included that fulfill the predefined inclusion criteria were included. A record chart was designed, and six years’ data was recorded in it from the medical records of the medico-legal clinic. It was entered and edited manually. Methods used to prevent data entry errors included double entry and validation following data entry Difference of proportions between variables, where appropriate, has been calculated by Pearson Chi-Square test and Fischer Exact test at 95% confidence interval. Data were analyzed using SPSS v23. All procedures performed in this study involving human participants were following the ethical standards of the institutional and/or national research committee and the Helsinki declaration. Results: Genito anal injury was present in 28.2% cases and was absent in 71.8% cases. Most of the victims were aged 11 to 15 years. The most common injury in the victims was a tear. In females, the most common injury site was the vagina, while the perianal area was the most injured site in males. There was a significant relation (p<0.05) between type and site of injury, gender, site of injury, and prior sexual intercourse experience and prevalence rate of injury. Conclusion: This study concludes that the presence of injuries in the Genito anal area is suggestive of sexual assault and provides useful court evidence.
Cameron P, Jelinek G, Kelly AM, Murray L, Brown AF. Textbook of adult emergency medicine E-book. Elsevier Health Sciences; 2011.
The Office on Women's Health. Sexual assault [Internet]. Department of Health and Human Services; 2015 [cited 1 June 2020]. Available from: https://www.womenshealth.gov/files/documents/fact-sheet-sexual-assault.pdf
Scharf MP. From the eXile files: An essay on trading justice for peace. Wash. & Lee L. Rev. 2006;63:339.
Amenu D, Hiko D. Sexual assault: Pattern and related complications among cases managed in Jimma University Specialized Hospital. Ethiop J Health Sci. 2014;24(1):3-14. Available from: doi:10.4314/ejhs.v24i1.1
Feeney H, Chiaramonte D, Campbell R, Greeson MR, Fehler-Cabral G. Anogenital and physical injuries in adolescent sexual assault patients: The role of victim–offender relationship, alcohol use, and memory impairment. J Forensic Nurs. 2017;13(2):52-61. Available from: doi:10.1097/JFN.0000000000000148
Bowyer L, Dalton ME. Female victims of rape and their genital injuries. Bjog-Int J Obstet Gy. 2005;104(5). Available from: doi:10.1111/j.1471-0528.1997.tb11543
Lincoln C. Genital injury: Is it significant? A review of the literature. Med Sci Law. 2001;41(3):206-16. Available from: doi:10.1177/002580240104100303.
Sommers MS. Defining patterns of genital injury from sexual assault. Trauma Violence Abuse. 2007;8(3):270-280. Available from: doi:10.1177%2F1524838007303194
Sommers MS, Zink TM, Fargo JD, et al. Forensic sexual assault examination and genital injury: Is skin colour a source of health disparity? Am J Emerg Med. 2008;26(8):857-866. Available from: doi:10.1016/j.ajem.2007.11.025
Goldberg AP. Genital piercings in the context of acute sexual assault. J Forensic Leg Med. 2017;52:181-183. Available from: doi: 10.1016/j.jflm.2017.09.009
Zilkens RR, Smith DA, Philips MA, et al. Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault. Forensic Sci Int. 2017;275:195-202. Available from: doi:10.1016/j.forsciint.2017.03.013
Zilkens RR, Smith DA, Kelly MC, et al. Sexual assault and general body injuries: A detailed cross-sectional Australian study of 1163 women. Forensic Sci Int. 2017;279;112-120. Available from: doi: 10.1016/j.forsciint.2017.08.001
Hirachan N, Limbu D. An Overview of Sexual Assault Cases in Nepal. J Gan Med Col Nep. 2016;9(2):43-6. Available from: doi: 10.3126/jgmcn.v9i2.17865
Slaughter L, Brown CR, Crowley S, et al. Patterns of genital injury in female sexual assault victims. Am J Obstet Gynecol. 1997;176:609-615. Available from: doi: 10.1016/s0002-9378(97)70556-8
Hochmeister MN, Whelan M, Borer UV et al. Effects of toluidine blue and destaining reagents used in sexual assault examination on the ability to obtain DNA profiles from post coital vaginal swabs. J Forensic Sci. 1997;42(2)316-319. PMID: 9068192.
Hirachan N. Use of toluidine blue dye in detection of anogenital injuries in consensual sexual intercourse. J Forensic Leg Med. 2019 May;64:14-19. Available from: doi:10.1016/j.jflm.2019.02.006.
Zink T, Fargo JD, Baker RB, et al. Comparison of methods for identifying anogenital injury after consensual intercourse. J Emerg Med. 2010;39:113-118. Available from: doi:10.1016%2Fj.jemermed.2008.08.024
Teixeira WR. Hymenal colposcopic examination in sexual offences. Am J Forensic Med Pathol. 1981;2(3):209-215. Available from: doi:10.1097/00000433-198109000-00004
Slaughter L, Brown CR. Colposcopy to establish physical findings in rape victims. Am J Obstet Gynecol. 1992;166(1):83-86. Available from: doi:10.1016/0002-9378(92)91834-w
Bowyer L, Dalton ME. Female victims of rape and their genital injuries. Br J Obstet Gynecol. 1997;104:617-620. Available from: 10.1111/j.1471-0528.1997.tb11543.x
Hilden M, Schei B, Sidenius K. Genitoanal injury in adult female victims of sexual assault. Forensic Sci Int. 2005;154(2-3):200-205. Available from: doi:10.1016/j.forsciint.2004.10.010.
Suttipasit P. Genitoanal injury in sexually assaulted adult women. Am J Forensic Med Pathol. 2018;39(4)312-324. Available from: doi:10.1097/PAF.0000000000000430
Ingemann-Hansen O, Sabroe S, Brink O, Knudsen M, Vesterby A. Characteristics of victims and assaults of sexual violence--improving inquiries and prevention. J Forensic Leg Med. 2008;16(4):182-8. Available from: doi:10.1016/j.jflm.2008.07.004
Acierno R, Resnick H, Kilpatrick DG, Saunders B, Best CL. Risk factors for rape, physical assault, and posttraumatic stress disorder in women: examination of differential multivariate relationships. J Anxiety Disord. 1999;13:541-63. Available from: doi:10.1016/s0887-6185(99)00030-4
Ernst AA, Green E, Fergusen MD, Weiss J, Green WM. The utility of anoscopy and colposcopy in the evaluation of male sexual assault victims. Ann Emerg Med. 2000;36:432-437. Available from: doi:10.1067/mem.2000.110993
Frazier P. A comprehensive study of male and female rape victims seen at a hospital-based rape crisis program. J Interpers Violence.1993;8:64-76. Available from: doi:10.1177%2F088626093008001005
Cartwright PS,Moore RA, Anderson JR, et al. Genital injury and implied consent to alleged rape. J Reprod Med.1986;31:1043-1044. PMID: 3806535
Mc Lean IA, Balding V, White C. Forensic medical aspects of male-on-male rape and sexual assault in greater Manchester. Med Sci Law. 2004;44(2):165-9. Available from: doi:10.1258/rsmmsl.44.2.165.
Palmer CM, McNulty AM, D’Este C, et al. Genital injuries in women reporting sexual assault. Sex Health. 2004;1:55-59. Available from: doi:10.1071/sh03004.
Sugar NF, Fine DN, Eckert LO. Physical injury after sexual assault: findings of large case series. Am J Obstet Gynecol. 2004;190:71-76. Available from: doi:10.1016/S0002-9378(03)00912-8
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