Injury Patterns in Women Resulting from Sexual Assault
Marilyn Sawyer Sommers, John Schafer, Therese Zink, Linda Hutson, & Paula Hillard
Published: Trauma, Violence, & Abuse, V. 2 (3), July 2001, 240-258
What is the scope of this article?
This article presents the state of technology and methods used in identifying injuries in women after sexual assault. The authors
Practice, policy and research implications are proposed.
- summarize several decades of literature that documents types, locations and severity of injuries suffered by female victims of sexual assault, and research findings regarding how different types of injuries, methods of injury identification, and documentation seem to affect the criminal prosecution of sexual assault;
- describe how injury identification methodology has evolved over the years, how injury rates from sexual assault have been determined historically, and currently, and what patterns of injury seem to result from nonconsensual sex;
- discuss the effectiveness of different methods of injury identification based on results reported in the literature.
Methods of sexual assault injury identification
Gross, direct visualization
In this method, injuries are identified through simple observation by a health care professional during a standard gynecological or forensic examination. It was the primary method used in examining female victims after sexual assault from about 1970 to 1990.
Several staining solutions have been used: Gentian violet, Lugol's solution, toluidine blue and flurorscein. A health care professional applies a staining solution in and around the female genitals. The solution makes injured tissues stand out from uninjured, surrounding areas. For example, with Lugol's, tears in the epithelium appear as unstained, lighter areas than surrounding, uninjured genital tissues; with toluidine blue, tears or injured genital tissues pick up the stain and appear darker than uninjured tissues.
Colposcopy refers to the use of a technical device, the colposcope, to illuminate and magnify the part of the body being inspected by a health care professional. Green lens filters make scars or abnormal patterns of blood vessels stand out from normal genital tissue. Colposcopy enables examiners to detect microscopic injury, and it reduces the need for repeated examinations of rape victims; the colposcope can be attached to a 35mm or video camera for documentation when evaluation by other medical experts is needed, or as evidence for prosecuting cases.
Effectiveness rates of injury identification methods after sexual assault
A review of the literature reveals that rates of injury identified after sexual assault varied greatly (ranging from 5% to 90%) depending on the method used to examine the sexual assault survivor. Colposcopy was found to have the highest injury detection rate after sexual assault followed by staining techniques. Direct, gross visualization had the lowest injury detection rate overall, but this method's highest rates of injury detection occur in the most recent studies involving direct visualization (from 1997 - 2000). The authors attribute this finding to a greater proficiency and knowledge about where to look for sexual assault injuries on the part of examiners participating in those studies.
What does the literature reveal about injury patterns resulting from sexual assault?
Types of injuries/ patterns of injuries
Consensual versus non-consensual sex
- Injury detection varies depending on both the method used to examine a sexual assault survivor and the experience and knowledge of the examiner.
- Not all women sustain injuries from sexual assault.
- Non-genital injuries predominate in sexual assault survivors; the majority of women sustain non-genital injuries from sexual assault.
- When sexual assault involves anal intercourse proportionately more non-genital injuries result.
- The posterior fourchette, identified by staining and colposcopy, is the anatomic (genital) site most often injured when women are sexually assaulted.
How are injury patterns and legal outcomes after sexual assault related?
- In women of reproductive age studies found that genital injuries from sexual assault were sustained lower in the vagina (posterior fourchette, labia minora, hymen and fossa navicularis) than genital injury resulting from consensual sex.
- Both staining and colposcopy techniques found significantly higher rates of injuries in sexual assault (nonconsensual sex) survivors than in women examined after consensual sex.
Severe injuries from sexual assault appear to be related to punishment of perpetrators of the assault by the U.S. legal system. Genital injuries, however, did not predict conviction rates in sexual assault cases.
What are the clinical, policy and research implications from this literature review?
- Given the pattern of injuries that occur with sexual assault, a full-body physical examination is recommended along with a complete examination of external structures of the genitalia of all female sexual assault survivors.
- Colposcopy is the preferred and most effective technique for identifying genital injuries of sexual assault survivors.
- Further research using prospective studies is recommended to shed more light on the relationship between conviction and injury patterns after sexual assault.
- Information about injury patterns and conviction rates should be shared with both law enforcement and health practitioners to aid them in better coordinating and collecting evidence in sexual assault cases.
Reviewed by Priscilla Schulz, LCSW
Center for Trauma Recovery
University of Missouri - St. Louis
September 19, 2001
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