Article

Persistence of vaginal spermatozoa as assessed by routine cervicovaginal (Pap) smears.

Journal of Forensic Sciences (Impact Factor: 1.31). 06/1987; 32(3):678-83.
Source: PubMed

ABSTRACT Retrospective review of cervicovaginal (Pap) smears of women with known sexual histories affords an opportunity to assess the potential for postcoital sperm recovery for large numbers of individuals. This study reviewed 542 individuals' Pap smears with accompanying sexual histories. Three hundred forty-nine respondents reported at least one act of sexual intercourse during the five days preceding the Pap smear. Unlike a previous report, the current study showed very poor sperm recovery (maximum of 25% during the first postcoital day). The observed results roughly correlate with the incidence of sperm noted on screening of large numbers of routine clinical Pap smears in a private reference laboratory. Routine Pap smears can detect sperm but do not appear to be an ideal method to substantiate recent sexual intercourse.

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    ABSTRACT: The forensic approach to the clinical examination of a rape victim is made up of two parts: an objective examination followed by an interpretation of findings (or lack of positive findings) The scientific foundation that forms the basis of interpretation is, in cases of sexual assault, less than perfect. It relies on casuistic knowledge and personal experience gathered from conducting many examinations. Furthermore, the scientific knowledge that is available is ethically problematic and in parts of low quality, especially when it comes to the gynaecological part of the rape examination. Regarding genital injury, the definition of lesions and the use of investigative techniques vary so much from study to study that comparison is difficult. Material and methods Forensic gynaecological examinations were carried out in two groups of women in a prospective setup. One group consisted of 98 women who had experienced a consensual sexual intercourse (CSI) within 48 hours of examination and the other group consisted of 39 women who had experienced sexual assault. In the CSI-­‐group 50 of the 98 women were seen three times during one week following intercourse. All 137 women were examined in the same settings by the same team of doctors. The three different techniques in use worldwide, namely the naked eye, colposcopy and toluidine blue dye were used when diagnosing genital injury. All examinations were documented using colposcopic photography and inter-­‐observer variation and validity of photographs were determined. Samples for detection of semen were taken from three different sample sites. Results The overall frequency of lesions were comparable in the two groups using the three investigative methods: 34 % vs. 36 % using the naked eye, 49 % vs. 49% using colposcopy, and 52 % vs. 51 % using toluidine blue dye. Women in the rape victim group had more complex lesions as significantly more had more than one lesion, significantly more had lesions in other locations than the posterior forchette and of other types than lacerations. Lacerations had a minimum, median survival time of 24 hours, 40 hours and 80 hours with the three different investigave methods, respectively. Inter-­‐ and intra-­‐observer variation of interpretation of colposcopic photographs were measured in Kappa-­‐values and were only ’fair’ in most comparisons. The positive predictive value in cases where all 4 investigators agreed on interpretation of a particular photograph was only 82 %. In other words when the four investigators agreed on: ’Yes, there is a lesion here’ they only agreed with the doctor doing the initial investigation in 4 out of 5 photographs. The equivalent negative predictive value, representing cases where investigators agreed on:’ No lesions here’, was 81 %. In the 1970’es studies regarding sampling of semen found that the cervical canal was the best sampling site. In the present study, the posterior fornix was a significantly better sampling site, both when it comes to number of spermatozoa and number of positive slides. Of special forensic interest was the fact that all but one slides from the labia minora was positive in case of a positive sample from the posterior fornix, allowing for sampling without the use of a speculum. Conclusions - The percentage of women presenting with one or more genital lesion following intercourse is comparable in the case and control groups, 34 % vs. 36 % using the naked eye, 49 % vs. 49% using colposcopy, and 52 % vs. 51 % using toluidine blue dye, respectively - The duration of lesions was dependant of the investigative method. Four days post coitus, 0 out of 50 women had a laceration visible to the naked eye, 6/50 had a lesion visible using colposcopy, and 11/50 had a lesion visible using toluidine blue dye. - A single laceration in the posterior forchette was the most common lesion in both groups, but there were significantly more different lesion types and lesion sites in the rape victim group. - Odds ratio for a woman in the rape victim group to have more than one lesion compared to the control group was 8.1 using the naked eye, 4.9 using colposcopy and 1.9 using toluidine blue dye. - The inter-­‐observer variation in interpretation of colposcopic photographs (lesion present vs. No lesion) was large, with Kappa values ranging from 0.34 to 0.60. Pair wise agreement between observers was 68 % -­‐ 80 %. Intra-­‐observer variation was also large with Kappa values from 0.50 to 0.61. - The four observers agreed on interpretation of 189 (48 %) of the photographs. In these 189 photographs, there was only agreement with results of the initial examination in 81 % of the cases. - The best sampling site for detection of spermatozoa was the posterior fornix. But it is also of interest that only one woman had a negative sample from the labia minora in the presence of a positive sample from the fornix. In other words: detection of spermatozoa is possible without the use of a speculum.
    10/2013, Degree: Ph.D, Supervisor: Jørgen Lange Thomsen, professor
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    ABSTRACT: In cases of sexual assault, the finding of semen can provide crucial evidence. The presence of spermatozoa serves as proof of a sexual act and may give the identity of the alleged perpetrator through DNA-profiling. In most western countries, there are guidelines for standardized examinations of sexual assault victims. For an objective evaluation of the findings, substantial knowledge of aspects regarding consensual sexual intercourse is crucial. The aim of this study was to examine detection frequencies and genital sampling sites of spermatozoa following consensual sexual intercourse. In a prospective setting, 60 women underwent forensic examination following consensual sexual intercourse. Specimens were obtained from the external genitalia, the posterior fornix and the cervical canal, and examined using the Papanicolau stain and standard light microscopy. We found that 88% of possible cases were positive for spermatozoa. The posterior fornix was significantly better than the other sites for detection of spermatozoa and the number of spermatozoa decreased significantly over time. In a large sub-group of women who reported that no intra-vaginal ejaculation had taken place during their latest intercourse, a significant number (14%) had spermatozoa in the vagina. Spermatozoa were best recovered from the posterior fornix, but spermatozoa were also present on swabs taken from the external genitalia. Detection of spermatozoa is thus possible in cases where a speculum examination is denied.
    Forensic science international 05/2012; 221(1-3):137-41. DOI:10.1016/j.forsciint.2012.04.024 · 2.12 Impact Factor
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    ABSTRACT: The forensic approach to the clinical examination of a rape victim is made up of two parts: an objective examination followed by an interpretation of findings (or lack of positive findings) The scientific foundation that forms the basis of interpretation is, in cases of sexual assault, less than perfect. It relies on casuistic knowledge and personal experience gathered from conducting many examinations. Furthermore, the scientific knowledge that is available is ethically problematic and in parts of low quality, especially when it comes to the gynaecological part of the rape examination. Regarding genital injury, the definition of lesions and the use of investigative techniques vary so much from study to study that comparison is difficult. Material and methods Forensic gynaecological examinations were carried out in two groups of women in a prospective setup. One group consisted of 98 women who had experienced a consensual sexual intercourse (CSI) within 48 hours of examination and the other group consisted of 39 women who had experienced sexual assault. In the CSI-­‐group 50 of the 98 women were seen three times during one week following intercourse. All 137 women were examined in the same settings by the same team of doctors. The three different techniques in use worldwide, namely the naked eye, colposcopy and toluidine blue dye were used when diagnosing genital injury. All examinations were documented using colposcopic photography and inter-­‐observer variation and validity of photographs were determined. Samples for detection of semen were taken from three different sample sites. Results The overall frequency of lesions were comparable in the two groups using the three investigative methods: 34 % vs. 36 % using the naked eye, 49 % vs. 49% using colposcopy, and 52 % vs. 51 % using toluidine blue dye. Women in the rape victim group had more complex lesions as significantly more had more than one lesion, significantly more had lesions in other locations than the posterior forchette and of other types than lacerations. Lacerations had a minimum, median survival time of 24 hours, 40 hours and 80 hours with the three different investigave methods, respectively. Inter-­‐ and intra-­‐observer variation of interpretation of colposcopic photographs were measured in Kappa-­‐values and were only ’fair’ in most comparisons. The positive predictive value in cases where all 4 investigators agreed on interpretation of a particular photograph was only 82 %. In other words when the four investigators agreed on: ’Yes, there is a lesion here’ they only agreed with the doctor doing the initial investigation in 4 out of 5 photographs. The equivalent negative predictive value, representing cases where investigators agreed on:’ No lesions here’, was 81 %. In the 1970’es studies regarding sampling of semen found that the cervical canal was the best sampling site. In the present study, the posterior fornix was a significantly better sampling site, both when it comes to number of spermatozoa and number of positive slides. Of special forensic interest was the fact that all but one slides from the labia minora was positive in case of a positive sample from the posterior fornix, allowing for sampling without the use of a speculum. Conclusions - The percentage of women presenting with one or more genital lesion following intercourse is comparable in the case and control groups, 34 % vs. 36 % using the naked eye, 49 % vs. 49% using colposcopy, and 52 % vs. 51 % using toluidine blue dye, respectively - The duration of lesions was dependant of the investigative method. Four days post coitus, 0 out of 50 women had a laceration visible to the naked eye, 6/50 had a lesion visible using colposcopy, and 11/50 had a lesion visible using toluidine blue dye. - A single laceration in the posterior forchette was the most common lesion in both groups, but there were significantly more different lesion types and lesion sites in the rape victim group. - Odds ratio for a woman in the rape victim group to have more than one lesion compared to the control group was 8.1 using the naked eye, 4.9 using colposcopy and 1.9 using toluidine blue dye. - The inter-­‐observer variation in interpretation of colposcopic photographs (lesion present vs. No lesion) was large, with Kappa values ranging from 0.34 to 0.60. Pair wise agreement between observers was 68 % -­‐ 80 %. Intra-­‐observer variation was also large with Kappa values from 0.50 to 0.61. - The four observers agreed on interpretation of 189 (48 %) of the photographs. In these 189 photographs, there was only agreement with results of the initial examination in 81 % of the cases. - The best sampling site for detection of spermatozoa was the posterior fornix. But it is also of interest that only one woman had a negative sample from the labia minora in the presence of a positive sample from the fornix. In other words: detection of spermatozoa is possible without the use of a speculum.
    10/2013, Degree: Professor, Supervisor: Jørgen Lange Thomsen