Article

Forensic sexual assault examination and genital injury: Is skin color a source of health disparity?

University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
The American journal of emergency medicine (Impact Factor: 1.15). 11/2008; 26(8):857-66. DOI: 10.1016/j.ajem.2007.11.025
Source: PubMed

ABSTRACT The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination.
A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse.
Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables--lightness/darkness-, redness/greenness-, and yellowness/blueness-confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable--redness/greenness--was significantly associated with injury occurrence and frequency in the internal genitalia.
Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.

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    • "Finally , differences in injury may be a result of differences in the mechanical properties of the skin, and skin mechanics were not measured in this study. If differences in injury prevalence result from differences in the innate properties as they differ across the continuum of skin color, then perhaps dark skin is in some way more elastic , or less likely to be injured, than light skin (Sommers et al., 2008). "
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    ABSTRACT: Differences in anogenital injury resulting from rape may occur because of racial or skin color differences in adult women. It is critical to determine if these differences also are associated with differences in injury prevalence and frequency in adolescents and young adults. In a retrospective review of medical records, we examined whether Black adolescent/young adult females had different anogenital injuries as compared to White females following rape. Next, we examined whether skin color differences explained a significant amount of the racial difference in injuries. We reviewed charts of 234 female victims of rape ages 14 to 29. Overall injury prevalence was 62.8%. Race was significantly associated with frequency of injuries in several anatomical locations, with White victims having a higher frequency of injuries than Black victims. Skin color was significantly associated with injury frequency in many anatomical locations, with victims with light skin sustaining more injuries than victims with dark skin. Even when skin color was included in the relationship, race remained a statistically significant factor, suggesting that the relationship between race and injuries may be more complicated than merely a skin color difference that has been mislabeled a racial difference.
    Journal of Forensic Nursing 01/2010; 6(3):144-50. DOI:10.1111/j.1939-3938.2010.01070.x
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    • "A sample size analysis (Hintze, 2001) indicated that 120 participants were necessary to achieve at least 80% power to detect (α = 0.05): 1) as small as a 5% change in the odds of anogenital injury occurrence (prevalence) associated with a 10-unit change in L* values (lightness/darkness) and 2) as small as a 5% increase in the number of observed injuries (frequency) associated with a 10-unit change in L* values. L* values were selected as they are the most analogous to White and Black skin color and their values are constrained to fall between 0 and 100, while a* and b* values are boundless (Sommers et al., 2008). All data were double entered and all discrepancies were rectified by consultation with the principal investigator. "
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    ABSTRACT: Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.
    Journal of Forensic Nursing 12/2009; 5(4):191-200. DOI:10.1111/j.1939-3938.2009.01054.x
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