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.

0 Bookmarks
 · 
118 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to analyze the usefulness of fibronectin and P-selectin in detecting the vitality of the wounds in everyday legal medicine practice, in uncontrolled conditions, and to see whether they can be used for estimating the age of the lesions. We used 17 cases with a short interval from the production of the wounds to death. On the integuments studied from the cases selected in the interest group, fibronectin (FbN) was positive at the dermis - epidermis junction relatively frequently, in the superficial dermis focally and in the deep dermis peri-axially (sudoriparous glands, sebaceous glands) with a sometimes marked reaction; it was also interstitially positive around hemorrhagic areas in the hypodermic conjunctive and adipose tissue. P-selectin (CD-62P) was positive variably and focally in the extracellular matrix and the vessels, with a low intensity and a fibrillar pattern. The P-selectin expression in the extracellular matrix was equal to the P-selectin expression in the capillaries. Between the expression Fb and CD-62-P and the postmortem interval there was no correlation. The fibroblasts in the extracellular matrix showed variable positivity. For forensic practice the usefulness of fibronectin and P-selectin is debatable. If they are very useful in detecting the vitality of the wound, for estimating the age there is a need for a much larger scale study, that must take into consideration factors like CPR, individual pathologies, and so on.The two used antibodies have a moderate sensitivity and low specificity, and as such they have to always be correlated with the Perls staining, and in a histopathological context only.
    Romanian Journal of Legal Medicine 12/2013; 21(4):281-286. DOI:10.4323/rjlm.2013.281 · 0.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to compare the prevalence, type and pattern of macroscopically detected female genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of genital injury resulting from vaginal penetrative sexual intercourse. Two groups of reproductive age women (aged 18-45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal genital sites. Forty one women who presented for forensic examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic genital examination and gynaecological examination of healthy and diseased sexually active women. Data collection and examination protocols were the same for both groups. The key finding was a statistically significant difference in genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one genital injury [OR 10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing genital 'infection' were found to be significantly associated with the presence of injury in the univariate analysis after adjusting for consent. Logistic regression demonstrated that women penetrated without consent were 19.5 times more likely to sustain at least one genital injury, than those penetrated consensually [OR 19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely to result in at least one genital injury than penetration without finger involvement [OR 4.25, CI (1.42, 12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalence in the consensual group limited interpretation, results revealed possible differences in genital injury typology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerations were seen after both consensual and non-consensual vaginal penetration, while abrasions and bruises were seen exclusively in the non-consensual group. This study demonstrated a significant consent group difference in genital injury prevalence and the highest macroscopically detected genital injury prevalence rate resulting from non-consensual vaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increases the likelihood of sex-related injury. The difference in type of injury sustained as a result of non-consensual and consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting genital injury based on consistent injury definitions, examination protocols, and examiner experience and suggest that macroscopic genital examination may be uniquely placed to detect consent group differences in injury typology and pattern if they exist.
    Journal of Forensic and Legal Medicine 10/2013; 20(7):884-901. DOI:10.1016/j.jflm.2013.06.025 · 0.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medical-legal-social science research has documented that nongenital and/or anogenital injuries play a significant role throughout the criminal justice system from victims reporting to judges determining the length of a sentence. What remains an open question is whether the documentation of anogenital injury influences women's willingness to engage in the criminal justice system. A sample of women age 21 years and older residing in an urban area were asked about willingness to report to police, file charges, and work with the courts to prosecute after rape. Questions were framed with a qualifying statement about the forensic examination being able to detect injury related to forced sexual intercourse. Results show that women had a high willingness to act if the examination could detect anogenital injury and women with and without a history of forced sexual intercourse had significant differences in their responses to these questions. Implications for health care, criminal justice system, and future research are discussed.
    Violence and Victims 12/2013; 28(6):968-83. DOI:10.1891/0886-6708.VV-D-12-00109 · 1.28 Impact Factor

Full-text (2 Sources)

Download
57 Downloads
Available from
May 27, 2014