Frequency of Injuries to Women after Sexual Offense – Relevance of a Gynecology Examination

Abstract

Introduction Up to a third of women worldwide report having experienced an act of sexual violence during their lifetime. The emergency gynecology department is often the first port of call for affected individuals. The aim of the current study was to evaluate the importance of gynecology examinations for women after a sexual offense and to evaluate the pattern of injuries sustained.

Methods This study is a retrospective single center analysis of the gynecology and forensic examination reports of all women examined for a suspected sexual offense in the central emergency department of a university hospital between 2013 and 2017 (n = 692). We evaluated genital and extragenital injury patterns, age, offender profile, time of offense, and substance use, as well as the administration of post-coital contraception and post-exposure prophylaxis for HIV.

Results The affected individuals had a mean age of 26 (12 – 91 years). Almost 75% of affected individuals presented within 24 hours of the reported sexual offense. Extragenital injuries were detected in 78.6% of patients and genital injuries in 28.5%. Overall, 20.1% of the women reported complete memory loss and 18.7% partial memory loss of the actual event. Risk factors for memory lapse were the consumption of alcohol and/or the (possibly non-consensual) administration of other substances acting on the central nervous system. A history of alcohol consumption by the victim (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.21 – 3.12, p = 0.006) and younger victims aged between 25 – 49 years (HR 1.75; 95% CI 1.07 – 2.85, p = 0.025) were associated with the occurrence of extragenital injuries. However, if the perpetrator was someone who was known to the affected individual, fewer extragenital injuries were sustained (HR 0.60; 95% CI 0.36 – 0.99, p = 0.046). Reports of genital injuries, associated with an older age of affected individuals and indications of anal penetration, resulted in more frequent administration of post-exposure prophylaxis (29.1% vs. 19.5%, p < 0.012) and hepatitis B (active) vaccination (40% vs. 28.5%, p < 0.028).

Conclusion Emergency gynecology examinations form a fundamental component of the medical care and the assessment of affected women after a sexual offense, since almost a third of victims sustain injuries to the genital region. In addition to a detailed complete physical examination and expert forensic documentation of physical and genital injuries, victims should also be offered psychological support which is easy for them to access.

Key words

sexual offense - gynecology examination - genital injuries - injury pattern - forensic medicine

Publication History

Received: 13 October 2021
Received: 09 February 2022

Accepted: 10 February 2022

Article published online:
05 April 2022

• References/Literatur

• 1 WHO, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council, eds.. Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. WHO; 2013
• 2 Bundeskriminalamt. Hrsg. Polizeiliche Kriminalstatistik. Bundesrepublik Deutschland. Einzelne Straftaten/-gruppen und ausgewählte Formen der Kriminalität. PKS Jahrbuch; 2019. Band 4, 67. Ausgabe V2.0: 17
• 3 Bundeskriminalamt. Polizeiliche Kriminalstatistik (PKS) 2020 (20.01.2021). Accessed September 10, 2021 at: http://www.bka.de/DE/AktuelleInformationen/StatistikenLagebilder/PolizeilicheKriminalstatistik/PKS2020/PKSTabellen/BundFalltabellen/bundfalltabellen.html?nn=145506
• 4 Vrees RA. Evaluation and Management of Female Victims of Sexual Assault. Obstet Gynecol Surv 2017; 72: 39-53
• 5 Suttipasit P. Genitoanal Injury in Sexually Assaulted Adult Women: Six-Year Retrospective in Bangkok. Am J Forensic Med Pathol 2018; 39: 312-324
• 6 Jewkes R, Christofides N, Vetten L. et al. Medico-legal findings, legal case progression, and outcomes in South African rape cases: retrospective review. PLoS Med 2009; 6: e1000164
• 7 McGregor MJ, Le G, Marion SA. et al. Examination for sexual assault: is the documentation of physical injury associated with the laying of charges? A retrospective cohort study. CMAJ 1999; 160: 1565-1569
• 8 Sommers MS. Defining patterns of genital injury from sexual assault: a review. Trauma Violence Abuse 2007; 8: 270-280
• 9 Zink T, Fargo JD, Baker RB. et al. Comparison of methods for identifying ano-genital injury after consensual intercourse. J Emerg Med 2010; 39: 113-118
• 10 Lenahan LC, Ernst A, Johnson B. Colposcopy in evaluation of the adult sexual assault victim. Am J Emerg Med 1998; 16: 183-184
• 11 Slaughter L, Brown CR. Colposcopy to establish physical findings in rape victims. Am J Obstet Gynecol 1992; 166: 83-86
• 12 Orellana-Campos C. Genital Injuries: Are They Telling us Something about Sexual Violence?. Rev Bras Ginecol Obstet 2020; 42: 106-113
• 13 Kennedy KM. Heterogeneity of existing research relating to sexual violence, sexual assault and rape precludes meta-analysis of injury data. J Forensic Leg Med 2013; 20: 447-459
• 14 Fryszer LA, Hoffmann-Walbeck H, Etzold S. et al. Sexually assaulted women: Results of a retrospective analysis of 850 women in Germany. Eur J Obstet Gynecol Reprod Biol 2020; 250: 117-123
• 15 White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013; 27: 113-130
• 16 Maguire W, Goodall E, Moore T. Injury in adult female sexual assault complainants and related factors. Eur J Obstet Gynecol Reprod Biol 2009; 142: 149-153
• 17 Anderson SL, Parker BJ, Bourguignon CM. Changes in genital injury patterns over time in women after consensual intercourse. J Forensic Leg Med 2008; 15: 306-311
• 18 Zilkens RR, Smith DA, Phillips 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
• 19 Poulos CA, Sheridan DJ. Genital injuries in postmenopausal women after sexual assault. J Elder Abuse Negl 2008; 20: 323-335
• 20 Sugar NF, Fine DN, Eckert LO. Physical injury after sexual assault: findings of a large case series. Am J Obstet Gynecol 2004; 190: 71-76
• 21 Hilden M, Schei B, Sidenius K. Genitoanal injury in adult female victims of sexual assault. Forensic Sci Int 2005; 154: 200-205
• 22 Kienast T, Stoffers J, Bermpohl F. et al. Borderline personality disorder and comorbid addiction: epidemiology and treatment. Dtsch Arztebl Int 2014; 111: 280-286
• 23 Foa EB, Zoellner LA, Feeny NC. An evaluation of three brief programs for facilitating recovery after assault. J Trauma Stress 2006; 19: 29-43
• 24 Holmes MM, Resnick HS, Kilpatrick DG. et al. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol 1996; 175: 320-324 discussion 324–325
• 25 Draughon JE. Sexual assault injuries and increased risk of HIV transmission. Adv Emerg Nurs J 2012; 34: 82-87
• 26 Gray RH, Wawer MJ, Brookmeyer R. et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet 2001; 357: 1149-1153