Anogenital Injuries in Adolescents after Consensual Sexual Intercourse

Jeffrey S Jones · Linda Rossman · Melissa Hartman · Carmen C. Alexander

98 citations0/0 files storedAcademic Emergency Medicine

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Sexual Assault and Victimization Studies Adolescent Sexual and Reproductive Health Child Abuse and Related Trauma

Abstract

OBJECTIVES: To compare the types and locations of anogenital injuries occurring in adolescent females (13-17 years old) after consensual and nonconsensual sexual intercourse. METHODS: The authors conducted a retrospective, matched case-control study to assess anogenital injuries in female adolescents presenting to a free-standing nurse examiner clinic during a four-year study period. Adolescents were selected for inclusion in the study if they reported consensual sexual intercourse (CSI) and agreed to a medical-legal examination. Control subjects were victims of alleged sexual assault or nonconsensual sexual intercourse (NCSI) matched to cases by age and prior sexual intercourse experience. Genital trauma was documented using colposcopy with nuclear staining and digital photography. Data were analyzed using chi-square and t-tests. RESULTS: Fifty-one cases of CSI were identified; the age range was 13 to 17 years (mean=15.1 years). Overall, 49% (25/51) of CSI subjects reported no prior sexual intercourse experience. CSI and NCSI were comparable in terms of race, time to physical examination, alcohol use, and frequency of genital injuries (73% vs. 85%, p=0.069). The mean number of documented anogenital injuries in CSI subjects was 1.9 +/- 1.5. These injuries commonly involved the hymen, fossa navicularis, and posterior fourchette. CSI subjects had a greater number of anogenital injuries (2.6 +/- 2.0; p=0.02), typically involving the fossa navicularis, labia minora, and hymen. The most common type of injury in both groups was lacerations (39% vs. 41%); however, NCSI subjects had a greater incidence of anogenital abrasions, ecchymosis, and edema (chi2=10.4, p=0.035). CONCLUSIONS: Anogenital trauma was documented in 73% of adolescent females after consensual sexual intercourse versus 85% of victims of sexual assault. The localized pattern and severity of anogenital injuries were significantly different when compared with victims of sexual assault.

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References

1997Patterns of genital injury in female sexual assault victims 2002The prosecution of sexual assault cases: Correlation with forensic evidence 1997Female victims of rape and their genital injuries 1992Colposcopy to establish physical findings in rape victims 1988Sexually Related Trauma 2001Adolescent Sexual Assault 2003Comparative Analysis of Adult versus Adolescent Sexual Assault: Epidemiology and Patterns of Anogenital Injury

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2004Comparison of sexual assaults by strangers versus known assailants in a community-based population 2005Genitoanal injury in adult female victims of sexual assault 2008Genital Findings of Women After Consensual and Nonconsensual Intercourse 2008Forensic sexual assault examination and genital injury: is skin color a source of health disparity?2006Genital Findings of Women After Consensual and Nonconsensual Intercourse 2008Visualizing sexual assault: An exploration of the use of optical technologies in the medico-legal context

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