10. A Comparison of Injury Patterns in Women After Consensual Intercourse

Abstract

Because of the importance of documenting the pattern and extent of injuries in a sexual assault examination, there is ongoing interest in identifying types and patterns of injuries following consensual intercourse. Sexual assault nurse examiners are often asked during testimony if the injuries observed were inconsistent with consensual intercourse. However, until more is known about the injuries following consensual intercourse, comparisons are difficult to make. The specific aim of the study was to compare genital injury findings from 2 groups of study participants: women who had consensual intercourse knowing they would be examined for a study (group 1), and women who consented to participate after they had intercourse (group 2). These studies were undertaken to further document and understand genital injury patterns following consensual intercourse. A descriptive, comparative study design was used to study healthy females who were examined within 72 hours of engaging in consensual intercourse. The study was conducted at a university hospital emergency department by sexual assault nurse examiners. The sample consisted of 15 healthy nonpregnant female volunteers between 18-45 years of age who were recruited through flyers placed in designated areas in the community. The women underwent colposcopic examination and photography of the external genitalia using standard sexual assault examination techniques. The number and location of the tears, abrasions, ecchymosis, redness, and swelling were documented. The documentation and photographs of all of the cases was peer reviewed by experienced sexual assault nurse examiners individually and as a group to determine percent agreement. Approximately one third of the women in both groups were found to have some type of genital injuries (tears, ecchymosis, and abrasions) after consensual intercourse. There were no statistical differences between groups based on types, numbers, and location of injuries (χ2 = .011, df = 1, P = .46). The nonscheduled examination group had a higher percentage (20%) of abrasions (χ2 = 2.32, df = 1, P = .06). There were differences found in age (group 1: 29.3 + 6.0 to group 2: 22.1 + 3.8) (P < .05) using an independent t test. Condom use also was statistically different (group 1: 19.6% to group 2: 40%) (P = .05) using chi-square. There were no differences between the groups based on prior knowledge of the study examination in the types, numbers, and location of the injuries identified. The group 2 women (nonscheduled) were younger and used condoms more often than did group 1 women. Additional studies with larger sample sizes are needed to corroborate these findings.