Abstract
This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.
Highlights
Differentiation between genital injury due to consensual penetrative vaginal intercourse and genital injury caused by non-consensual penetrative vaginal intercourse is a matter of ongoing scientific debate and obviously incorporates a fundamental issue in sexual assault medicine
The presumably most cited investigation in this context is by Slaughter et al [3]; as one of the first studies to compare genital injury after consensual and non-consensual intercourse using magnification techniques authors found genital trauma in 11% of consenting women and in 68% of rape victims
With these results it was evident that consensual intercourse might lead to genital injuries, which on the other hand does not have to be the case in women who allege sexual assault
Summary
Differentiation between genital injury due to consensual penetrative vaginal intercourse and genital injury caused by non-consensual penetrative vaginal intercourse is a matter of ongoing scientific debate and obviously incorporates a fundamental issue in sexual assault medicine.Benjamin Tuschy and Sebastian Berlit have contributed to this workMedical Centre Mannheim, Heidelberg University, Theodor‐Kutzer‐Ufer 1‐3, 68167 Mannheim, GermanyUniversity, Heidelberg, GermanyThe first hypothesis regarding this context rose in the mid-twentieth century as authors stated that physiologic changes (e.g. lubrication) and concurring interaction during consensual intercourse prevented genital trauma [1, 2].On the other hand it was supposed that women who had been raped lacked these reactions, so that genital harm was possible. The presumably most cited investigation in this context is by Slaughter et al [3]; as one of the first studies to compare genital injury after consensual and non-consensual intercourse using magnification techniques authors found genital trauma in 11% of consenting women and in 68% of rape victims. With these results it was evident that consensual intercourse might lead to genital injuries, which on the other hand does not have to be the case in women who allege sexual assault
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