Fossa navicularis disruptions in adolescent sexual assault victims

Abstract

Background Adolescent females have typically comprised a significant portion of the total population of patients seen for medical-legal exams by the SART team. Recent studies have documented the correlates of injury in sexual assault victims and noted the frequency of injury to the fossa navicularis in both adult and adolescent victims of sexual assault. Methods A retrospective case review inclusive of the history, physical exam and colposcopic photographs of 136 adolescents seen between January, 1990 through December, 1994 was conducted. Colposcopy at 15 X was utilized. Six cases were eliminated from inclusion due to inadequacy of the photodocumentation. Patients were seen after sexual assault, molest or consenting intercourse with a minor. 69(53%) of the 130 were found to have positive fossa findings. The nature of positive fossa findings was divided into two time frames: 1.) acute/resolving acute fossa trauma and 2.) old/non-acute fossa disruptions. Results 69 females had positive fossa findings. Their mean age was 14.8 y.o. 65% (45/69 had old fossa disruptions. 35% (24/69) had fossa trauma that was either acute or resolving. The range of time to exam was from less than 24 hrs. to 30 days. 29% of the acute group (7/24) were examined in less than 24 hrs. Another 29% received evaluation within 72 hours. Overall, 79% of this acute group received an exam within 2 weeks of the assault (19/24). In the positive fossa group, these factors were documented: history of penile/vaginal contact 62% (43/69); history of pain: 74% (51/69); post-assault bleeding: 29% (20/69); history of prior victimization: 33 1/3% (23/69) and acknowledgement of prior consenting sexual activity: 48% (33/69). In 62% (43/69), genital trauma to sites other than the fossa navicularis was present. In this sample, 26% (18/69) returned for a follow-up exam, which included colposcopy to document the overall resolution of trauma. Of the 24 cases with acute or resolving fossa trauma, 66.6% (16/24) returned for follow-up. In 100% of these cases, the fossa defect persisted on follow-up exam. Conclusions in 130 females adolescents evaluated using colposcopy during a 5 year period, fossa defects were present in 53%. These were associated with penile-vaginal contact, pain, bleeding, prior vaginal penetration and other genital trauma. Acute and resolving/acute fossa defects noted on initial exam persisted in 100% of the cases which returned for follow-up exam, representing a persistent, post-traumatic disruption to this structure. Adolescent females have typically comprised a significant portion of the total population of patients seen for medical-legal exams by the SART team. Recent studies have documented the correlates of injury in sexual assault victims and noted the frequency of injury to the fossa navicularis in both adult and adolescent victims of sexual assault. A retrospective case review inclusive of the history, physical exam and colposcopic photographs of 136 adolescents seen between January, 1990 through December, 1994 was conducted. Colposcopy at 15 X was utilized. Six cases were eliminated from inclusion due to inadequacy of the photodocumentation. Patients were seen after sexual assault, molest or consenting intercourse with a minor. 69(53%) of the 130 were found to have positive fossa findings. The nature of positive fossa findings was divided into two time frames: 1.) acute/resolving acute fossa trauma and 2.) old/non-acute fossa disruptions. 69 females had positive fossa findings. Their mean age was 14.8 y.o. 65% (45/69 had old fossa disruptions. 35% (24/69) had fossa trauma that was either acute or resolving. The range of time to exam was from less than 24 hrs. to 30 days. 29% of the acute group (7/24) were examined in less than 24 hrs. Another 29% received evaluation within 72 hours. Overall, 79% of this acute group received an exam within 2 weeks of the assault (19/24). In the positive fossa group, these factors were documented: history of penile/vaginal contact 62% (43/69); history of pain: 74% (51/69); post-assault bleeding: 29% (20/69); history of prior victimization: 33 1/3% (23/69) and acknowledgement of prior consenting sexual activity: 48% (33/69). In 62% (43/69), genital trauma to sites other than the fossa navicularis was present. In this sample, 26% (18/69) returned for a follow-up exam, which included colposcopy to document the overall resolution of trauma. Of the 24 cases with acute or resolving fossa trauma, 66.6% (16/24) returned for follow-up. In 100% of these cases, the fossa defect persisted on follow-up exam. in 130 females adolescents evaluated using colposcopy during a 5 year period, fossa defects were present in 53%. These were associated with penile-vaginal contact, pain, bleeding, prior vaginal penetration and other genital trauma. Acute and resolving/acute fossa defects noted on initial exam persisted in 100% of the cases which returned for follow-up exam, representing a persistent, post-traumatic disruption to this structure.