Abstract
BackgroundThe prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood. This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. In such cases, health care providers face major challenges in presenting and defending their findings. The aim of this paper is to describe the absence of genito-anal injuries by site in a group of rape survivors and to identify factors associated with the absence of these injuries.MethodsIn a cross-sectional study rape cases reported to the police in one province in South Africa were randomly sampled using a two stage sampling procedure. Data were obtained on the survivor, the circumstances of the rape and the findings of the medicolegal examination. Descriptive statistics were conducted for the prevalence of genito-anal injuries by site and logistic regression models were built to identify factors associated with the absence of genito-anal injuries for all survivors and those reported to be virgins.ResultsIn the sample of 1472 women injuries ranged from 1% to 36%. No significant injuries were reported for 749 (51%) survivors. In the multivariable model there was a significantly lower odds of having no injuries in survivors who were virgins, those raped by multiple perpetrators and those examined by a doctor with additional qualifications. In the model for survivors who were virgins, those with disabilities had a greater odds of having no injuries while those between the ages of 8 and 17 years had a lower odds of having no injuries compared to survivors below four years of age.ConclusionsThis study found that being a virgin, multiple perpetration rape and the examiner’s qualifications were significantly associated with the absence of genito-anal injuries. Health providers should thus be aware that in all other respects there was no difference in survivors who had injuries and those who did not. It is important to reiterate the message that the presence of injuries does not necessarily prove that rape occurred nor does the absence disprove the fact.
Highlights
The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood
Additional training appears to play a significant role in improving the quality of services provided to survivors of rape, and it is interesting that this study found that there was a significant association between doctors who had some advanced training and the recording on injuries on the J88 form
This study provides valuable data that health care providers can use during presentation in court as expert witnesses
Summary
The prevalence of genito-anal injuries in rape survivors varies significantly and the factors associated with the absence of injuries are not well understood This plays a major role in the conviction of cases as the absence of injury is equated with a lack of assault. A classification of injuries has been developed [4] but in adults, the interpretation of evidence is much more complex This allows for health care providers to be challenged in court especially in cases where no injuries have been found as some literature have reported on the presence of injuries after consensual intercourse as well [5,6,7,8,9]. Higher rates of prosecution and conviction have been found in cases with injuries documented [10,11].
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