The pattern of genito-anal injuries in female sexual assault cases in Mumbai, India

Abstract

BackgroundThe prevalence of genito-anal injuries in victims of sexual assault depends on several factors. Forensic examination, documentation of injuries and preparing report thus becomes challenging for healthcare providers as the presence or absence of injuries aids in the subsequent laying of charges against the accused. This paper aims to determine the pattern of genito-anal injuries and factors associated with the laying of charges against the accused. MethodsA cross-sectional study of victims of sexual assault (n = 440) was conducted between 2014 and 2017 in a specialized tertiary care center in a Metropolitan city in India. The results were expressed as proportion and percentage. Chi-squared test was used to analyse data using SPSS version 23.0. ResultsThere was no statistically significant association between reporting within 72 h of sexual assault and the arrest of the accused. Vaginal and anal bleeding were present in 4.1% cases and 2.7% cases respectively. Genital and anal injuries were present only in 30.9% of cases. The most common genito-anal injury was laceration (72.08%). Posterior fourchette injury (most common site) was present in 27.94% of cases. Extra genital injuries were found in 24.09% of victims. The most common extra genital injury was abrasion (26.42%). Intoxicants were found in the blood of 4.8% of victims and spermatozoa/semen was found in swabs from 3.6% of victims. In this study 25.9% of perpetrators were arrested, out of which 84.37% of adult victim’s cases and 94.23% of minor (<18 years) victims cases went to trial. In 3.12% of adults and 0.6% of minor victims, the accused was found guilty and sentenced to imprisonment. The presence of genital injury, visualization of sperm by direct microscopy, assailant known to the victim and pregnancy of the victim were not significantly associated with the laying of charges (p > 0.05) and were dropped from the model. The odds ratio (OR) for charge-laying associated with the age of the victim < 18 years was 3.02 (95% confidence interval [CI] 1.02–9.14). Arrests in accused of both victims > 18 years age and < 18 years age were more common if the accused was known to the victim. Injuries in victims < 18years of age and > 18 years of age did not appear to have any influence over the arrest. A notable finding was a high proportion (75.51% in <18 years and 77.77% in >18 years) of cases where an arrest was effected in adults and child sexual assault cases where no injuries were described. ConclusionThis study shows the pattern of genito-anal injuries and factors associated with the laying of charges in sexual assault cases in a developing country. It should be noted that most of those exposed to sexual assault do not have visible genito-anal injuries. We report that age is significantly associated with the presence of genito-anal injuries. However, it is important to note that the presence of injuries does not prove rape, neither its absence disproves the act. The information gathered by a meticulous forensic examination does make a difference in the legal outcome for cases of sexual assault.