Consensual Intercourse Research Articles

Evaluation of anogenital injuries using white and UV-light among adult volunteers following consensual sexual intercourse

ObjectivesNew clinical forensic examination techniques for sexual assaults have not been introduced over the last few decades. We evaluated the benefit of ultraviolet light compared to white light for detecting minor anogenital injuries and scars, following consensual sexual intercourse among adult volunteers. DesignA prospective study comparing female genital findings utilising white and ultraviolet light. A colposcopy with photographic documentation was used. SettingPersonal invitation to healthcare students, hospital employees or acquaintances to volunteer for a gynecological examination, with a focus on clinical forensic aspects. ParticipantsEighty-eight adult female volunteers were recruited for the study. The examination was performed after consensual intercourse. Age ranged from 20 to 52 years (median 26.5 years). Main outcome measuresPresence of acute findings and scars in the genital area using white and UV-light. ResultsAcute genital injury rate was 14.8% under white light colposcopy and 23.0% using UV light. Submucosal hemorrhages in the genital area were documented significantly better under UV-light than white light (14.9% vs. 6.8%; p=0.016), whereas petechiaes (4.5%) and abrasions (2.3%) were detected using either method. UV-light revealed significantly more often delivery-associated genital scars compared to white light (39.8% vs. 31.8%; p=0.016). Furthermore, 10 out of 31 (33.3%) women had no residual anogenital skin or mucosal surface findings, despite a prior episiotomy or rupture of the vaginal outlet wall during delivery, supporting its enormous ability to heal even after major trauma. ConclusionsUV-light may provide additional value for the evaluation of physical findings in clinical forensic examinations after sexual assault, and is especially useful in detecting otherwise invisible early submucosal hemorrhages and scars.

The Impact of Father Absence on Daughter Sexual Development and Behaviors

Our study investigated the relationship among daughters from father-absent homes, daughters’ age of menarche, and daughters’ first sexual intercourse. This study was conducted as a paper-and-pencil survey with a total of 12 questions answered by 342 undergraduate female students. Results indicated that females from father-absent homes reported experiencing menarche significantly earlier than females from father-present homes; significant correlations at the p < .001 level were found between first reported menarche and first reported consensual intercourse. There was a significant group difference found between father-present and father-absent homes in terms of the age at which participants reported the first onset of their menarche. As there was a significant correlation between onset of menarche and age of first intercourse, it could be surmised that pubertal timing could serve as a mediating factor between father absence and initial engagement in sexual activity.

Postcoital Vaginal Rupture in a Young Woman with No Prior Pelvic Surgery

Reports of postcoital vaginal rupture in the literature are limited to cases involving women who are postmenopausal, have recently undergone pelvic surgery, or have suffered genitourinary trauma. We report a case of postcoital vaginal rupture in a 23-year-old woman with no prior surgical history who complained of acute onset, severe vaginal pain after consensual intercourse. Examination under anesthesia revealed a 6-cm laceration of the posterior fornix, which extended into the abdominal cavity. The laceration was repaired using a combined vaginal and laparoscopic approach. Coitus-induced vaginal rupture in a reproductive aged woman with no prior pelvic surgery or other risk factors is a rare clinical presentation. Prior reports of rupture in premenopausal women have recommended repair via laparotomy. This case documents successful transvaginal and laparoscopic repair, and reviews the etiological mechanisms for coitus-induced injury.

Genital Injury After Forced or Consensual Intercourse

Both consensual and nonconsensual intercourse can cause female genital injury; health care providers cannot yet accurately determine the cause of such injury based on examination.

The Underutilization of Emergency Contraception

Despite the availability of effective contraceptive methods, unintended pregnancy continues to be a significant health problem for women throughout the world. The reasons for unplanned pregnancy include failure to use contraception, incorrect use of contraception, unplanned consensual intercourse, and rape. Emergency contraception was once heralded as a means of reducing the rates of unintended pregnancy, elective abortion, and unwanted childbirth. But more than three decades after the first oral form was introduced, the use of emergency contraception remains suboptimal-even in the United States, where it is available to most women of childbearing age without a prescription. Nurses can help narrow this clinical gap in women's health care by increasing awareness of emergency contraception, correcting common misconceptions about its mechanism of action and potential adverse effects, and facilitating patient access.

A pilot study to test the differential validity of a genital injury severity scale, in development for use in forensic sexual assault examinations

Methods of examining the sexual assault patient are not standardized and a definition of what constitutes significant genital injury after sexual assault (SA) remains controversial. This pilot study tests the empirical validity (initial differential validity) of a genital injury severity scale (GISS) under development by the authors with the hypothesis that women who report SA have more severe external genital injuries than those who engage in consensual intercourse (CI). In this observational, prospective study, an initially developed GISS is applied and the exam results of 59 CI volunteers and 185 SA patients are compared. All examinations were performed by experienced sexual assault forensic examiners (SAFE) using toluidine blue (TB) and colposcopy. The Independent Samples Median Test indicates a significant difference in median genital injury type between CI and SA subjects (p < 0.0001). There is a significant difference in the prevalence of Class A (less severe) and Class B injuries (more severe) between the SA and the CI groups (SA: Class A 60%/Class B 40%; CI: Class A 90%/Class B 10% (p= 0.0001)). This initial validation study shows effectiveness in using magnification and TB, combined with a standardized injury severity scale, in describing external genital injury in women after sexual intercourse.

Pediatric Emergency Health Care Providers’ Knowledge, Attitudes, and Experiences Regarding Emergency Contraception

The objective was to describe knowledge, attitudes, and experiences regarding emergency contraception (EC) among pediatric emergency health care providers (HCPs). This multicenter, focus group study elicited thoughts and experiences from pediatric emergency HCPs about EC. Participants were physicians, nurse practitioners (NPs), and nurses in one of three urban, geographically distinct, pediatric emergency departments (EDs). A professional moderator used a semistructured format for sessions, which were audiotaped, transcribed, and analyzed for recurrent themes. Participants provided demographic information and completed a written survey evaluating EC knowledge. Eighty-five HCPs (41 physicians, eight NPs, and 36 nurses) participated in 12 focus groups. Overall knowledge about EC was poor. Participants identified barriers including cost, privacy, knowledge, and provider refusal. Provision of EC for adolescents was supported by the majority of physicians and NPs; however, many nurses were not supportive, especially following consensual intercourse. The authors identified use of social judgment by nurses as a novel barrier to EC provision. The majority of HCPs did not support screening for potential EC need. The majority of physicians and NPs felt obligated to provide adolescents with all contraceptive options, while more nurses supported provider refusal to provide EC. This study identified important HCP perceptions and barriers about EC provision in the pediatric ED. These findings may inform future efforts to improve EC provision for adolescents. Specifically, future studies to evaluate the differences in attitudes between nurses, physicians, and NPs, and the use of social judgment in EC provision, are warranted.

Vaginal lacerations from consensual intercourse in adolescents

Objective (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock. Results Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall. Conclusions Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation. Practice implications Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences.

87: Vaginal Injuries After Consensual Versus Nonconsenual Sexual Intercourse In a Community-Based Population

87: Vaginal Injuries After Consensual Versus Nonconsenual Sexual Intercourse In a Community-Based Population

Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings

The purpose of this study was to determine which persons reporting sexual assault to a hospital-based treatment centre may have been covertly drugged and to provide information about whether a sexual assault may have occurred. Each consecutive adolescent and adult presenting at a sexual assault treatment centre was screened for drug-facilitated sexual assault (DFSA). Urine was collected and tested for central nervous system active drugs. Oral, vaginal, and/or rectal swabs were tested for male DNA. Unexpected drugs were defined as those not reported as having been voluntarily consumed within the previous 72 h. Positive swabs for unexpected DNA were determined by whether the person reported having had consensual intercourse in the previous week. A total of 184 of 882 eligible participants met suspected DFSA criteria. Mean age was 25.8 years (SD = 8.5), 96.2% were female and 64.7% White. Urine samples were positive for drugs in 44.9% of cases, alcohol in 12.9%, and both drugs and alcohol in 18.0%. The drugs found on toxicological screening were unexpected in 87 of the 135 (64.4%) cases with a positive drug finding and included cannabinoids (40.2%), cocaine (32.2%), amphetamines (13.8%), MDMA (9.2%), ketamine (2.3%), and GHB (1.1%). Male DNA was unexpected in 30 (46.9%) of 64 cases where it was found. Among those persons presenting to a sexual assault treatment centre with a suspicion of DFSA, the presence of unexpected drugs and male DNA was common, lending support for their contention that they had been intentionally drugged and sexually assaulted. Most unexpected drugs found were not those typically described as ‘date rape drugs’.

Female genital injuries resulting from consensual and non-consensual vaginal intercourse

Objectives The purpose of this study was to compare the incidence of genital injury following penile–vaginal penetration with and without consent. Design This study compared observations of genital injuries from two cohorts. Setting Participants were drawn from St. Mary's Sexual Assault Referral Centre and a general practice surgery in Manchester, and a general practice surgery in Buckinghamshire. Participants Two cohorts were recruited: a retrospective cohort of 500 complainants referred to a specialist Sexual Assault Referral Centre (the Cases) and 68 women recruited at the time of their routine cervical smear test who had recently had sexual intercourse (the Comparison group). Main outcome measures Presence of genital injuries. Results 22.8% ( n = 00, 95% CI 19.2–26.7) of adult complainants of penile–vaginal rape by a single assailant sustained an injury to the genitalia that was visible within 48 h of the incident. This was approximately three times more than the 5.9% ( n = 68, 95% CI 1.6–14.4) of women who sustained a genital injury during consensual sex. This was a statistically significant difference ( a < 0.05, p = 0.0007). Factors such as hormonal status, position during intercourse, criminal justice outcome, relationship to assailant, and the locations, sizes and types of injuries were also considered but the only factor associated with injury was the relationship with the complainant, with an increased risk of injury if the assailant was known to the complainant ( p = 0.019). Conclusions Most complainants of rape ( n = 500, 77%, 95% CI 73–81%) will not sustain any genital injury, although women are three times more likely to sustain a genital injury from an assault than consensual intercourse.

Health disparities in the forensic sexual assault examination related to skin color

Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.

Paradoxical air embolism through patent foramen ovale during consensual intercourse in a non-pregnant young female

Sudden vaginal bleeding and a cardiac arrest occurred in a 18-year-old female during consensual intercourse. Resuscitation procedures, applied at the arrival of a medical emergency team, restored the cardiac function allowing admission to hospital, where two vaginal mucosal lacerations were diagnosed and sutured. Cardiological investigations diagnosed a left ventricle myocardial infarction and a patent foramen ovale while a brain CT scan showed ischemic signs and intravascular air images. Death occurred after 48h, due to heart failure, cerebral anoxia and multiorgan failure. Autopsy confirmed a patent foramen ovale considered as responsible for a paradoxical air embolism. Judicial Authority evaluated the fatal paradoxical air embolism as a consequence of an unpredictable accident occurred during consensual intercourse without sexual violence.

Predictors of Genital Injury After Nonconsensual Intercourse

Understanding differences in genital injuries after nonconsensual and consensual intercourse is an important element of prosecuting sexual assault cases. In order to determine if the injury patterns and total surface area of genital injuries can differentiate between the types of intercourse (consensual or non-consensual), eighty women were examined after non-consensual (retrospective chart review, n = 40) and consensual (recruited, n = 40) intercourse within 48 hours using colposcopy, toluidine blue dye, and digital photography to document genital injuries. Differences between types of injuries found in the nonconsensual and consensual groups, based on the univariate analysis, were found with the number of sites (NoS) with ecchymosis (p < 0.01) and NoS with redness (p < 0.01). Based on the logistic hierarchical regression model, 85% of the nonconsensual group and 90% of the consensual group were classified correctly by using the NoS with tears, ecchymosis, abrasions, and redness and SA of injury when controlling for time from intercourse to examination. The NoS with redness (p = 0.017), NoS with ecchymosis, and SA of injury (p = 0.039) were individually predictive. The NoS with ecchymosis were also a significant finding when addressed as an individual block (p < 0.001). In this small sample, exploratory study, while controlling for time, the injury patterns and total SA of genital injuries were able to correctly classify the nonconsensual group 85% of the time. Replication of this study with a larger sample is essential.

Comparison of Methods for Identifying Ano-Genital Injury After Consensual Intercourse

Microtrauma occurs after consensual intercourse. Understanding the injury pattern from consensual intercourse may enlighten our understanding of the ano-genital injury after sexual assault. The purpose of this report is to compare consensual intercourse-related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy, and 3) toluidine-blue contrast application. Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling). Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p < 0.05). More tears were identified on the anus with toluidine-blue as compared to direct visualization (p < 0.05), but not colposcopy. Fewer ecchymoses were identified on the internal genitalia and fewer areas of redness were identified on both the external and internal genitalia when toluidine-blue was used, as compared to either direct visualization or colposcopy (p < 0.05). The scientific community needs to continue to build information about ano-genital injury prevalence after consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic examination. It is the health care provider's role to collect all possible evidence and the courts' role to determine what evidence is admissible and to ensure a rightful conviction.

Prevalence, Characteristics, and Associations of Sexual Abuse with Sociodemographics and Consensual Sex in a Population-Based Sample of Swedish Adolescents

The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.

Forensic sexual assault examination and genital injury: is skin color a source of health disparity?

Purpose The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination. Methods A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse. Results Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants ( P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables—lightness/darkness–, redness/greenness–, and yellowness/blueness–confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable—redness/greenness—was significantly associated with injury occurrence and frequency in the internal genitalia. Conclusions Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.

Life threatening vaginal haemorrhage from coital laceration in a post-menopausal woman

Background: Life threatening coital laceration from consensual intercourse in the postmenopausal period is unusual without any predisposing factors(s). The usual site of occurrence is the right side of the posterior fornix. Aim: To report a case of haemorrhagic shock from coital laceration. Design: Case report Case report: A 55-year-old woman who presented as an emergency with haemorrhagic shock following vaginal bleeding from consensual coitus is presented. She was resuscitated with intravenous fluids and blood transfusions. The vaginal laceration of about 5 cm on the right side of the posterior fornix was sutured following examination under anaesthesia. Conclusion: Coital laceration should be considered a differential diagnosis in any postmenopausal vaginal bleeding while prompt recognition and treatment are important to avoid morbidity and even mortality. Keywords: Life threatening, Postmenopausal, Coital, Laceration, Posterior fornixPort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 275-277

Changes in genital injury patterns over time in women after consensual intercourse

To date, there are no studies in the literature addressing whether or not microscopic genital injuries change over time or change in appearance during the 72 h time period following intercourse. In this study, women ( n = 35) had two evidentiary type pelvic examinations to document injuries after consensual intercourse. At Time 1 (within 48 h of consensual intercourse) a: larger total surface area of injury ( p = 0.02); larger surface area of injury to the posterior fourchette ( p = 0.02); larger surface area of abrasions ( p = 0.04); and larger surface area of redness ( p = 0.04) were found compared to Time 2 (24 h after Time 1). Since this research is exploratory, larger studies are needed to explore the differences in genital injuries based on the time of examination and in women after non-consensual intercourse.

Geographical variations and contextual effects on age of initiation of sexual intercourse among women in Nigeria: a multilevel and spatial analysis

BackgroundThe age of initiation of sexual intercourse is an increasingly important issue to study given that sexually active young women are at risk of multiple outcomes including early pregnancies, vesico-vaginal fistula, and sexually transmitted infections. Much research has focused on the demographic, familial, and social factors associated with sexual initiation and reasons adolescents begin having consensual intercourse. Less is known, however, about the geographical and contextual factors associated with age of initiation of sexual intercourse. Therefore, the purpose of this study was to examine the extent of regional and state disparities in age of initiation of sexual intercourse and to examine individual- and community-level predictors of early sexual debut.MethodsMultilevel logistic regression models were applied to data on 5531 ever or currently married women who had participated in 2003 Nigeria Demographic and Health Survey. Coital debut at 15 years or younger was used to define early sexual debut. Exploratory spatial data analysis methods were used to study geographic variation in age at first sexual intercourse.ResultsThe median age at first sexual intercourse for all women included in the study was 15 years (range; 14 – 19). North West and North East had the highest proportion of women who had reported early sexual debut (61% – 78%). The spatial distribution of age of initiation of sexual intercourse was nonrandom and clustered with a Moran's I = 0.635 (p = .001). There was significant positive spatial relationship between median age of marriage and spatial lag of median age of sexual debut (Bivariate Moran's I = 0.646, (p = .001). After adjusting for both individual-level and contextual factors, the probability of starting sex at an earlier age was associated with respondents' current age, education attainment, ethnicity, region, and community median age of marriage.ConclusionThe study found that individual-level and community contextual characteristics were independently associated with early sexual debut, suggesting that interventions to reduce adolescent high-risk sexual behaviour should focus on high-risk places as well as high-risk groups of people.