Objective: To correlate historic and physical examination findings in female sexual assault victims. Methods: All adult women between January 1997 and September 1999 reporting to an urban hospital after sexual assault underwent a standardized history and physical examination by a resident in obstetrics and gynecology (n = 819). Retrospective data abstraction was verified. Logistic regression analyses were used to identify predictors of nongenital and genitoanal trauma. Results: Mean age was 29.3 years (SD = 11.9, range 15–87). Of the women, 35% were nonwhite, 26% had major psychiatric diagnoses, and 10% were homeless. Fifty three percent had recent alcohol or drug (AOD) use. Nongenital trauma was found in 52%. Measures independently associated with nongenital trauma were: age younger than 20 or older than 49 (ref., 20–49, OR 2.0, 3.8), assault by stranger (OR = 1.9), assault by an intimate partner (OR = 1.7), being choked (OR = 3.9), or being anally raped (OR = 1.6). Genitoanal trauma, identified in 194 of 762 patients (26%), was independently associated with age (<20, OR = 0.4; > 49, OR = 1.2, ref. 20–49), anal rape (OR = 1.8), virginal status (OR = 3.7), and those with general body trauma (OR = 1.8). Relationship, number of assailants, and substance use were not associated with genitoanal trauma. Conclusion: More violent sexual assaults were by strangers or intimate partners, or involved anal rape, but the absence of physical injury is frequent. Prevention and treatment strategies should target vulnerable populations, including those with substance use and psychiatric illness.