Signs of genital trauma in adolescent rape victims examined acutely

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      Background: Adolescent females are the most frequent victims of sexual assault, but studies to document the presence of genital findings in patients examined within 72 hours, using magnification and dye, have not been published. This study was designed to document the frequency and types of genital injuries in adolescent women following acute sexual assault, using chart and photograph review.
      Methods: A retrospective chart review was done of examination records of all female patients age 14 to 19 years of age who were evaluated at a Sexual Assault Response Team program over a 5 year period. Data was abstracted from charts by the nurse examiners, and photographs were evaluated by the physician reviewer. Analysis was done to determine the frequency, location, and severity of genital and anal injuries, and any historical factors correlating with injury, using Pearson correlation and two-tailed t tests.
      Results: Charts of 214 female subjects (mean age 16.3 years) were reviewed. The most common findings recorded by the nurse examiner were posterior fourchette tear (36%), erythema of the labia minora, hymen, cervix or posterior fourchette (18% to 32%), and swelling of the hymen (19%). Uptake of Toluidine dye was noted in 66% of patients in whom it was applied. Overall, 21% of patients were found to have no findings, and 40% had tears of the posterior fourchette or fossa. Time to examination was highly correlated with the degree of injury noted (p = .000). The incidence of hymenal tears in self-described virgins was higher than in non-virgins (19% vs. 3%, p = .008), however the total number or severity of other injuries was not significantly higher in virgins. Reported anal penetration was associated with a high frequency of anal bruising, abrasions or tears (14/23, 61%), while only 2/150 victims who denied anal penetration had tears (1%, p = .000). Victims who reported multiple physical symptoms such as pain, nausea, or vomiting were significantly more likely to be older (p = .034) and to have an increased number of non-genital injuries such as bruising, abrasions, and bite marks (p = .001). A higher number of non-genital injuries was also correlated with a higher number of total genital injuries (p = .003).
      Conclusions: Adolescent victims of sexual assault who were examined within 72 hours, using a magnification and dye were found to have tears of the posterior fourchette or fossa in 40% of cases. Hymenal tears were rare, even in self-described virginal girls. Timely examination of adolescent victims is important to document injuries, however, many victims will still have non-specific examination findings.
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