Patterns of genital injury in female sexual assault victims

Am J Obstet Gynecol. 1997 Mar;176(3):609-16. doi: 10.1016/s0002-9378(97)70556-8.


Objective: New colposcopic protocols allow examiners to better document genital trauma in rape victims. We report our findings on the locations and types of genital injury seen in female assault victims versus women engaging in consensual sex.

Study design: Physical examinations were performed on 311 rape victims seen by San Luis Obispo County's Suspected Abuse Response Team between 1985 and 1993 and contemporaneously on 75 women after consensual sexual intercourse.

Results: Among 213 (68%) victims with genital trauma, 162 (76%) had 3.1 mean sites of injury. Comparatively, 8 (11%) consenting women had just single-site trauma. Two hundred (94%) victims had trauma at one or more of four locations, as follows: posterior fourchette, labia minora, hymen, fossa navicularis. Trauma types varied by site; tears appeared most often on the posterior fourchette and fossa, abrasions appeared on the labia, and ecchymosis was seen on the hymen.

Conclusion: A localized pattern of genital trauma can frequently be seen in women reporting nonconsensual sexual intercourse; such findings are useful for the clinical forensic examiner.

PIP: New colposcopic protocols for US forensic examiners enable documentation of genital trauma in 87-92% of rape victims--a significant improvement over protocols based on gross visualization or toluidine blue dye enhancement. It remains unresearched, however, whether colposcopic genital findings in sexual assault victims differ substantially from those in women who have had consensual intercourse. Thus, the type, extent, and distribution of genital injuries observed through colposcopy in 311 rape victims seen by the San Luis Obispo (California) County's Suspected Abuse Response Team in 1985-93 were compared to genital changes in 75 healthy women who had engaged in consensual intercourse in the past 24 hours. 213 assault victims (68%) had evidence of anogenital trauma. Among the 178 women (57%) with nongenital trauma, 132 (74%) also had genital injury (tears, ecchymoses, abrasions, redness, and swelling). The most common trauma site was the posterior fourchette (70%). Examination findings were significantly greater at 24 hours after rape than at 72 hours or more, but almost half the women seen at 72 hours or more after assault had positive genital findings. The injury pattern was not affected by age. In the consensual sex group, trauma was noted in eight women (11%). The proportion with genital injury was significantly higher for women reporting nonconsensual sex than those reporting consensual sex.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Coitus
  • Colposcopy
  • Female
  • Genitalia, Female / injuries*
  • Humans
  • Middle Aged
  • Rape* / diagnosis