Jones Jeffrey S, Rossman Linda, Hartman Melissa, Alexander Carmen C
Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, YWCA Nurse Examiner Program, Grand Rapids, MI 49503-2560, USA.
Acad Emerg Med. 2003 Dec;10(12):1378-83. doi: 10.1111/j.1553-2712.2003.tb00013.x.
To compare the types and locations of anogenital injuries occurring in adolescent females (13-17 years old) after consensual and nonconsensual sexual intercourse.
The authors conducted a retrospective, matched case-control study to assess anogenital injuries in female adolescents presenting to a free-standing nurse examiner clinic during a four-year study period. Adolescents were selected for inclusion in the study if they reported consensual sexual intercourse (CSI) and agreed to a medical-legal examination. Control subjects were victims of alleged sexual assault or nonconsensual sexual intercourse (NCSI) matched to cases by age and prior sexual intercourse experience. Genital trauma was documented using colposcopy with nuclear staining and digital photography. Data were analyzed using chi-square and t-tests.
Fifty-one cases of CSI were identified; the age range was 13 to 17 years (mean=15.1 years). Overall, 49% (25/51) of CSI subjects reported no prior sexual intercourse experience. CSI and NCSI were comparable in terms of race, time to physical examination, alcohol use, and frequency of genital injuries (73% vs. 85%, p=0.069). The mean number of documented anogenital injuries in CSI subjects was 1.9 +/- 1.5. These injuries commonly involved the hymen, fossa navicularis, and posterior fourchette. CSI subjects had a greater number of anogenital injuries (2.6 +/- 2.0; p=0.02), typically involving the fossa navicularis, labia minora, and hymen. The most common type of injury in both groups was lacerations (39% vs. 41%); however, NCSI subjects had a greater incidence of anogenital abrasions, ecchymosis, and edema (chi2=10.4, p=0.035).
Anogenital trauma was documented in 73% of adolescent females after consensual sexual intercourse versus 85% of victims of sexual assault. The localized pattern and severity of anogenital injuries were significantly different when compared with victims of sexual assault.
比较在自愿和非自愿性交后发生于青春期女性（13至17岁）的肛门生殖器损伤的类型和部位。
作者进行了一项回顾性配对病例对照研究，以评估在四年研究期间到独立护士检查诊所就诊的女性青少年的肛门生殖器损伤情况。如果青少年报告有自愿性交（CSI）并同意进行法医检查，则将其纳入研究。对照对象是被指控性侵犯或非自愿性交（NCSI）的受害者，按年龄和既往性交经历与病例进行匹配。使用阴道镜检查结合核染色和数码摄影记录生殖器创伤情况。采用卡方检验和t检验分析数据。
共识别出51例自愿性交病例；年龄范围为13至17岁（平均 = 15.1岁）。总体而言，49%（25/51）的自愿性交对象报告无既往性交经历。自愿性交和非自愿性交在种族、体检时间、饮酒情况以及生殖器损伤频率方面具有可比性（73%对85%，p = 0.069）。自愿性交对象记录的肛门生殖器损伤平均数量为1.9 ± 1.5。这些损伤通常累及处女膜、舟状窝和后阴唇系带。自愿性交对象的肛门生殖器损伤数量更多（2.6 ± 2.0；p = 0.02），通常累及舟状窝、小阴唇和处女膜。两组中最常见的损伤类型均为撕裂伤（39%对41%）；然而，非自愿性交对象的肛门生殖器擦伤、瘀斑和水肿发生率更高（χ2 = 10.4，p = 0.035）。
73%的青春期女性在自愿性交后出现肛门生殖器创伤，而性侵犯受害者这一比例为85%。与性侵犯受害者相比，肛门生殖器损伤的局部模式和严重程度存在显著差异。
