Sommers Marilyn S, Regueira Yadira, Tiller Deborah A, Everett Janine S, Brown Kathleen, Brignone Emily, Fargo Jamison D
University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
University of Puerto Rico School of Nursing, Medical Sciences Campus, Box 365067, San Juan, PR, 00936, USA.
J Forensic Leg Med. 2019 Aug;66:120-128. doi: 10.1016/j.jflm.2019.06.019. Epub 2019 Jul 2.
A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status.
We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status.
We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40).
Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.
一系列研究表明，在遭受性侵犯和自愿性交后，非西班牙裔白人女性比非西班牙裔黑人女性受伤的情况明显更多。对此差异的一种解释是，由于皮肤力学和皮肤色素沉着不同，皮肤的保护程度可能会有所差异。本研究的目的是在控制年龄、吸烟史、体重指数（BMI）、日晒情况和健康状况的条件下，确定自愿性交后女性生殖器 - 肛门损伤、肤色、皮肤粘弹性和皮肤水合作用之间的关联。
我们采用前瞻性队列研究设计，在两个研究地点招募21岁及以上的女性。她们接受了两次数据收集，分别是基线期和自愿性交后的随访期。基线期生殖器 - 肛门损伤的识别通过标准法医检查（直接可视化、用甲苯胺蓝对比剂进行核染色以及阴道镜检查）以及其他变量（肤色、皮肤粘弹性、皮肤水合作用、年龄、吸烟史、体重指数[BMI]、日晒情况和健康状况）的测量来进行。然后，参与者被要求与自己选择的男性伴侣进行自愿性交，并返回接受第二次法医检查以检测损伤情况。将生殖器 - 肛门损伤与肤色、皮肤粘弹性、皮肤水合作用、年龄、吸烟史、BMI、日晒情况和健康状况进行回归分析。
我们招募了341名参与者，其中88名非西班牙裔白人（25.8%），54名非西班牙裔黑人（15.8%），190名西班牙裔/拉丁裔（55.7%），9名其他身份（2.6%）。在基线期，生殖器 - 肛门损伤患病率为57.77%，在自愿性交后的随访期，损伤患病率为72.73%。基线期时，外生殖器损伤患病率与L*（亮度）值升高（调整优势比[AOR]=1.98，95%置信区间[CI]=1.03，4.04）以及皮肤弹性降低（AOR=0.96，95%CI=0.93，0.99）相关。随访期时，皮肤水合作用增加与外生殖器、内生殖器、肛门以及总的生殖器 - 肛门损伤频率显著更高（调整率比[ARR]>1.27）相关。同样在随访检查中，与非西班牙裔白人参与者相比，西班牙裔/拉丁裔参与者的外生殖器和总的生殖器 - 肛门损伤患病率及频率显著更低（AOR<0.40）。
我们的研究结果为法医检查中肤色的重要性提供了有限的支持。肤色较浅的女性可能比肤色较深的女性更容易受伤。相比之下，与深色皮肤的女性相比，浅色皮肤的女性外生殖器损伤可能更容易被识别，这在医疗保健和刑事司法系统中都是重要情况。此外，粘弹性降低和水合作用增加的女性可能更容易受伤。这些研究结果支持需要开发对各种肤色人群都有效的法医程序，并在解释法医结果时考虑皮肤的固有特性。
