University of Pennsylvania School of Nursing, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA 19104, 513-314-9967, USA.
Utah State University Department of Psychology, 2810 Old Main Hill, Logan, UT 84322, 435-797-8558, USA.
J Forensic Leg Med. 2021 Apr;79:102138. doi: 10.1016/j.jflm.2021.102138. Epub 2021 Feb 18.
Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases.
To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables.
We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted.
We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears.
External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.
评估性侵后的生殖器-肛门（GA）损伤有助于促进健康，并帮助检方立案。损伤模式有助于区分自愿和非自愿的性行为，增强幸存者的可信度，并增加性侵案件的起诉。
在控制与性行为相关的变量的情况下，确定最能有效区分女性自愿性行为和性侵的 GA 损伤相关特征组合。
我们采用了一项比较研究，分为两组：一组是有自愿参与者的前瞻性队列组，另一组是来自现有性侵登记处的组。在前瞻性队列中，我们对 21 岁及以上的女性进行性侵法医检查，并在基线和自愿性行为后进行检查。我们将她们的损伤模式与 21 岁及以上的性侵女性的损伤记录进行比较。
我们纳入了 834 名女性的样本：528 名自愿（63.3%）参与者和 306 名非自愿（36.7%）登记案例。在控制种族/民族、年龄和性行为与检查之间的时间后，逻辑回归分析显示，外部生殖器撕裂的存在使非自愿性行为的可能性增加了两倍以上（调整后的优势比 [AOR] = 2.70，95%CI = 1.28-5.56）。逻辑回归分析还表明，外部和内部生殖器红肿、缺乏避孕套使用和润滑剂、存在肛门穿透的发生率较低和频率较低，非自愿性行为的可能性显著更大。潜在类别分析在自愿和非自愿样本中都确定了高和低 GA 损伤发生率亚组。出现了一个可能表明非自愿性行为的子集结果，与自愿性行为相比：外部生殖器和肛门撕裂的发生率更高。
非自愿组中外部生殖器撕裂更常见，使非自愿性行为的可能性增加了两倍以上。外阴和肛门撕裂、肿胀、瘀斑和肛门穿透是非自愿性行为的标志物，应增加对缺乏同意的怀疑。
