Adolescent Sexual Assault: Documentation of Acute Injuries Using Photo-colposcopy

Objective: To document the frequency and types of genital injuries in adolescent women examined acutely following a sexual assault, and determine any historical correlates of injury. Design: Retrospective chart review. Setting: Sexual Assault Response Team services at a community hospital in an urban setting. Patients: All female patients aged 14–19 yr who were referred by law enforcement for an acute sexual assault examination and were examined between May 1994 and May 1999. Outcome Measures: The frequency of signs of genital trauma at various anal and genital sites, as recorded by the examining clinician. Results: Charts of 214 female subjects (mean age 16.3 yr) were reviewed. The most common findings were posterior fourchette tear (36%); erythema of the labia minora, hymen, cervix, or posterior fourchette (18%–32%); and swelling of the hymen (19%). 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 nonvirgins (19% vs. 3%, P = .008); however, the total number or severity of other injuries was not significantly higher in virgins. Victims reporting anal penetration had a higher frequency of anal injuries than those who denied such contact (14/31, 61% vs. 2/150, 1%; P = .000). Conclusions: Tears of the posterior fourchette or fossa were the most common findings (40%). Hymenal tears were uncommon, even in self-described virginal girls. Timely examination of adolescent victims is important to document injuries; however, many victims will still not have signs of bruising, abrasions, or tears.