Comparative Analysis of Adult versus Adolescent Sexual Assault: Epidemiology and Patterns of Anogenital Injury

Abstract

Objectives: To compare the characteristics of sexual assault in pubertal girls (\18 years old) and adults in a communitybased population of women presenting to an urban sexual assault clinic. Methods: This case-series analysis evaluated consecutive female patients presenting to a sexual assault clinic during a three-year study period. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medicolegal examinations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from the two patient groups (adolescents vs. women $18 years of age) were analyzed using chi-square test and t-test. Results: A total of 766 cases were identified: 43% of the victims were 13 to 17 years old (mean 15.0 years old), and 57% were older than 17 years old (mean 30.8 years old). Adolescents were more likely to be assaulted by an acquaintance or relative (84% vs. 50%, p \ 0.001) and to delay medical evaluation (17 hours vs. 12 hours, p \ 0.001) than were older women. Adolescent sexual assault was less likely to involve weapons or physical coercion (29% versus 57%, p \ 0.001) and was associated with fewer nongenital injuries (33% vs. 55%, p \ 0.001). Adolescents had a greater frequency of anogenital injuries (83% vs. 64%, p \ 0.001), however, compared with older women. Common sites of injury in adolescents were posterior, including the fossa navicularis, hymen, fourchette, and labia minora. The injuries showed consistent topologic features, varying with the site and nature of tissue. Adult victims of sexual assault had a less consistent pattern of anogenital injuries with fewer hymenal injuries, greater injury to the perianal area, and widespread erythema. Conclusions: Of women presenting to an urban sexual assault clinic, 43% were adolescents. The epidemiology of sexual trauma and the pattern of anogenital trauma in this age group are unique and may pose special challenges to emergency health care providers. Key words: sexual assault; adolescent; epidemiology; anogenital; injury. ACADEMIC EMERGENCY MEDICINE 2003; 10:872-877. Sexual assault is a violent crime that affects men, women, and children of all ages. One third of all victims of sexual assault reported to law enforcement agencies are adolescents (13 to 17 years old). 1Adolescents and young adults (18 to 24 years old) are four times more likely to be victims of sexual assault than women in all other age groups.1,2 Despite this high incidence, the epidemiology of sexual assault in adolescents has received little attention. One purpose of this study was to describe the epidemiology of sexual assault by examining patient demographics and assault characteristics in adolescents compared with women older than 17 years of age.The second purpose of this study was to examine the type and frequency of anogenital injuries in adolescents. Despite reports confirming that a lack of physi...

Injuries to the cervix in sexual trauma

“… Note . Cervical trauma in the Jones et al (2003) study and Rossman et al (2004) is read from a bar graph and approximate. Anal injuries and non‐genital results not reported here. …”

“…Jones et al (2003) compared 766 consecutive female rape victims over a 3‐year period (1999 to 2001). The sample had 57% adult victims (18 years and over) and 43% adolescent victims (between the ages of 13 to 17 years).…”

“…Types of assaults included vaginal, oral, anal, and digital penetration. Methods of assault are not matched to injury pattern with the exception of the penis which is associated with posterior entry injury (fossa navicularis, hymen, posterior fourchette, and labia minora) (Jones et al, 2003). …”

The challenges forensic nurses face when their patient is comatose: Addressing the needs of our most vulnerable patient population

“…The head‐to‐toe examination of a comatose patient should include assessment of the ano‐genital area for acute traumatic injury, bleeding, or foreign material. Because ano‐genital injury rates after sexual assault range from 12% to 83% depending on the studies and variables examined (Magid et al, 2004; Jones, Rossman, Wynn, Dunnuck, & Schwartz, 2003), it is important that a trained examiner assess the area, and that the examination occur before activities such as bladder catheterization, which may interfere with the ability of the examiner to effectively recover biological evidence.…”

With Care and Compassion

“…This issue is important to examine because, although the forensic components for adult and adolescent examinations are similar, recent research has found that adolescents differ from adults with respect to anogenital injuries (Jones, Rossman, Wynn, Dunnuck, & Schwartz, 2008), indicating that these populations may have distinct healthcare needs. This issue is important to examine because, although the forensic components for adult and adolescent examinations are similar, recent research has found that adolescents differ from adults with respect to anogenital injuries (Jones, Rossman, Wynn, Dunnuck, & Schwartz, 2008), indicating that these populations may have distinct healthcare needs.…”