Defining Patterns of Genital Injury From Sexual Assault

Sommers, Marilyn S.

doi:10.1177/1524838007303194

Cited by 107 publications

(33 citation statements)

References 52 publications

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“…Possibly because epithelial layers can become ulcerated because of sexually transmitted infections and can be damaged by inflammations such as those caused by common infections like yeast (candidiasis) 6 and herpes simplex virus 2 (HSV-2) 7 . Also, intercourse itself may damage this layer, as epithelial microabrasions were detected in 60% of women following consensual intercourse 8, 9 . The damaged areas provide open access to the sub-epithelial structures where HIV-1 cell targets predominantly reside.…”

Section: Introductionmentioning

confidence: 99%

Cervico‐Vaginal Tissue Ex Vivo as a Model to Study Early Events in HIV‐1 Infection

Merbah¹,

Introini²,

Fitzgerald³

et al. 2011

American J Rep Immunol

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Vaginal intercourse remains the most prevalent route of infection of women. In spite of many efforts the detailed mechanisms of HIV-1 transmission in the female lower genital tract, remain largely unknown. With all the obvious restrictions on studying these mechanisms in humans, their understanding depends on the development of adequate experimental models. Isolated cell cultures do not faithfully reproduce important aspects of cell-cell interactions in living tissues and tissue responses to pathogens. Explants and other types of ex vivo tissue models serve as a bridge between cell culture and tissues in vivo. Here, we discuss various cervico-vaginal tissue models and their use in studying HIV vaginal transmission and consider future directions of such studies.

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Section: Introductionmentioning

confidence: 99%

Cervico‐Vaginal Tissue Ex Vivo as a Model to Study Early Events in HIV‐1 Infection

Merbah¹,

Introini²,

Fitzgerald³

et al. 2011

American J Rep Immunol

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“…Genital injury after consented sex is rare, estimated in about 5–6% of cases, and more likely to occur in postmenopausal women 87–89 . All studies agree that genital injury after non-consensual sexual intercourse is significantly higher compared to consented sex, but incidence of injury vary depending on the method used to determine it 87, 90 . Gross visualization includes only bruising, abrasions and lacerations as injuries and is seen in 40% of reported cases, while inspection by colposcopy, which includes “subjective” injuries such as swelling and redness, results in up to 87% incidence 87, 90 .…”

Section: Biological Implications Of Sexual Assault and Female Genitalmentioning

confidence: 93%

“…All studies agree that genital injury after non-consensual sexual intercourse is significantly higher compared to consented sex, but incidence of injury vary depending on the method used to determine it 87, 90 . Gross visualization includes only bruising, abrasions and lacerations as injuries and is seen in 40% of reported cases, while inspection by colposcopy, which includes “subjective” injuries such as swelling and redness, results in up to 87% incidence 87, 90 . Presence of “subjective” injuries in 87–92% of victims within 48 hours after sexual assault 39 appears of extreme relevance as a risk factor for HIV acquisition, since it results in active inflammation and the increased presence of HIV-target cells at the site of exposure.…”

Section: Biological Implications Of Sexual Assault and Female Genitalmentioning

confidence: 93%

Immunobiology of Genital Tract Trauma: Endocrine Regulation of HIV Acquisition in Women Following Sexual Assault or Genital Tract Mutilation

Ghosh

Rodriguez-García

Wira

2012

American J Rep Immunol

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Studies on HIV acquisition and transmission in women exposed to sexual trauma throughout their life cycle are lacking but some findings suggest that rates of HIV acquisition through coercive sex are significantly higher than that seen in consensual sex. Sexual trauma can also occur as a result of female genital mutilation, which makes sex extremely painful and can cause increased abrasions, lacerations and inflammation, which enhances the risk of HIV acquisition. This review presents an overview of the immune system in the human female reproductive tract from adolescence, through puberty to pregnancy and menopause. What is clear is that the foundation of information on immune protection in the female reproductive tract throughout the life cycle of women is extremely limited and at some stages such as adolescence and menopause are grossly lacking. Against this back backdrop, forced or coercive sexual intercourse as well as genital mutilation further complicates our understanding of the biological risk factors that can result in transmission of HIV and other sexually transmitted infections.

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“…Swelling is edematous or transient engorgement of tissues. 49 However, in the past 30 years, scientist and clinicians from more than a dozen countries as diverse as Nigeria, Brazil, Australia, and China 6,29,30,43,50-69 have used a variety of typologies other than TEARS to classify injuries related to consensual sexual intercourse as well as those associated with IPV and SV. Clearly there is a need to classify genital and non-genital injuries related to violence, but we could find no consensus in the literature with respect to the best approach that will serve clinicians and scientists alike.…”

Section: Current Status Of Injury Classification Systemsmentioning

confidence: 99%

“…While their terminology is slightly different, both essentially use the TEARS system to describe injury type. Neither provides a specific definition for each injury type; the definition of the terms in TEARS seems to first appear in the work published by Sommers et al 29,49 Several authors include physical symptoms of injury, such as bleeding, 33,72,73 tenderness, 46,55 _ENREF_55 and pain 46,51 _ENREF_51 in their typologies, but such inclusion is unusual.…”

Section: Current Status Of Injury Classification Systemsmentioning

confidence: 99%

Injuries from intimate partner and sexual violence: Significance and classification systems

Sommers

Brown

Buschur³

et al. 2012

Journal of Forensic and Legal Medicine

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While intimate partner violence (IPV) and sexual violence (SV) are highly associated with injury, the healthcare and legal significance of these injuries is controversial. Purpose: Herein we propose to explore the significance of injury in IPV and SV and examine the current status of injury classification systems from the perspectives of the healthcare and criminal justice systems. We will review current injury classification systems and suggest a typology of injury that could be tested empirically. Findings: Within the published literature, we found that no commonly-accepted injury typology exists. While nuanced and controversial issues surround the role of injury detection in the sexual assault forensic examination, enough evidence exists to support the continued pursuance of a scientific approach to injury classification. We propose an injury typology that is measureable, is applicable to the healthcare setting and criminal justice system, and allows us to use uses a matrix approach that includes a severity score, anatomic location, and injury type. We suggest a typology that might be used for further empirical testing on the validity and reliability of IPV and SV injury data. Conclusion: We recommend that the community of scientists concerned about IPV and SV develop a more rigorous injury classification system that will improve the quality of forensic evidence proffered and decisions made throughout the criminal justice process.

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Defining Patterns of Genital Injury From Sexual Assault

Abstract: The forensic examination following rape has two primary purposes: to provide health care and to collect evidence. Physical injuries need treatment so that they heal without adverse consequences.

Cited by 107 publications

References 52 publications

Cervico‐Vaginal Tissue Ex Vivo as a Model to Study Early Events in HIV‐1 Infection

Cervico‐Vaginal Tissue Ex Vivo as a Model to Study Early Events in HIV‐1 Infection

Immunobiology of Genital Tract Trauma: Endocrine Regulation of HIV Acquisition in Women Following Sexual Assault or Genital Tract Mutilation

Injuries from intimate partner and sexual violence: Significance and classification systems

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