Do we miss half of the injuries sustained during rape because we cannot see them? An overview of the use of toluidine blue tissue stain in the medical assessment of rape cases

Kotze, J.M.; Brits, Hanneke

doi:10.1080/20786190.2017.1386868

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Lack of resources, such as adequate lighting, toluidine blue tissue stain to highlight injuries and a colposcope may all lower the sensitivity and specificity of clinical examinations. 35,36,37,38,39 Lack of technical support has the additional consequence that peer review may be unattainable.…”

Section: Reasons For the Lack Of Confirmation Of Child Sexual Abuse Omentioning

confidence: 99%

Child sexual abuse: The significance of the history and testifying on non-confirmatory findings

Kotze¹,

Brits²

2019

African Journal of Primary Health Care & Family Medicine

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Background Despite numerous studies and publications, there is still a common expectation that a medical assessment can confirm or rule out child sexual abuse (CSA). The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds. Aim The objective of this article was to suggest which aspects to consider when the expert medical witness in a CSA case needs to explain why CSA can seldom be confirmed and can never be ruled out. The importance of a sound medical and medico-legal history was discussed because the history was generally the only positive ‘finding’ of the assessment of children who have possibly been abused. Method Authoritative sources were used to support the explanation of reasons for an absence of corroborative clinical findings in CSA, as defined by the World Health Organization. The authors structured the individual sections by providing a background on which to base the testimony. They then summarised the clinical forensic significance of the information which should be offered in the courts and which should reflect on the court records, to be taken into account in the eventual decision, which will be made by the court. Results A guideline was provided for answering questions frequently posed to the expert witness in child abuse cases where there were no positive findings. Conclusion A structure for the explanation of reasons for a normal clinical examination when evaluating children who may have been sexually abused may reduce the discomfort of medical witnesses and improve the quality of expert medical testimony.

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Section: Reasons For the Lack Of Confirmation Of Child Sexual Abuse Omentioning

confidence: 99%

Child sexual abuse: The significance of the history and testifying on non-confirmatory findings

Kotze¹,

Brits²

2019

African Journal of Primary Health Care & Family Medicine

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“…Detecting sex-related genital injuries, which are usually small and superficial, on the female genitalia, with its many creases and rugae, can be difficult, but examination enhancement techniques such as magnification (colposcopy), staining with toluidine blue (22), or the use of ultraviolet light (23) will increase the likelihood of detection. Toluidine blue is said not to compromise biological evidence but false negatives may occur if any barrier overlies the lesions and false positives may occur in some genital skin conditions (e.g., vulvitis, herpes) (Image 3).…”

Section: Identifying Oral Genital and Anal Injurymentioning

confidence: 99%

Sexual Assault: Forensic Examination in the Living and Deceased

Lincoln¹

2018

Academic Forensic Pathology

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The forensic examination of a person suspected of having been sexually assaulted encapsulates the breadth of forensic medicine possibly more completely than any other situation in forensic practice. Whether in the living or deceased, detection of injury and biological material to support or exclud e sexual activity requires a careful, methodical approach to ensure robust evidentiary value and an understanding of genito-anal anatomy and sexual physiology to interpret its significance for the courts. This paper is not intended as an exhaustive guideline but aims to provide a general overview of the key components of forensic sexual assault examination highlighting the common and different aspects in living and deceased persons.

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Genital lacerations following sexual assault and consensual sexual intercourse: A systematic review and meta‐analysis

Crawford,

Downing,

Famurewa

et al. 2024

Journal of Forensic Sciences

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The identification of genital injuries during a medical‐forensic examination may impact the investigation and prosecution of sexual assault. The purpose of this meta‐analysis was to compare prevalence of genital lacerations (or tears) in persons reporting consensual versus non‐consensual vaginal penetration. We hypothesized there would be greater prevalence of genital injuries in the non‐consensual group. We searched PubMed, CINAHL, Web of Science, and gray literature for relevant observational case–control studies. Relative risk (RR) ratios using Mantel–Haenszel method were calculated to compare prevalence of genital lacerations between patients reporting consensual versus non‐consensual penetration. Mantel–Haenszel chi‐square tested significance and Cochran's Q determined between‐study heterogeneity. In all studies, genital injuries were observed in both groups. The overall RR of 1.26 indicated a 26% greater risk of genital lacerations in the non‐consensual group compared to the consensual group (p = 0.003). Study heterogeneity was 54% (p = 0.05). Findings suggest a greater likelihood of observing genital lacerations in persons reporting non‐consensual vaginal penetration. High heterogeneity reflects variations between studies regarding provider education and training, visualization techniques, patient characteristics, time between assault and examination, and documentation practices. A major limitation is the lack of observer blinding creating potential bias. Findings support the need to standardize genital visualization techniques and documentation in sexual assault medical forensic examinations. Healthcare providers conducting medical forensic examinations must understand the limitations of studies comparing non‐consensual and consensual injury findings if asked to provide information or testimony on this topic.

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Do we miss half of the injuries sustained during rape because we cannot see them? An overview of the use of toluidine blue tissue stain in the medical assessment of rape cases

Cited by 3 publications

References 10 publications

Child sexual abuse: The significance of the history and testifying on non-confirmatory findings

Child sexual abuse: The significance of the history and testifying on non-confirmatory findings

Sexual Assault: Forensic Examination in the Living and Deceased

Genital lacerations following sexual assault and consensual sexual intercourse: A systematic review and meta‐analysis

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