Understanding rates of genital-anal injury: Role of skin color and skin biomechanics

Sommers, Marilyn S.; Regueira, Yadira; Tiller, Deborah; Everett, Janine S.; Brown, Kathleen M.; Brignone, Emily; Fargo, Jamison D.

doi:10.1016/j.jflm.2019.06.019

Cited by 9 publications

(11 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vaginal injuries after sexual intercourse are not only of medical relevance but also play a pivotal role for medicolegal expertise in cases of sexual assault. The opinion that vaginal injuries are only caused by NCSI has long been falsified [ 21 , 23 , 24 , 26 – 28 , 32 , 33 ]. To date, a number of clinical studies on vaginal injuries following CSI focusing on emergency cases have been published [ 21 , 23 – 28 , 34 – 36 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Vaginal injuries after consensual sexual intercourse — a survey among office-based gynecologists in Hamburg, Germany

Lohner

Nigbur

Klasen

et al. 2022

Forensic Sci Med Pathol

View full text Add to dashboard Cite

Studies on the occurrence of injuries following consensual sexual intercourse (CSI) among patients treated by office-based gynecologists are lacking. This survey aimed to assess the presence and medical relevance of vaginal injuries after CSI in gynecological office-based practice, associated risk factors, and their significance for forensic medical assessment practice. All office-based gynecologists in Hamburg, Germany (n = 316), were asked to fill in a one-page questionnaire via a fax survey. The questionnaire covered various aspects such as having observed CSI-related injuries, injury severity, risk factors, and concomitant factors (bleeding, need for surgical care, hospitalization). Response rate was 43.2% (n = 115). Overall, 83.5% of office-based gynecologists reported having observed vaginal injuries after CSI at least once and 59.1% repeatedly. Regarding maximum injury severity, 52.1% observed mucosal erosions, 32.3% mucosa penetrating injuries, and 14.6% injuries penetrating the vagina. Having observed bleeding was reported by 56.3%, 28.1% had to perform surgical suture care, and hospital admission was initiated by 20.8%. Menopause (37.5%), use of objects (19.8%), alcohol, and/or drug use (16.7%) were reported as the most frequently observed associated risk factors. Vaginal injuries after CSI have been observed by the majority of office-based gynecologists in Hamburg involving a wide spectrum of severity, including the necessity of surgical care and hospital admission. Complementing published work in clinical and emergency medicine, these findings are highly relevant to the forensic evaluation of injuries in an allegation of sexual assault, as the severity of a vaginal injury in this setting does not necessarily support a conclusion on the issue of consent.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Studies on the frequency of CSI-related injuries included patients examined at hospitals, woman’s health care centers, and college students, with 6–73% of patients showing injuries [ 21 , 23 , 24 , 26 – 28 , 32 , 33 ]. Again, the large span in detection rates can be explained by differences in individual study design.…”

Section: Discussionmentioning

confidence: 99%

Vaginal injuries after consensual sexual intercourse — a survey among office-based gynecologists in Hamburg, Germany

Lohner

Nigbur

Klasen

et al. 2022

Forensic Sci Med Pathol

View full text Add to dashboard Cite

show abstract

“…Only the most recently updated IWII wound infection guidelines acknowledged that skin tone can impact erythema presentation, but fails to provide images or descriptions to guide clinical examination [16]. A comprehensive review by Oozageer-Gunowa (2022) highlights the gaping lack of evidence and literature addressing racialized skin tone bias in wound care [30] and that studies in this area are exclusive to PUs/PIs [7][8][9][10][11], with the exception of a prospective study assessing the role of skin color on skin biomechanics in acute genital-anal injury [43]. However, even in PU/PI-specific resources, which stress that non-blanching erythema is a key indicator for early PU/PI formation [42], actionable information regarding PU/PI assessment on dark skin is lacking.…”

Section: Discussionmentioning

confidence: 99%

Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations

Johnson¹,

Johnson

Andersen

et al. 2023

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

Underrepresentation of diverse skin tones in medical education and providers’ implicit racial bias drives inequities in wound care, such as disproportionally poor outcomes for Black patients. Diagnostic indicators (e.g., erythema) can present differently depending on skin pigmentation. This post hoc analysis of 350 chronic wounds from a prospective 14-site clinical trial aimed to determine how the perception of clinical signs and symptoms of infection (CSS) differs by patient skin tone and if fluorescence-imaging can offer a more objective diagnostic solution. Participants were grouped by skin tone (low, medium, high) as measured by the Fitzpatrick Skin Phototype Classification (FSPC) scale. CSS and total bacterial load (TBL) were compared across FSPC groups, along with sensitivity to detect TBL >104 CFU/g using CSS alone and combined with fluorescence-imaging. Erythema was reported less often with increasing FSPC score (p = 0.05), from 13.4% (low), to 7.2% (medium), to 2.3% (high), despite comparable bacterial loads (median = 1.8 × 106 CFU/g). CSS sensitivity in the high group (2.9%) was 4.8-fold to 8.4-fold lower than the low (p = 0.003) and medium groups (p = 0.04). Fluorescence-imaging significantly improved the detection of high bacterial load in each group, peaking in the high group at 12-fold over CSS alone. These findings underscore the threat of pervasive racialized health inequities in wound care, where missed diagnosis of pathogenic bacteria and infection could delay treatment, increasing the risk of complications and poor outcomes. Fluorescence-imaging is poised to fill this gap, at least in part, serving as a more objective and equitable indicator of wound bacteria. Clinicaltrials.gov#NCT03540004 registered 16-05-2018.

show abstract

“…While prior studies have found race to have a direct effect on the prevalence and frequencies of injuries identified by forensic nurses, skin tone mediates this relationship and provides a better explanation for discrepancies in injury identification (Sommers et al, 2008). Due to a lack of access to photos of survivors and sophisticated measures of skin tone (Hussain et al, 2013; Sommers et al, 2019), the current study uses race/ethnicity as a proxy for skin tone (1 = Black ; 2 = Hispanic ; 3 = ’ ). The amount of melanin produced in the skin exists on a continuum that overlaps across races and ethnicity (Sommers et al, 2008).…”

Section: Methodsmentioning

confidence: 99%

The Darker the Skin, the Greater the Disparity? Why a Reliance on Visible Injuries Fosters Health, Legal, and Racial Disparities in Domestic Violence Complaints Involving Strangulation

Brady

Zedaker

McKay³

et al. 2023

J Interpers Violence

View full text Add to dashboard Cite

The reliance on external injuries for justice is misguided given that assault injuries may be less visible among victims of color due to increased melanin in the skin. To date, however, less is known whether racial/ethnic disparities extend to officers’ identification of signs of nonfatal strangulation (NFS). The current study estimates the extent of NFS indicators identified by officers who completed a standardized strangulation assessment in 133 family violence complaints. Breathing difficulties were the most common symptoms identified by officers (98%), followed by external signs (89%), and symptoms of impeded blood circulation (87%). Compared to cases involving White/Asian survivors, officers were less likely to identify external injuries on Black survivors’ neck, chin, and chest/shoulders. While racial/ethnic differences did not emerge for symptoms of disrupted airflow, Hispanic survivors were twice as likely to report losing control of bodily functions. Implications for policy and practice are discussed.

show abstract

Understanding rates of genital-anal injury: Role of skin color and skin biomechanics

Cited by 9 publications

References 47 publications

Vaginal injuries after consensual sexual intercourse — a survey among office-based gynecologists in Hamburg, Germany

Vaginal injuries after consensual sexual intercourse — a survey among office-based gynecologists in Hamburg, Germany

Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations

The Darker the Skin, the Greater the Disparity? Why a Reliance on Visible Injuries Fosters Health, Legal, and Racial Disparities in Domestic Violence Complaints Involving Strangulation

Contact Info

Product

Resources

About