Male sexual assault: Physical injury and vulnerability in 103 presentations.

OBJECTIVES: To i) describe the demographic and assault characteristics of males alleging recent sexual assault, ii) determine the severity and frequency of general body injury and the frequency of anal and genital injury, iii) identify vulnerability factors and assault characteristics associated with injury. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 103 post-pubertal males attending SARC from Jan-2009 to Dec-2016. METHODS: Men underwent a standardised medical examination and data collection by forensically trained doctors following consent for general body and/or ano-genital examination. Men were considered vulnerable if at least one of the following factors was present: current mental illness; intellectual or physical disability; alcohol intoxication; previous sexual victimization; living in prison or homeless (no fixed address), aged < 18 years. Statistical analysis was performed by Fisher exact test. An algorithm was used to classify general body injuries as mild, moderate or severe. RESULTS: At least one vulnerability factor was present in 88.3% of the 103 men. More than one factor was present in 54.4%. General body injury was observed in 58.0% (40/69) of men consenting to general body examination; 46.4%, 10.1% and 1.4% were classified as having respectively, mild, moderate and severe injuries. Three assault characteristics were associated with general body injury: the use of blunt force (p = 0.002), multiple assailants (p = 0.049) and deprivation of liberty (p = 0.040). Genital injury and anal injury was observed in, respectively, 6.5% (5/77) and 14.3% (11/77) of men consenting to ano-genital examination. Of the 49 men examined following completed penetrative anal assault, 18.4% (9/49) had anal injuries. In these 49 men, those assaulted by strangers were more likely to have an anal injury compared to non-stranger assaults (p = 0.019). No demographic, clinical or vulnerability characteristics of the sexually assaulted men were associated with general body, genital and/or anal injury. CONCLUSION: Although general body injuries were more frequent than genital and anal injuries, most of the body injuries were mild in severity. While the majority of men in our study presented with one or more vulnerabilities only assault characteristics (not vulnerabilities) were associated with injury.

Capturing sexual assault data: An information system designed by forensic clinicians and healthcare researchers.

BACKGROUND: The Sexual Assault Resource Center (SARC) in Perth, Western Australia provides free 24-hour medical, forensic, and counseling services to persons aged over 13 years following sexual assault. OBJECTIVE: The aim of this research was to design a data management system that maintains accurate quality information on all sexual assault cases referred to SARC, facilitating audit and peer-reviewed research. METHODS: The work to develop SARC Medical Services Clinical Information System (SARC-MSCIS) took place during 2007-2009 as a collaboration between SARC and Curtin University, Perth, Western Australia. Patient demographics, assault details, including injury documentation, and counseling sessions were identified as core data sections. A user authentication system was set up for data security. Data quality checks were incorporated to ensure high-quality data. RESULTS: An SARC-MSCIS was developed containing three core data sections having 427 data elements to capture patient's data. Development of the SARC-MSCIS has resulted in comprehensive capacity to support sexual assault research. Four additional projects are underway to explore both the public health and criminal justice considerations in responding to sexual violence. The data showed that 1,933 sexual assault episodes had occurred among 1881 patients between January 1, 2009 and December 31, 2015. Sexual assault patients knew the assailant as a friend, carer, acquaintance, relative, partner, or ex-partner in 70% of cases, with 16% assailants being a stranger to the patient. CONCLUSION: This project has resulted in the development of a high-quality data management system to maintain information for medical and forensic services offered by SARC. This system has also proven to be a reliable resource enabling research in the area of sexual violence.

Sexual assault and general body injuries: A detailed cross-sectional Australian study of 1163 women.

OBJECTIVES: To describe the frequency and severity of general body injury in women alleging recent sexual assault and then identify demographic and assault characteristics associated with injury severity. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 1163 women attending SARC from Jan-2009 to Mar-2015. METHODS: Women underwent a standardised medical examination and data collection by forensically trained doctors. Multivariate ordinal logistic regression analyses were performed. An algorithm was used to classify general body injuries as mild, moderate or severe. RESULTS: General body injury was observed in 71% of women; 52%, 17% and 2% were classified as having respectively, mild, moderate and severe injuries. Moderate or severe injury was observed in 30.4% of women assaulted by intimate partners, 16.4% of women assaulted by strangers and 14.9% of women assaulted by friends/acquaintances. In regression analysis, an interaction between mental illness and assailant type existed after adjusting for age, intellectual disability, time-to-examination, number of assailants and location. Mental illness was an independent predictor for lower injury severity (adjusted odds ratio=0.5, 95% CI 0.3, 0.9) in women assaulted by strangers and higher injury severity in women assaulted by a friend/acquaintance (adjusted odds ratio=2.4, 95% CI 1.6, 3.6). While women assaulted by intimate partners had more frequent moderate-to-severe injuries than other women their current mental illness status was not associated with risk of injury severity. CONCLUSION: This study highlights the increased injury severity in women assaulted by intimate partners. The risk of moderate/severe injury for women with mental illness assaulted by their acquaintances was unexpected and requires further investigation.

Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.

OBJECTIVES: To describe the frequency of genital and anal injury and associated demographic and assault characteristics in women alleging sexual assault. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 1266 women attending SARC from Jan-2009 to Mar-2015. METHODS: Women underwent a standardised data collection procedure by forensically trained doctors. Multivariate logistic regression analyses were performed. MAIN OUTCOME MEASURES: (1) Frequency of genital and anal injuries by type of sexual assault. (2) Identification of independent factors associated with genital and anal injuries following, respectively, completed vaginal and anal penetration. RESULTS: Genital injury was observed in 24.5% of all women with reported completed vaginal penetration; in a subset with no prior sexual intercourse 52.1% had genital injury. Genital injury was more likely with no prior sexual intercourse (adjusted odds ratio [adj. OR] 4.4, 95% confidence interval [95%CI] 2.4-8.0), multiple types of penetrants (adj. OR 1.5, 95%CI 1.0-2.1), if general body injury present and less likely with sedative use and delayed examination. Anal injury, observed in 27.0% of reported completed anal penetrations, was more likely with multiple types of penetrants (adjusted OR 5.0, 95%CI 1.2-21.0), if general body injury present and less likely with delayed examination. CONCLUSION: This study separately quantifies the frequency of both genital and anal injuries in sexually assaulted women. Genital injuries were absent in a large proportion of women regardless of prior vaginal intercourse status. It is anticipated that findings will better inform the community, police and medico-legal evidence to the criminal justice system.

Non-fatal strangulation in sexual assault: A study of clinical and assault characteristics highlighting the role of intimate partner violence.

OBJECTIVE: To describe the prevalence, risk factors, signs and symptoms of non-fatal strangulation (NFS) in women referred to a Sexual Assault Resource Centre (SARC) following recent sexual assault. METHODS: A cross-sectional study using data routinely collected at time of forensic examination of women (age ≥ 13 years) referred to the Western Australian SARC between Jan-2009 and Mar-2015 alleging a recent sexual assault. Data on demographics, assault characteristics and forensic findings were available. RESULTS: A total of 1064 women were included in the study; 79 (7.4%) alleged NFS during the sexual assault. The prevalence of NFS varied significantly by age-group and assailant type. Of women aged 30-39 years 15.1% gave a history of NFS compared to less than 8.2% in all other age groups. Of women assaulted by an intimate partner, 22.5% gave a history of NFS compared to less than 6% of women assaulted by other assailant types. Of all sexual assaults with NFS, intimate partners were the assailant in 58.2% of cases, whereas in sexual assault cases without NFS, intimate partners were the assailant in 15.9% of cases. Odds of NFS were 8.4 times higher in women sexually assaulted by an intimate partner compared to women assaulted by an acquaintance/friend and 4.9 times higher compared to women assaulted by a stranger. When considering both age and assailant type the highest proportion of NFS (33.9%) was in women aged 30-39 years sexually assaulted by an intimate partner. Other factors associated with NFS during sexual assault included deprivation of liberty, verbal threats, being assaulted in the woman's home and use of additional blunt force. External physical signs of NFS were absent in 49.4% of all NFS sexual assault cases. CONCLUSIONS: This study identifies and quantifies NFS risk factors in female sexual assault and highlights the strong association with intimate partner sexual assault. Greater awareness of NFS in sexual assault should lead to improvement in medical screening, forensic management and safety risk assessment by sexual assault and domestic violence services, emergency departments and police.

Early evidence kits in sexual assault: an observational study of spermatozoa detection in urine and other forensic specimens.

PURPOSE: To determine the detection frequency of spermatozoa in early evidence kit specimens and in subsequent full forensic specimens in alleged sexual assault. METHODS: Observational cohort study of 100 consecutive alleged sexual assault cases, presenting in Western Australia between 19th July 2008 and 6th February 2012, with both early evidence kit and full forensic evidence specimen collections. Eighty-eight cases were included in the study. Smears from all forensic specimens were analyzed by light microscopy to determine the detection frequency and structural characteristics of spermatozoa. Patient demographic features, characteristics of the alleged assault and details and timing of forensic collections were also recorded. RESULTS: Spermatozoa were detected in early evidence kit specimens in 35 % (31/88) and in full forensic specimens in 42 % (37/88) of all cases (irrespective of type of alleged penetration). In alleged penile-vaginal penetration, spermatozoa were detected in early evidence kit specimens in 40 % (21/53) of cases when both first void urine and vulval gauze wipe were collected. Spermatozoa were detected in full forensic specimens in 45 % (31/69) of cases. Spermatozoa were detected in early evidence kit oral rinse specimens in 6 % (1/18) of cases of alleged penile-oral penetration and in early evidence perianal gauze wipe specimens in 33 % (2/6) cases of alleged penile-anal penetration. Spermatozoa were detected in the early evidence kit first void urine specimen in a single case, 11 % (1/9), in which the nature of the alleged assault was unknown. Spermatozoa were detected in early evidence kit specimens and not in full forensic specimens in 3 % (3/88) of cases. CONCLUSIONS: Early evidence kit specimens are effective in recovery of spermatozoa, and in particular urine and vulval gauze wipe are worthwhile early forensic specimens for the detection of spermatozoa. Collection of early evidence specimens led to detection of spermatozoa-positive cases, which were not detected by subsequent full forensic specimen collection.