The element of naturalness when evaluating image quality of digital photo documentation after sexual assault.

Digital photography is a valuable adjunct to document physical injuries after sexual assault. In order for a digital photograph to have high image quality, there must exist a high level of naturalness. Digital photo documentation has varying degrees of naturalness; however, for a photograph to be natural, specific technical elements for the viewer must be satisfied. No tool was available to rate the naturalness of digital photo documentation of female genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate technical elements for naturalness. Using this tool, experts evaluated randomly selected digital photographs of female genital injuries captured following sexual assault. Naturalness of female genital injuries following sexual assault was demonstrated when measured in all dimensions.

Usefulness: forensic photo documentation after sexual assault.

The forensic medical legal evaluation following sexual assault establishes evidence for law enforcement's investigation and criminal prosecution by the legal system. The sexual assault nurse examiner performs the forensic evaluation and uses digital photography to document physical injuries after sexual assault. Photographs have varying degrees of usefulness, but for a photograph to be useful, it must exhibit technical elements for the viewer. There was no tool available to evaluate the usefulness of digital photographs taken during forensic evaluation of genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate photographic technical elements for usefulness. Using this tool, three experts on two separate occasions evaluated a series of digital photographs taken following sexual assault. The PDIQSS tool predicted usefulness in digital photography of female genital injuries following sexual assault when measured in all dimensions.

Child sexual abuse examination: is there a need for routine screening for N. gonorrhoeae?

PURPOSE: To determine the yield of routine vaginal cultures for Neisseria gonorrhoeae from asymptomatic girls following sexual abuse. METHODS: Cultures were obtained from 865 prepubertal girls seen within 72 hours following an assault. Adult females (2743), age 18 or older, who were treated according to the same protocol constitute the control group. Data were analyzed using chi square analysis and comparison of proportions. RESULTS: It was found that 165 (4.6%) cultures were positive for N. gonorrhoeae. Of the 2743 adults, 153 were positive (5.6%) compared with 12 of the 865 prepubertal girls (1.4%). The differences are statistically significant. All 12 prepubertal children who had positive vaginal cultures for N. gonorrhoeae revealed that they had signs of acute vulvovaginitis. CONCLUSION: Routine vaginal cultures in asymptomatic prepubertal girls may not be indicated as part of the initial evaluation.

Adolescent victims of sexual assault.

PURPOSE: The purpose of this study was to evaluate a group of female adolescent victims (n = 176) of sexual assault and assess the similarities and differences between them and older female victims. METHODS: All the adolescents in this study were physically mature. The demographic data and the findings of the medical evaluation are compared with those of women, 25-44 years of age, who were assaulted during the same time period (n = 197). RESULTS: The mean age of the adolescent patients was 15.2 (+/- 1.6), while the control group had a mean age of 31.9 (+/- 5.1). Racial distribution was similar in both groups. One hundred thirty-nine (79%) adolescents reported prior consensual sexual activity and 32 (18%) had been pregnant at least once. Thirty-one adolescents (19%) reported a previous sexual assault. Many adolescent victims (64%) knew their assailant. Weapons or physical force was used less frequently to subdue an adolescent victim, and firearms were used very infrequently in adolescent assault. Use of alcohol or drugs just prior to the assault was prevalent among adolescent victims (47%). Finally, adolescent victims were less likely to sustain physical injuries during the assault. CONCLUSION: The preexisting relationship between the victim and the assailant may explain other elements that distinguish an adolescent rape victim from her adult counterpart. Compared to adolescent victims, the assault on adult women is more often perpetrated by a stranger, the victim is more likely to be abducted, and weapons, especially firearms, are more likely to be used to carry out the victim's capture.

Male victims of sexual assault.

OBJECTIVE: To compare the demographics, physical findings, and assault characteristics of incarcerated, sexually assaulted men with those of nonincarcerated, sexually assaulted men. DESIGN: Case series of 99 adult male victims of sexual assault evaluated over a 3-year period. SETTING: Memphis Sexual Assault Resource Center, a nonhospital-based clinic that serves as the primary resource for sexually assaulted victims in the Memphis and Shelby County, Tennessee, area. PARTICIPANTS: All adult male victims of sexual assault evaluated at the Memphis Sexual Assault Resource Center during the study period were included in the study. Ninety-nine victims were studied, including 80 incarcerated men and 19 men from the community. RESULTS: The victims of sexual assault in the community group were older than the victims in the incarcerated group. Apart from the age difference and weapon use, there were no statistically significant differences between the incarcerated and nonincarcerated victims. CONCLUSIONS: The similarities between the two groups suggest that sexual assault of men may not be unique to prisons, and all men are potential victims. Further studies are required to better understand these crimes and to develop education and prevention programs.

Genital abnormalities in female siblings and friends of child victims of sexual abuse.

We evaluated the merit of a directive issued by The Tennessee Department of Human Services (TDHS) requesting a medical evaluation for all children who were closely associated with a victim of sexual assault, even if these children denied being victims themselves. In a 6-month period, 247 girls, age 12 and under, were referred for medical evaluation. Of these, 188 were primary victims of sexual abuse, and 59 girls were secondary victims, associates of victims of abuse. All examinations were performed in an office setting. A colposcope was used to magnify the findings. Of these 59 girls, 45 girls were found to have abnormal genital findings. Nonspecific findings were present in 5 girls (8%), and findings considered specific for sexual abuse were observed in 40 girls (68%). When compared with 5 girls (8%), and findings considered specific for sexual abuse were observed in 40 girls (68%). When compared with primary victims, secondary victims were more likely to demonstrate genital abnormalities suggestive of sexual abuse. (chi 2 = 13.7, p = .0011). Of the 50 secondary victims who were later interviewed by TDHS, 24 girls (48%) reported that they were also victims of assault. We strongly recommend that siblings of sexual abuse victims, as well as other children who are closely associated with them and exposed to the perpetrator, be evaluated to determine whether they have abnormalities suggestive of sexual assault.