Identifying the prevalence of genito-anal injuries amongst clients attending St Mary's Sexual Assault Referral Centre following an allegation of anal penetration.

BACKGROUND: There is a lack of clarity around the prevalence of anal injuries sustained following anal penetration. The aim of this study was to identify the prevalence of injury amongst clients attending Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK following anal penetration and identify predisposing or protective factors such as age, sex and pubertal status. This should facilitate an evidence-based approach to providing evidence statements in court for allegations of anal penetration. METHOD: This was an observational retrospective study analysing the forensic medical examination (FME) case notes of 239 clients between January 2015 and December 2016. Subjects were excluded if the nature of alleged assault was unclear. Data was extracted from the FME case notes on to a data collection proforma and statistical analysis undertaken. RESULTS: Of the 239 subject, 156 [65.3%] were female and 83 [34.7%] male. Subjects were predominantly post-pubertal, 185 [79.4%]. The alleged assaults were categorised in to penile anal, digital anal and object anal; penile anal assault was the most common type, 177 [75.97%]. No association was found between type of assault and presence of anal injury. Anal injuries did not occur more frequently in one sex than another [21.15% female, 21.69% male]. Logistic regression indicated pre-pubertal children were less likely to have injury [(odds ratio = 0.34, 95% CI (0.078, 0.70), p = 0.016)], although this was not significant when adjusted for time since assault. Most pre-pubertal children presented more than 72 h after alleged assault, [68.2% female, 73.1% male] The presence of anal injury was significantly associated with time since assault across all subjects, with those examined after 72 h less likely to have injury [p = 0.0016]. A greater proportion of single suspect assaults [22.8%] resulted in anal injury than multiple suspect assaults [13.9%]. Whilst there was alcohol consumption in most alleged assaults against post-pubertal subjects [56.1% female, 50.9% male], there was no statistically significant data to associate alcohol consumption with anal injury. And, the same was true of drug consumption. Among post-pubertal females 96.21% of assaults involved threats or violence, comparable with 71.70% amongst post-pubertal males. The data did not suggest threats and violence increase the rate of anal injury. CONCLUSION: The study identifies a statistically significant relationship between time since assault and prevalence of anal injury. Further, a relationship between pubertal status and prevalence of anal injury was found. The low prevalence of anal injury amongst pre-pubertal children suggests that absence of injury at the time of examination, following allegation of anal assault, is a common finding. Importantly, whilst not demonstrating statistical significance, it should be noted that the majority of assaults reported in the study did not result in anal injury. The study provides contemporary evidence in the field of forensic medicine which can be used in court proceedings in allegations of anal assault.

Female genital injuries resulting from consensual and non-consensual vaginal intercourse.

OBJECTIVES: The purpose of this study was to compare the incidence of genital injury following penile-vaginal penetration with and without consent. DESIGN: This study compared observations of genital injuries from two cohorts. SETTING: Participants were drawn from St. Mary's Sexual Assault Referral Centre and a general practice surgery in Manchester, and a general practice surgery in Buckinghamshire. PARTICIPANTS: Two cohorts were recruited: a retrospective cohort of 500 complainants referred to a specialist Sexual Assault Referral Centre (the Cases) and 68 women recruited at the time of their routine cervical smear test who had recently had sexual intercourse (the Comparison group). MAIN OUTCOME MEASURES: Presence of genital injuries. RESULTS: 22.8% (n=00, 95% CI 19.2-26.7) of adult complainants of penile-vaginal rape by a single assailant sustained an injury to the genitalia that was visible within 48h of the incident. This was approximately three times more than the 5.9% (n=68, 95% CI 1.6-14.4) of women who sustained a genital injury during consensual sex. This was a statistically significant difference (a<0.05, p=0.0007). Factors such as hormonal status, position during intercourse, criminal justice outcome, relationship to assailant, and the locations, sizes and types of injuries were also considered but the only factor associated with injury was the relationship with the complainant, with an increased risk of injury if the assailant was known to the complainant (p=0.019). CONCLUSIONS: Most complainants of rape (n=500, 77%, 95% CI 73-81%) will not sustain any genital injury, although women are three times more likely to sustain a genital injury from an assault than consensual intercourse.

Further aspects of male-on-male rape and sexual assault in greater Manchester.

The purpose of this paper is to describe pertinent non-medical circumstances around male-on-male sexual assault, and supplements the earlier article in this journal regarding forensic medical aspects of this population. As services (medical, policing and judicial) see more males they will need to adapt themselves to their needs as well as those of their female clients. St. Mary's Sexual Assault Referral Centre (Greater Manchester, UK) opened in October 1986. Up to May 2003 it had seen 376 male (370 individual clients) and 7,789 female cases (7,403 clients). Of these, significantly fewer males reported to the police than females, although this difference has disappeared in recent years. There were also significant differences between the sexes regarding relationship, number of assailants, and assault location. There were no statistically significant differences between the sexes for age of the client, and presence in the assault of weapons or additional violence.

Forensic medical aspects of male-on-male rape and sexual assault in greater Manchester.

Male-on-male rapes and sexual assaults comprise fewer than 10% of such assaults reported to the police, and so many physicians seldom encounter them. This paper provides an overview of the nature of sexual assault encountered by males, ensuing injuries, and comparisons with male-on-female assault cases. The retrospective epidemiological study was on two cohorts seen at St. Mary's Sexual Assault Referral Centre, Manchester. The participants were Centre clients seen between October 1986 and mid-May 2003; 376 male eases (370 individual clients) and 7,789 female cases (7,403 individual clients). The main outcome measure was the presence of injury (abrasion, laceration, or bruise) to defined body areas. The results showed that 66% of male cases (when assault type was known) had been raped, significantly fewer than in female cases, (p 0.00, a 0.05, O.R. 0.474, 95% C.I. 0.357 to 0.63). Eighteen per cent of male cases that had a forensic medical examination presented with an anal injury, significantly more than in females (p 0.00, a 0.05, O.R. 6.101, 95% C.I. 4.216 to 8.829). Significantly fewer males than females sustained injuries to other body areas. The conclusion was that males were significantly more likely (six times) than females to receive at least one injury to the anal area. Even so, males are five times more likely to have no anal injury.

The accuracy of guestimates.

At times a clinician must describe the size of a lesion when measurement presents difficulties. A 'guestimate' may then be recorded. We tested the accuracy of forensic clinicians (10 physicians and 1 nurse) in guestimating the sizes of ten test objects, comparing their performance with 13 individuals from other professions. The participants were permitted to handle the objects but not to use a measuring device. For three of the objects (a balloon, a scratch and a coin) the entire sample of participants significantly overestimated size, by 13-22%. Both participant groups overestimated the size of a scratch, the clinicians being more accurate but not significantly so. Guestimates should be avoided unless the use of a ruler or tape measure will be against the interests of the client.