American Journal of Emergency Medicine
Volume 26, Issue 8 , Pages 857-866, October 2008

Forensic sexual assault examination and genital injury: is skin color a source of health disparity?☆

  • Marilyn S. Sommers, PhD, RN

      Affiliations

    • University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 215 746 8320, +1 513 314 9967 (Mobile); fax: +1 215 573 7496.
    • ,
  • Therese M. Zink, MD

      Affiliations

    • University of Minnesota Department of Family Medicine, Minneapolis, MN, USA
    • ,
  • Jamison D. Fargo, PhD

      Affiliations

    • Utah State University Department of Psychology, Logan, UT, USA
    • ,
  • Rachel B. Baker, PhD, RN

      Affiliations

    • Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
    • ,
  • Carol Buschur, RN, MSNc

      Affiliations

    • The University Hospital, Cincinnati, OH, USA
    • ,
  • Donna Z. Shambley-Ebron, PhD, RN

      Affiliations

    • University of Cincinnati, College of Nursing, Cincinnati, OH, USA
    • ,
  • Bonnie S. Fisher, PhD

      Affiliations

    • University of Cincinnati Division of Criminal Justice, Cincinnati, OH, USA

Received 26 September 2007; received in revised form 14 November 2007; accepted 14 November 2007.

Abstract 

Purpose

The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination.

Methods

A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse.

Results

Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02).

Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables—lightness/darkness–, redness/greenness–, and yellowness/blueness–confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable—redness/greenness—was significantly associated with injury occurrence and frequency in the internal genitalia.

Conclusions

Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.

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☆ The study was designed and data were collected when the principal investigator (Marilyn Sommers) was a faculty member at the University of Cincinnati. Previous presentation: Injury prevalence preliminary data on a sub-sample and a review of injury detection methods were presented at a podium presentation at the State of the Science Congress in Washington, DC, in October, 2004 and at the Midwest Nursing Research Society, Cincinnati, OH in April, 2005. The difference in skin color and the relationship to methods of injury detection at various anatomic locations were presented at a podium presentation at the Midwest Nursing Research Society, Cincinnati, OH, in April, 2005. Comparisons of injury prevalence across injury detection techniques were presented at State of the Science Congress in Washington, DC, in October, 2006 and Scientific Meeting on the Health Implications of Violence against Women, University of Kentucky in June, 2006. Final study findings have not been presented.

 Funded by the National Institute of Nursing Research (R01NR05352), Bethesda, MD.

PII: S0735-6757(07)00781-4

doi:10.1016/j.ajem.2007.11.025

American Journal of Emergency Medicine
Volume 26, Issue 8 , Pages 857-866, October 2008

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