Advertisement

Significance of toluidine blue positive findings after speculum examination for sexual assault

  • Jeffrey S Jones
    Correspondence
    Address reprint requests to Jeffrey S. Jones, MD, Department of Emergency Medicine, Spectrum Health-Butterworth Campus, 100 Michigan Street NE, Grand Rapids, MI 49503-2560 USA
    Affiliations
    Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus; and the YWCA Nurse Examiner Program, Grand Rapids, Michigan, USA
    Search for articles by this author
  • Chris Dunnuck
    Affiliations
    Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus; and the YWCA Nurse Examiner Program, Grand Rapids, Michigan, USA
    Search for articles by this author
  • Linda Rossman
    Affiliations
    Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus; and the YWCA Nurse Examiner Program, Grand Rapids, Michigan, USA
    Search for articles by this author
  • Barbara N Wynn
    Affiliations
    Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus; and the YWCA Nurse Examiner Program, Grand Rapids, Michigan, USA
    Search for articles by this author
  • Cathy Nelson-Horan
    Affiliations
    Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital-Butterworth Campus; and the YWCA Nurse Examiner Program, Grand Rapids, Michigan, USA
    Search for articles by this author

      Abstract

      To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 × magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury—an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lauber A.A
        • Souma M.L
        Use of toluidine blue for documentation of traumatic intercourse.
        Obstet Gynecol. 1982; 60: 644-648
        • McCauley J
        • Guzinski G
        • Welch R
        • et al.
        Toluidine blue in the corroboration of rape in the adult victim.
        Am J Emerg Med. 1987; 5: 105-108
        • Gold C.R
        Sexual assault.
        in: Marx J.A Rosen’s Emergency Medicine Concepts and Clinical Practice. ed 5. Mosby, St Louis2002: 857-865
        • Braen G.R
        Examination of the sexual assault victim.
        in: Roberts J.R Hedges J.R Clinical Procedures in Emergency Medicine. ed 3. WB. Saunders Co, Philadelphia1998: 1028-1029
        • Lauber A.A
        • Souma L
        Use of toluidine blue for documentation of traumatic intercourse.
        Obstet Gynecol. 1982; 60: 644-648
        • Bays J
        • Lewman L.V
        Toluidine blue in the detection at autopsy of perineal and anal lacerations in victims of sexual abuse.
        Arch Pathol Lab Med. 1992; 116: 620-621
        • Hochmeister M.N
        • Whelan M
        • Borer U.V
        • et al.
        Effects of toluidine blue and destaining reagents used in sexual assault examinations on the ability to obtain DNA profiles from postcoital vaginal swabs.
        J Forensic Sci. 1997; 42: 316-319