Genital trauma associated with forced digital penetration

Clinicians may not perform a medical-legal examination in cases in which a sexual assault was attempted but no penile-vaginal contact occurred. This retrospective study was conducted to document the frequency and type of genital injuries in women in whom forced digital penetration was the only reported type of assault. Study patients were consecutive female patients presenting to an urban sexual assault clinic during a 3-year study period. The clinic is associated with a university-affiliated urban hospital and is staffed by registered nurses trained to perform forensic examinations using colposcopy with nuclear staining. Case files of 941 patients were reviewed; 6% (53) reported only digital-vaginal contact. Genital injuries were documented in 81% of the patients (mean number of genital injuries, 2.4). Fifty-six percent of the injuries occurred at four sites: fossa navicularis, labia minora, cervix, and posterior fourchette. The most common type of injury was erythema (34%) followed by superficial tears (29%) and abrasions (21%). Colposcopy with nuclear staining was useful in detecting these injuries-and can provide valuable legal information in sexual assault victims reporting only digital-vaginal penetration.