Professional Documents
Culture Documents
Bowyer 1997
Bowyer 1997
Objective A minority (some report < 10%) of women report sexual assault. Of those that negotiate the
police process, only a minority will come to a court hearing. It is thought that the courts still rely
upon medical evidence, in particular evidence of genital injury to 'prove' the rape. This study aimed
to ascertain the incidence of genital injury in victims of alleged rape
Design Retrospective review of case records of women who reported they had had been raped, provided
by women doctors on the Northumbrian Police Doctors scheme.
Sample Case records from Newcastle, North and South Tyneside, Sunderland and Northumbria.
Methods Analysis of records in the standardised booklet used by police surgeons to examine women
reporting rape.
Main outcome measures Presence of genital injury, presence of other physical injuries.
Results A minority of women had genital injuries (22/83); the majority had some form of physical injury
(68/83), although most of these were minor.
Conclusion The study shows that only a minority of women examined by specifically trained police
doctors show evidence of genital injury. The absence of genital injury does not exclude rape.
carry more weight in the courts to obtain conviction. Table 1. The anatomical location of general injuries, such as bruises,
The following study reports an analysis of the casenotes scratches or grazes, in association with the number of women report-
of 83 women who alleged rape, and in particular ing rape.
describes the genital injuries recorded. Anatomical location of injury n
No injury 15
METHODS Arm 42
Thighhpperleg 36
Examination and interview Neck 22
Breadchest 17
The woman is usually brought to the examination suite Calfhhinilowerleg 16
by a woman police constable (WPC), although those Facehead 15
who do not wish the involvement of the police will be Back 14
seen as self-referrals. Two examination suites exist Knee 14
Shoulder 10
in the Northern Region, both located near or within Hand 13
general hospital grounds. The suite consists of interview Buttock I
rooms, an examination room and bathroom, kitchen and
office where the counsellors are based. The rooms are
furnished in a ‘noninstitutional’ style in order to create a
homelike atmosphere. A brief medical and gynaecolog- After the examination the woman is offered a prelim-
ical history is taken with a detailed description of the inary counselling session, usually a fortnight later to
assault. An account is also provided by the WPC if she allow her time to recover from the initial shock; these
accompanies the woman. Detailed enquiries are made sessions are undertaken by trained autonomous counsel-
concerning the events before, during and after the lors. All women are offered review by the genitourinary
assault, in particular details of micturition, defaecation, medicine clinic approximately two weeks later to
eating, drinking, and washing. If the woman has not discuss screening for HIV, hepatitis and other sexually
changed since the assault she is asked to remove her transmitted diseases.
clothing onto a sheet of brown paper, in order to catch A statement is submitted to the police officer in
any possible items for evidence, such as hairs from the charge, describing the injuries sustained and whether
assailant. Any serious injury is treated as a priority these are consistent with the alleged assault.
before the forensic examination.
RESULTS
Physical examination Eighty-three cases of alleged rape were reviewed from
A thorough physical examination is undertaken ensur- the notes of the women doctors on the scheme. The
ing the dignity of the woman is maintained, with a following details were documented: age; time between
detailed explanation of each element of the examination alleged rape and examination; previous sexual activity;
and her consent at each stage. The woman is carefully assaults in addition to rape; general injuries; genital
examined for evidence of recent injury, such as grazes, injuries.
bruises and scratches and an estimate made of the The mean age of the women reporting rape was 25.3
timing of the injuries. Hair combings and cuttings are years (range 16-48 years). The mean time between the
taken. Her injuries are described in writing and drawn occurrence of the alleged rape and the examination was
with measurements on a body chart. The final examina- 34 hours (range 1 hour to 11 days). The majority of
tion is of the external genitalia and the pelvis. The need women were seen within 24 hours of being raped. Four
to take swabs from the vulva, introitus, low vagina, high women had been virgins.
vagina, cervix, perianal and rectal areas is assessed Implements, such as a fist or clothing, had been
according to the time from the assault. Control swabs inserted into the vaginaof three women, seven had had
(unopened plain swabs from the same batch) are forced anal intercourse, and two had been unsuccess-
included with the specimens. Pubic hair combings and fully strangled. Table 1 shows the associated injuries
cuttings are also taken. Blood samples are taken for and Table 2 the genital injuries.
grouping and DNA and blood alcohol levels. A saliva
specimen is also taken. The woman is examined again DISCUSSION
in one or two days later when new bruising may
be more easily seen, and a comparison of the age of dif- The association of genital injury and rape is question-
ferent bruises can be made. The need for contraception able, the incidence of genital injury varying between 10
is also discussed. and 87% (Table 3).
0 RCOG 1997 Br J Obstet Gynaecol 104, 617-620
RAPE AND GENITAL INJURIES 619
Table 3. Studies reporting genital injuries in association with rape. Values are presented as n / n (%).
Studies Year No. injured Type of injury
Table 2. Genital injuries sustained by women reporting rape. were examined colposcopically within six hours of
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of the medico-legal examination in most, but not all, 9 Goodyear-Smith FA. Medical evaluation of sexual assault findings in
cases of rape and attempted rape in 1975 and 1980. theAucklandregion. NZMedJ 1989; 102: 493-495.
10 Bradham GB. The establishment of a treatment centre for victims of
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11 Solala A, Scott C, Severs H, Howell J. Rape: Management in a nonin-
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12 Amir M. Patterns in Forcible Rape. Chicago: University of Chicago
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14 CartWright PS. Factors that correlate with injury sustained by sur-
their legal statement regarding the allegation, nor in vivors of sexual assault. Obstet Gynecoll987; 70: 44-46.
their treatment of the woman. The absence of genital 15 Everett RB, Jimerson GK. The rape victim: a review of 117 comecu-
injury should not be used as pivotal evidence by the tive cases. Obstet Gynecoll977; 50: 88-90.
16 Lauber AA, Souma ML. Use of toluidine blue for documentation of
jury, police or the Crown Prosecution Service. traumatic intercourse. Obstet Cynecoll982; 6 0 644-648.
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18 Manser TI. The results of examinations of serious sexual offences-a
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19 McCauley J, Gyzinski G, Welch R, Gorman R, Osmers F. Am JEmerg
Med 1987; 5: 105-108.
Acknowledgements 20 Olusanya 0, Ogbemi S, Unuigbe J, Oronsaye A. The pattern of rape
in Benin City, Nigeria. Tmp Geogr Med 1986; 38: 215-220.
We are grateful to the following doctors for allowing us 21 Ramin SM, Satin AJ. Stone IC, Wendel GD. Sexual assault in post
to analyse their data: Dr J. Welbury, Dr E. Fraser and Dr menopausal women. Obstet Gynecoll992; 80: 86G864.
22 Slaughter L, Brown CR. Colposcopy to establish physical findings in
G. Bannerjee. rape victims. Am JObstet Gynecol1992; 166: 83-86.
23 Frith K. Rape, divorce and nullity. Br JHosp Med 1970; 4: 762-767.
24 Paul D. Medico-legal examination of the living. In Mant AK, editor.
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