Skin Color May Affect Visual Detection of Genital Trauma

May 2010

By Heidi Splete
Elsevier Global Medical News

BOSTON -- The prevalence of genital injuries was significantly higher among white patients, compared with black patients, based on a review of 2,234 women aged 13 years and older who were examined after being raped. This may be misleading, though, because methods of recognizing these injuries can be ineffectual in black women.

"Little is known about the role of race on the prevalence of genital injury following rape or sexual assault," Linda Rossman, M.S.N., said in a poster presented at the Scientific Assembly of the American College of Emergency Physicians.

Data from previous studies have shown that direct visualization, contrast media, and colposcopy may be less effective at identifying genital injuries in darker-skinned patients, said Ms. Rossman of Michigan State University, East Lansing, and her colleagues.

"Color awareness may be an important component of the sexual assault forensic examination," the researchers said.

To examine the impact of skin color on identifying genital injuries after sexual assault, the researchers reviewed data from 2,234 consecutive female patients who were referred to a community-based Sexual Assault Nurse Examiner program (SANE) from four urban emergency departments during a 10-year period.

In this study, genital injury was defined as any visible tissue trauma that could be categorized using the TEARS classification system (tears, ecchymoses, abrasions, redness, and swelling).

The primary outcome of the study was the identification of physical injuries from sexual assault in white vs. black women living in the same community. In this patient population, 83% of the women were white and 17% were black.

The patients had similar demographic characteristics such as age and marital status, and the details of the assault cases were similar in the types of sexual assault, role of drugs or alcohol, knowledge of the assailant, and time to the physical exam.

Overall, the prevalence of documented anogenital injuries was significantly higher in whites, compared with blacks (64% vs. 54%). The pattern of anogenital injuries was similar in both groups. The injuries typically involved the fossa navicularis, followed by the posterior fourchette, labia, and hymen, the researchers said. In addition, the prevalence of documented nongenital injuries was significantly higher in whites, compared with blacks (39% vs. 26%).

Lacerations were the most common injuries in all patients, but whites had a significantly greater incidence of documented erythema, compared with blacks, the researchers noted.

The study was limited in part by the disproportionate number of white patients vs. black patients, but the results suggest that individuals with darker skin may be at a disadvantage for injury identification using current forensic techniques, the researchers said. The SANE clinic in this study was associated with a university-affiliated emergency medicine residency program and was staffed by nurses trained to use colposcopy with nuclear staining for medicolegal examinations, they added.

The researchers had no financial conflicts to disclose.

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