Female genital injury—which findings have to be considered physiological using colposcopy with and without toluidine blue dye?

This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.

Strangulation of the penis with a metal ring. Clinical case

Penile trauma is the most complex, diverse and hard to rehabilitate injury. The reasons are anatomical structure and localization of the organ and its multifunctionality. Penile strangulation is the most common and typical type of genital injury; incidence is 1 case per 5,000 males. However, urologists in their practice rarely encounter penile strangulation with a metal ring. Some objects, metallic or other, can be placed on the penis to increase sexual activity. We describe a clinical case of a 70-year-old patient who sought medical care at the emergency room due to penile strangulation by a metal ring (a nut). The patient sought assistance 3 days after putting the metal ring on his penis by himself.

Aplicación de la escala de gravedad de lesiones genitales en víctimas de violencia sexual

Introducción: La violencia de tipo sexual puede afectar a todo ser humano sin importar edad, sexo, etnias, condición social o laboral; un punto importante a recalcar es que afecta a la libertad de decisión y de consentimiento expreso del goce de los derechos e integridad sexual de quien se está formando y no tiene la capacidad de decidir sobre actividades sexuales de manera libre. Según el Instituto Nacional de Estadísticas y Censos (2011) el 25,7% de mujeres ecuatorianas han sido víctimas de violencia sexual. Dentro de la exploración física de la víctima es importante detectar lesiones a nivel extragenital, paragenital y/o genital; para ayudar en el proceso se han creado escalas de aplicación durante el examen sexológico forense, una de estas es la Escala de Gravedad de Lesiones Genitales (GISS: Genital Injury Severity Scale) desarrollada por Kelly D. et al. en el año 2013, para valorar y dar una gradación a las lesiones en el área genital de las víctimas femeninas. Objetivo: Aplicar la Escala de Gravedad de Lesiones Genitales (GISS) y relacionarla con la observación directa durante el examen sexológico forense. Metodología: El diseño del estudio fue observacional, transversal y analítico, en mujeres víctimas de presunta agresión sexual que se les realizó el examen sexológico forense. Resultados: Se demostró que existe relación entre la escala de gravedad de lesiones genitales (GISS) y la observación directa (OD) (Índice de Kappa: 0,66; IC95%: 0,52-0,79) para establecer lesiones genitales en mujeres víctimas de presunta agresión sexual. Conclusiones:La Escala de gravedad de lesiones genitales (GISS) no presenta ventajas de identificación de lesiones con respecto a la observación directa.

Medications at the Emergency Department After Recent Rape

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Medico-Legal Findings in Victims and Accused of Sexual Assault

Background: Sexual assault is one of the heinous and barbarous crimes and continues to plague our nation. It is present in every countries cutting across boundaries of culture, race, gender, relationship, social standing and the extremes of ages. The current study aims to analyze the incidence of sexual assault cases, their socio-demographic parameters, incidence to reporting time and relationship of the assailant with the victim and pattern of injury for evaluation of sexual assault. Materials and Methods: The medico-legal reports of 102 sexual assaults cases were retrieved and analyzed retrospectively which was examined by Department of Forensic Medicine from October 2019 to September 2020 at Dhulikhel hospital. All the data were entered in SPSS version 25 and results were ascertained. Results: Out of 102 samples, 52 female victims and 48 accused were analyzed. Two were male victims of sodomy. The mean age was 20.54±10.78 and 27.67±11.08 for victim and accused respectively, the most vulnerable being unmarried teenagers. Most of the accused and victims were familiar with each other (81.25%) and the common incident locale was victim’s own house. Genital injury was seen in 53.85% and general injury in 32.7% of the victims. Only 13.46 % victims and 12.50% of accused were brought for examination on the same day. Genital injury had significant association with age (p=0.003) and day of examination (p=0.029). Four of the victims were positive for pregnancy test. Conclusion: Hence this study aims to highlight that sexual assault is a catastrophe and there is a dire need of educating the vulnerable groups.

Obstetrics and gynaecology

This chapter in the Oxford Handbook of Emergency Medicine investigates obstetrics and gynaecology in the emergency department (ED). It reviews gynaecological problems, vaginal discharge, contraceptive problems, genital injury, assault and female genital mutilation, gynaecological pain, and vaginal bleeding. It discusses the pregnant patient and explores prescribing, hyperemesis gravidarum, vaginal bleeding, miscarriage, ectopic pregnancy, vaginal bleeding in later pregnancy, abdominal pain, and medical complications of pregnancy. It also reviews emergency normal delivery, obstetric emergencies, trauma and cardiac arrest in pregnancy, and post-partum problems.

Genital Injuries: Are They Telling us Something about Sexual Violence?

Genital injury has a forensic relevance after a sexual assault and it has been discussed and investigated among professionals who work in this field. To analyze the studies published in the last decades, the present review examines different factors that may influence this finding, first clarifying terms of the forensic field, such as the peculiarity of the legal medical examination, and the distinction of the terms “legal” and “anatomical” vagina. Finally, it analyses if it is possible that the existence of these injuries in victims explain the lack of consent in sexual contact, and to clarify the meaning of the absence of injuries.