Genital and anal injury in women after sexual assault: prevalence rates and associated risk factors in 294 cases

Objectives: To investigate the prevalence of, and risk factors for, genito-anal injury in females who attended a Sexual Assault Treatment Unit in a capital city following sexual assault.

Design: Cross-sectional study.

Method: All females who underwent a genital and/or anal forensic examination between 1/1/2023 and 31/12/2023 were included. A standardised dataset of demographic and assault metrics was collated. Genito-anal injury data was contemporaneously collected by forensically trained specialist doctors and nurses using prescribed definitions and a standardised tool. Descriptive bivariate analysis and logistic regression analysis were performed on these data. Statistical significance was defined as a p-value < 0.05.

Results: During the study period, 405 women accessed this SATU service of whom 294 (72.6%) underwent a forensic examination that included a genital and/or anal examination. The overall prevalence of genito-anal injury was 25.9% (n = 76/294), with those who reported completed vaginal penetration having a genito-anal injury prevalence rate of 31.1% (n = 65/209). Anal injury was observed in 20% (n = 8/40) of those who reported completed anal penetration. The most commonly injured genital site was the posterior fourchette (n = 29) followed by the fossa navicularis (n = 24) and the labia minora (n = 23), with the most common injury type being a laceration (n = 81) followed by an abrasion (n = 37). Genito-anal injury was significantly more likely to be present in women who disclosed a mental health history (OR1.94 CI1.11-3.39 p = 0.01), were certain that a sexual assault had taken place (OR2.91 CI1.31-6.45 p = 0.008), who disclosed genital bleeding after the incident (OR2.35 CI1.25-4.42 p = 0.007) and had extra-genital injuries (2.20 (1.27–3.80) p < 0.004). Absense of previous sexual activity (p = 0.39), menopausal status (p = 0.09), age (p = 0.64), assailant-survivor relationship (p = 0.07) or incident location (p = 0.17) did not have a significant association on the presence of genito-anal injury. Extra-genital/bodily injury was present in 53% (n = 156) of women who attended.

Conclusion: This study demonstrates the prevalence and patterns of genital and anal injuries in women presenting to a single unit following sexual assault, and provides valuable insights into the nature and extent of harm experienced by survivors when consistent data collection tools are used. The study also highlights how frequently injury is absent, even when penetration is disclosed. These findings contribute to the body of evidence guiding forensic examination protocols and care strategies, as well as to the evidence base considered during detection and prosecution of sexual crime.