Understanding women's risks for injury from sexual assault

Presence of physical injuries from a sexual assault has been linked to the development of significant long term psychological and physical health consequences in women. Effective prevention of consequences requires an understanding of injuries and risks for injuries yet the literature on risks for injuries is inconsistent. The purpose of this research was to examine the evidence regarding rates and severity of injuries and the influence of various risk factors on injuries.

A systematic review was conducted of studies involving sexual assault injuries and effects of risk factors. Categories of injury varied across the 43 studies included (e.g.-genital, nongenital and physical) as did the definitions of injuries. Rates of genital injury were higher among sexual assault nurse examiners (SANEs) compared to physicians, especially if aids to visualize genital injury were used. Rates of nongenital injury were higher if the exam was conducted by an emergency physician versus SANEs, or if women reported to police. Nongenital injuries tended to be more severe but genital injuries were more numerous. The risk factors associated with genital injury differed from those associated with nongenital injury.

A theoretical model was developed to explain the association between various risk factors and genital or nongenital injury outcomes. The model was tested using data from 485 women seen by an urban sexual assault team. Physical aggression had the largest effect on the severity of nongenital injuries and was increased if women were more awake, used physical resistance, or did not know the assailant. It was also increased if the setting was more public and the assailant used verbal aggression. Nongenital injury was more severe if there was attempted versus completed penetration. Genital injury severity was increased with completed anal penetration or multiple sites of penetration and if women were more conscious.

Further research is needed, including validation of the model and testing of the influence of various risk factors on injuries in different sexual assault populations and settings. In order for this research to be meaningful, sexual assault examiners need to begin using standard examination practices, consistent injury definitions and collect data on similar sets of risk factors.