The Role of Colposcopy in Rape Exams

Some highlights from an interesting discussion on the role of using colposcopy in rape exams.

Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped.

Several investigators using colposcopy have identified the posterior fourchette* as the most common genital location for injury in women after rape.

*[posterior fourchette=band of tissue that connects the two labia minora. It extends inferiorly as a low tissue ridge that fuses in the middle.]

In one study, the frequency of injury by anatomic sites was posterior fourchette (70%), labia minora (53%), hymen (29%), and fossa navicularis (25%).

Adolescent girls were most likely to experience injuries at the fossa navicularis, hymen, posterior fourchette, and labia minora.

Anal and rectal injuries are known as markers for marital rape.

In married couples the most frequent type of forced sex was vaginal intercourse (82.7%), the second most frequent type was forced anal intercourse (52.8%).

An absence of rigorous studies with large sample sizes limits our knowledge about injuries following rape as compared to consensual sexual intercourse.

When examining women after consensual sexual intercourse, some studies found a 10% injury rate; others have found higher rates of injury (61%).

With consensual intercourse most women have microtrauma (telangiectasia, broken blood vessels, microabrasions with superficial denuding of the epithelium and increased vascularity). The most common types of lesions: petechiae, erythema, abrasions [scrapes], and edema.

The issue of identifying an injury pattern that has a high sensitivity to predict rape remains problematic.

Non-reporting estimates for completed rape in a variety of populations range from 63%-95%.

The level of injury sustained during rape increases the likelihood of the victimization being reported to the police. In addition, whether or not the victim sustained physical injury besides rape injuries (injuries ranged from severe injuries such as gunshot wounds and broken bones to minor injuries such as bruises, cuts, and scratches) was one of two factors (the race of the victim, specifically being African American was the other) that significantly increased the likelihood of a rape victimization being reported to the police.

A recent study suggests that women's knowledge of genital injury, particularly in the absence of non-genital injury, is important to the victim's decision to report to police.

In one U.S. survey, of the 31.5% of rape victims who reported having suffered an injury, only 35.6% of these women received medical care.

Among the most frequently given reasons for not reporting to the police is "lack of proof that the incident happened".

The U.S. Federal Bureau of Investigation reported that 8% of all rape complaints were unfounded by the police nationwide in 1997.

The role of injury is relevant to the police decision to unfound rape cases.

One examination of felony-level cases of rape found that nearly 35% of the victims in the sample agreed to undergo the forensic exam at a local hospital. The police were less likely to unfound a case when the victim agreed to undergo the forensic exam. This increased probability represents either the willingness of the victim to cooperate with the investigation or the usefulness of the examination to provide evidence that could then be used by the prosecutor.

Prosecutors consider the presence of medical evidence in deciding whether or not to prosecute a rape case

Forensic examiners are not decision-makers per se in the criminal justice process, they play a pivotal role in the evidence component of the justice process.

Two primary issues at stake in rape cases are identification and consent.

In the future, colposcopy, depending upon the degree of confidence with which images of consensual sex and rape can be differentiated, may offer valid and reliable scientific evidence that can address the issue of consent and thus could be used to corroborate reports of rape and aid in the prosecution of rape cases.