Table 1. Genital injuries by location
Gynaecological
examination
Scratches/
abrasions/tears
Cuts
Bruising/
haematoma
Bleeding
Hymenal clefts
Hymen swollen
Scars from
?assault
Redness/
inflammation
Tenderness/
pain
Urethral
orifice and
paraurethral
folds
(N=139)
Labias
majora and
minora
(N=235)
Posterior
fouchette
(N=451)
Total
(N=1472)
Clitorus
and
frenulum
(N=80)
535 (36.3%)
20 (1.4%)
35 (43.8%)
1 (1.3%)
65 (46.8%)
5 (3.6%)
126 (53.6%)
8 (3.4%)
364 (80.7%)
10 (2.2%)
130 (59.9%)
5 (2.3%)
62 (78.5%)
5 (6.3%)
254 (17.3%)
145 (9.9%)
32 (40.0%)
14 (17.5%)
48 (34.5%)
22 (15.8%)
75 (31.9%)
29 (12.3%)
140 (31.0%)
57 (12.6%)
100 (22.2%)
15 (6.9%)
78 (5.3%)
4 (5.0%)
11 (7.9%)
17 (7.2%)
66 (14.6%)
238 (16.2%)
62 (77.5%)
107 (77.0%)
139 (59.2%)
76 (5.2%)
7 (8.9%)
6 (4.3%)
16 (6.8%)
Fossa
navicularis
(N=217)
Perineum
(N=79)
Hymen
(N=666)
Vagina
(n=188)
Cervix
(N=70)
237 (35.6%)
1 (0.2%)
97 (51.6%)
1 (0.5%)
19 (27.1%)
0 (0.0%)
38 (48.1%)
14 (17.7%)
119 (17.9%)
58 (8.7%)
63 (9.5%)
138 (20.7%)
47 (25.0%)
79 (42.0%)
15 (21.4%)
52 (74.3%)
11 (5.1%)
5 (6.3%)
12 (1.8%)
1 (0.5%)
0 (0.0%)
106 (23.5%)
86 (39.6%)
36 (45.6%)
24 (3.6%)
19 (10.1%)
10 (14.3%)
16 (3.5%)
12 (5.5%)
6 (7.6%)
36 (5.4%)
51 (27.1%)
4 (5.7%)
Table 2. Anal injuries by location
Anal examination
Scratches/abrasions/tears
Bruising
Bleeding
Swelling
Scars from ?assault/funelling/tyre sign
Redness/inflammation
Tenderness/pain
Total (N=371)
30 (8.1%)
10 (2.7%)
2 (0.5%)
11 (3.0%)
9 (2.4%)
16 (4.3%)
3 (0.8%)
Skin around orifice (N=38)
23 (60.5%)
10 (26.3%)
1 (2.6%)
11 (28.9%)
7 (18.4%)
16 (42.1%)
2 (5.3%)
Orifice (N=29)
21 (72.4%)
4 (13.8%)
2 (6.9%)
9 (31.0%)
8 (27.6%)
11 (37.9%)
2 (6.9%)
Sphincter/ Anus (N=16)
9 (56.3%)
3 (18.8%)
0 (0.0%)
3 (18.8%)
3 (18.8%)
7 (43.8%)
2 (12.5%)
Table 3. Absence of genito-anal injuries by factors related to the patient, rape and examination
Absence of genito-anal
Presence of genito-anal
Total
injuries (N=749)
injuries (N=723)
p value
PATIENT INFORMATION
Age (N=1447)
< 18 years
532 (36.8%)
221 (30.0%)
311 (43.9%)
0.000
18 - 44 years
853 (59.0%)
489 (66.3%)
364 (51.3%)
≥ 45 years
62 (4.3%)
28 (3.8%)
34 (4.8%)
Virgin (N=1311)
No
950 (72.5%)
526 (80.4%)
424 (64.5%)
0.000
Yes
361 (27.1%)
128 (19.6%)
233 (35.5%)
Previously pregnant (N=1131)
No
502 (44.4%)
243 (40.5%)
259 (48.8%)
0.004
Yes
629 (55.6%)
357 (59.5%)
272 (51.2%)
Disability (N=1472)
No
Yes
Under influence of drugs or alcohol (N=1114)
No
Yes
RAPE
Length of offence (N=1411)
Less than a day
1 day of more
Multiple perpetrators (N=1437)
No
Yes
Perpetrator victim relationship (N=1414)
Any relative
Curent of ex-partner
Stranger or someone known only slightly/by sight
Some other known person
1447 (98.3%)
25 (1.7%)
734 (98.0%)
15 (2.0%)
713 (98.6%)
10 (1.4%)
1061 (95.2%)
53 (4.8%)
536 (95.4%)
26 (4.6%)
525 (95.1%)
27 (4.9%)
1204 (85.3%)
207 (14.7%)
620 (86.6%)
96 (13.4%)
584 (84.0%)
111 (16.0%)
0.354
0.835
0.224
0.038
1168 (81.3%)
269 (18.7%)
616 (83.6%)
121 (16.4%)
552 (78.9%)
148 (21.1%)
99 (7.0%)
200 (14.1%)
697 (49.3%)
418 (29.6%)
46 (6.4%)
113 (15.6%)
346 (47.9%)
218 (30.2%)
53 (7.7%)
87 (12.6%)
351 (50.8%)
200 (28.9%)
0.320
Perpetrator armed (N=1442)
No
Yes
Victim hurt with weapon (N=517)
No
Yes
Victim threatened (N=1472)
No
Yes
Physical force used (N=1429)
No
Yes
Victim resisted (N=1472)
No
Yes
Number of penetrations (N=1272)
1
>1
EXAMINATION
Time from rape to examination (N=1262)
<2 days
2 - 10 days
Doctor's qualification (N=1223)
Medical degree
Higher than medical degree
917 (63.6%)
525 (36.4%)
448 (61.1%)
285 (38.9%)
469 (55.2%)
240 (33.9%)
0.039
399 (77.2%)
118 (22.8%)
226 (79.6%)
58 (20.4%)
173 (74.3%)
60 (25.8%)
0.116
809 (55.0%)
663 (45.0%)
401 (53.5%)
348 (46.5%)
408 (56.4%)
315 (43.6%)
0.273
557 (39.0%)
872 (61.0%)
273 (37.4%)
457 (62.6%)
284 (40.6%)
415 (59.4%)
0.192
809 (55.0%)
663 (45.0%)
410 (54.7%)
339 (45.3%)
399 (55.2%)
324 (44.8%)
0.857
861 (67.7%)
411 (32.3%)
465 (69.8%)
201 (30.2%)
396 (65.4%)
210 (34.7%)
0.117
1056 (83.7%)
206 (16.3%)
528 (83.5%)
104 (16.5%)
528 (83.8%)
102 (16.2%)
0.899
1072 (87.7%)
151 (12.4%)
562 (91.5%)
52 (8.5%)
510 (83.7%)
99 (16.3%)
0.001
Table 4. Multivariable model to test the factors associated with the absence of genito-anal injuries
Univariate analysis p value Multivariable analysis (N=974)
PATIENT INFORMATION
Age (N=1447)
< 18 years
18 - 44 years
1.9 (1.5 - 2.4)
0.000
1.4 (0.9 - 2.0)
≥ 45 years
1.1 (0.6 - 1.9)
0.835
0.5 (0.2 - 1.1)
Virgin (N=1311)
No
Yes
0.4 (0.3 - 0.6)
0.000
0.4 (0.3 - 0.7)
Previously pregnant (N=1131)
No
Yes
1.4 (1.1 - 1.8)
0.011
Disability (N=1472)
No
Yes
1.5 (0.7 - 3.6)
0.329
Under influence of drugs or alcohol (N=1114)
No
Yes
1.0 (0.5 - 1.8)
0.945
RAPE
Length of offence (N=1411)
Less than a day
1 day of more
0.8 (0.6 - 1.1)
0.182
Multiple perpetrators (N=1437)
No
Yes
0.7 (0.5 - 1.0)
0.022
0.6 (0.4 - 0.9)
Perpetrator victim relationship (N=1414)
Any relative
Current of ex-partner
1.6 (1.0 - 2.7)
0.062
Stranger or someone known only slightly/by sight
1.2 (0.8 - 1.9)
0.356
Some other known person
1.4 (0.9 - 2.2)
0.154
Perpetrator armed (N=1442)
No
1.3 (1.0 - 1.6)
0.042
p value
0.157
0.078
0.000
0.017
Yes
Victim hurt with weapon (N=517)
No
Yes
Victim threatened (N=1472)
No
Yes
Physical force used (N=1429)
No
Yes
Victim resisted (N=1472)
No
Yes
Number of penetrations (N=1272)
1
>1
EXAMINATION
0.7 (0.5 - 1.1)
0.124
1.2 (0.9 - 1.4)
0.192
1.1 (0.9 - 1.4)
0.435
1.0 (0.8 - 1.3)
0.898
0.8 (0.6 - 1.0)
0.035
Time from rape to examination (N=1262)
<2 days
2 - 10 days
1.0 (0.7 - 1.4)
Doctor's qualification (N=1223)
Medical degree
Higher than medical degree
0.6 (0.4 - 0.9)
0.874
1.5 (1.0 - 2.3)
0.035
0.010
0.6 (0.4 - 0.9)
0.020
Table 5. Multivariable model to test the factors associated with the absence of genito-anal injuries in survivors who were virgins
Univariate analysis p value Multivariable analysis (N=275) p value
PATIENT INFORMATION
Age (N=349)
<4 years
4 - 7 years
0.8 (0.3 - 1.8)
0.563
0.5 (0.2 - 1.5)
0.232
8 - 12 years
0.2 (0.1 - 0.6)
0.002
0.2 (0.1 - 0.5)
0.001
13 - 17 years
0.2 (0.1 - 0.6)
0.001
0.2 (0.1 - 0.4)
0.000
18 - 34 years
0.5 (0.2 - 1.6)
0.219
0.3 (0.1 - 1.1)
0.070
35 - 44 years
0.8 (0.0 - 17.4)
0.887
0.7 (0.0 - 15.3)
0.813
Disability (N=361)
No
Yes
2.8 (0.9 - 8.8)
0.083
4.9 (1.2 - 20.1)
0.028
RAPE
Length of offence (N=321)
Less than a day
1 day of more
0.8 (0.4 - 1.6)
0.484
Multiple perpetrators (N=342)
No
Yes
0.8 (0.3 - 1.6)
0.424
Perpetrator victim relationship (N=324)
Any relative
Current of ex-partner
0.3 (0.0 - 1.5)
0.138
Stranger or someone known only slightly/by sight
0.5 (0.2 - 1.0)
0.048
Some other known person
0.9 (0.5 - 1.8)
0.769
Perpetrator armed (N=339)
No
Yes
0.5 (0.3 - 1.0)
0.064
Victim hurt with weapon (N=59)
No
Yes
0.5 (0.1 - 2.4)
0.355
Victim threatened (N=361)
No
0.7 (0.4 - 1.2)
0.202
Yes
Physical force used (N=337)
No
Yes
Victim resisted (N=361)
No
Yes
Number of penetrations (N=274)
1
>1
EXAMINATION
Time from rape to examination (N=281)
<2 days
2 - 10 days
Doctor's qualification (N=310)
Medical degree
Higher than medical degree
0.6 (0.4 - 1.0)
0.057
0.7 (0.5 - 1.2)
0.195
0.9 (0.5 - 1.8)
0.774
1.4 (0.8 - 2.4)
0.244
1.0 (0.5 - 2.0)
0.944
1.3 (0.7 - 2.4)
0.348