Table 1. Genital injuries by location
Gynaecological
Total
Clitorus
*
examination
(N=1472)
and
frenulum
(N=80)#
Urethral
orifice and
paraurethral
folds
(N=139)#
35 (43.8%)
65 (46.8%)
Labias
majora and
minora(N=
235)#
Posterior
fouchette
(N=451)#
Fossa
navicularis
(N=217)#
Perineum
(N=79)#
Hymen
(N=666)#
Vagina
(n=188)#
Cervix
(N=70)#
Scratches/
535
126 (53.6%) 364 (80.7%)
130 (59.9%) 62 (78.5%)
237 (35.6%) 97 (51.6%) 19 (27.1%)
abrasions/tears
(36.3%)
Cuts
20 (1.4%)
1 (1.3%)
5 (3.6%)
8 (3.4%)
10 (2.2%)
5 (2.3%)
5 (6.3%)
1 (0.2%)
1 (0.5%)
0 (0.0%)
Bruising/
254 32 (40.0%)
48 (34.5%)
75 (31.9%) 140 (31.0%)
100 (22.2%) 38 (48.1%)
119 (17.9%) 47 (25.0%) 15 (21.4%)
haematoma
(17.3%)
Bleeding
145 (9.9%) 14 (17.5%)
22 (15.8%)
29 (12.3%)
57 (12.6%)
15 (6.9%) 14 (17.7%)
58 (8.7%) 79 (42.0%) 52 (74.3%)
Hymenal clefts
63 (9.5%)
Hymen swollen
138 (20.7%)
Scars from
78 (5.3%)
4 (5.0%)
11 (7.9%)
17 (7.2%)
66 (14.6%)
11 (5.1%)
5 (6.3%)
12 (1.8%)
1 (0.5%)
0 (0.0%)
?assault
Redness/
238 62 (77.5%) 107 (77.0%) 139 (59.2%) 106 (23.5%)
86 (39.6%) 36 (45.6%)
24 (3.6%) 19 (10.1%) 10 (14.3%)
inflammation
(16.2%)
Tenderness/
76 (5.2%)
7 (8.9%)
6 (4.3%)
16 (6.8%)
16 (3.5%)
12 (5.5%)
6 (7.6%)
36 (5.4%) 51 (27.1%)
4 (5.7%)
pain
*
Total sample size includes all patients who underwent a gynecological examination
#
Total number of patients who had injuries recorded at a specific site, for which type of injuries are presented in the rows. Patients could have injuries at
more than one site, and could have more than one type of injury per site. Each cell in the table represents the proportion of patients who had injuries
reported of a specific type at a specific site.
Table 2. Anal injuries by location*
Anal examination
Total (N=371)
Skin around orifice (N=38)
Orifice (N=29)
Sphincter/ Anus (N=16)
Scratches/abrasions/tears
30 (8.1%)
23 (60.5%)
21 (72.4%)
9 (56.3%)
Bruising
10 (2.7%)
10 (26.3%)
4 (13.8%)
3 (18.8%)
Bleeding
2 (0.5%)
1 (2.6%)
2 (6.9%)
0 (0.0%)
$
Swelling/tyre sign
13 (3.5%)
13 (34.2%)
11 (35.5%)
3 (18.8%)
^
Scars from ?assault/funelling
7 (1.9%)
5 (13.2%)
6 (20.7%)
3 (18.8%)
Redness/inflammation
16 (4.3%)
16 (42.1%)
11 (37.9%)
7 (43.8%)
Tenderness/pain
3 (0.8%)
2 (5.3%)
2 (6.9%)
2 (12.5%)
*
Total sample size includes all patients who underwent an anal examination
#
Total number of patients who had injuries recorded at a specific site, for which type of injuries are presented in the rows. Patients could have injuries at
more than one site, and could have more than one type of injury per site. Each cell in the table represents the proportion of patients who had injuries
reported of a specific type at a specific site.
$
Perianal swelling in the form of a ring.
^
Relaxation of the external anal sphincter but not of the internal anal sphincter which results in a funnel-like appearance of the anus on physical
examination. Appears with repeated abuse.
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 time perpetrator detained victim
(N=1411)
Less than a day
1 day of more
Multiple perpetrators (N=1437)
No
Yes
Perpetrator victim relationship (N=1414)
Any relative
Curent or ex-partner
Stranger or someone known only slightly/by sight
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%)
0.354
0.835
0.224
1204 (85.3%)
207 (14.7%)
620 (86.6%)
96 (13.4%)
584 (84.0%)
111 (16.0%)
1168 (81.3%)
269 (18.7%)
99 (7.0%)
200 (14.1%)
697 (49.3%)
418 (29.6%)
616 (83.6%)
121 (16.4%)
46 (6.4%)
113 (15.6%)
346 (47.9%)
218 (30.2%)
552 (78.9%)
148 (21.1%)
53 (7.7%)
87 (12.6%)
351 (50.8%)
200 (28.9%)
0.038
0.320
Some other known person
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)
OR (95% CI)
OR (95% CI)
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 time perpetrator detained victim
(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
1.6 (1.0 - 2.7)
0.062
Current or ex-partner
1.2 (0.8 - 1.9)
0.356
Stranger or someone known only slightly/by sight
1.4 (0.9 - 2.2)
0.154
p value
0.157
0.078
0.000
0.017
Some other known person
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
1.3 (1.0 - 1.6)
0.042
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)
0.874
1.5 (1.0 - 2.3)
0.035
Doctor's qualification (N=1223)
Medical degree
Higher than medical degree
0.6 (0.4 - 0.9)
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
OR (95% CI)
OR (95% CI)
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 time perpetrator detained victim
(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 or 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
Victim threatened (N=361)
No
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
0.5 (0.1 - 2.4)
0.355
0.7 (0.4 - 1.2)
0.202
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