title: Comparison of methods for identifying ano-genital injury after consensual intercourse.
abstract: BACKGROUND
  Microtrauma occurs after consensual intercourse. Understanding the injury pattern from consensual intercourse may enlighten our understanding of the ano-genital injury after sexual assault.
  
  
  OBJECTIVE
  The purpose of this report is to compare consensual intercourse-related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy, and 3) toluidine-blue contrast application.
  
  
  METHODS
  Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling).
  
  
  RESULTS
  Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p < 0.05). More tears were identified on the anus with toluidine-blue as compared to direct visualization (p < 0.05), but not colposcopy. Fewer ecchymoses were identified on the internal genitalia and fewer areas of redness were identified on both the external and internal genitalia when toluidine-blue was used, as compared to either direct visualization or colposcopy (p < 0.05).
  
  
  CONCLUSIONS
  The scientific community needs to continue to build information about ano-genital injury prevalence after consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic examination. It is the health care provider's role to collect all possible evidence and the courts' role to determine what evidence is admissible and to ensure a rightful conviction.
authors.affiliation: Department of Family and Community Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Therese
authors.initials: T
authors.lastname: Zink
authors.forename: Jamison D
authors.initials: JD
authors.lastname: Fargo
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Baker
authors.forename: Carol
authors.initials: C
authors.lastname: Buschur
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Fisher
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Sommers
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000293:injuries*; D003075:Coitus; D004396:Coloring Agents; D003127:Colposcopy; D005260:Female; D005836:Genitalia, Female / Q000293:injuries*; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination; D014048:Tolonium Chloride; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride