title: Assailants' sexual dysfunction during rape: prevalence and relationship to genital trauma in female victims.
abstract: BACKGROUND
  Partial or complete failure to maintain an erection sufficient for coitus is known to occur in a proportion of sexual assailants during the rape episode.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether the presence of coercion, physical violence, and genital injury associated with sexual assaults is influenced by the assailant's erectile impotence.
  
  
  METHODS
  This prospective, observational study evaluated consecutive female patients presenting to a free-standing urban sexual assault clinic during a 3-year study period. Sexual assault victims presenting directly to four downtown emergency departments (EDs) are routinely referred to the clinic for evaluation after triage and initial assessment. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medical-legal examinations. The primary outcome was to compare the frequency of anogenital findings documented in women whose assailant experienced no erectile dysfunction vs. those victims who reported erectile impotence in the assailant.
  
  
  RESULTS
  During the study period, 569 sexual assault victims were eligible to participate in the study; 47 (8.3%) reported that their assailants had experienced erectile impotence. Except for assailant age, the two victim groups were comparable in terms of marital status, alcohol and drug use, known assailant, and time to physical examination. In attacks where erectile dysfunction occurred, there was a higher incidence of physical coercion (60% vs. 32% without physical coercion, p < 0.001) and subsequent non-genital trauma (72% vs. 46%, respectively, p < 0.001). Thirty-two women (68%) had documented anogenital trauma despite the assailant having erectile dysfunction. There was no significant difference in the overall pattern of anogenital injury between the two groups (chi(2) = 9.1, p = 0.036).
  
  
  CONCLUSIONS
  Erectile impotence occurred in up to 8% of sexual assailants during the rape episode. Despite this erectile dysfunction, the majority of sexual assault victims sustained anogenital trauma. In the attacks with erectile impotence, there was a higher incidence of intra-rape violence and subsequent non-genital injuries.
authors.affiliation: Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Spectrum Health Hospital - Butterworth Campus, Grand Rapids, Michigan 49503-2560, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.forename: Linda
authors.initials: L
authors.lastname: Rossman
authors.forename: Barbara N
authors.initials: BN
authors.lastname: Wynn
authors.forename: Herald
authors.initials: H
authors.lastname: Ostovar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000293:injuries*; D004636:Emergency Service, Hospital; D007172:Erectile Dysfunction / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005836:Genitalia, Female / Q000293:injuries*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011902:Rape; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult