title: Health disparities in the forensic sexual assault examination related to skin color.
abstract: Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.
authors: University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA. ssommer@nursing.upenn.edu
authors: Marilyn S
authors: MS
authors: Sommers
authors: Jamison D
authors: JD
authors: Fargo
authors: Rachel B
authors: RB
authors: Baker
authors: Bonnie S
authors: BS
authors: Fisher
authors: Carol
authors: C
authors: Buschur
authors: Therese M
authors: TM
authors: Zink
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000293:injuries / Q000473:pathology; D044383:Black People; D003124:Colorimetry; D004396:Coloring Agents; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D053604:Forensic Nursing; D005836:Genitalia, Female / Q000293:injuries / Q000473:pathology; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination; D011902:Rape; D012880:Skin Pigmentation; D014048:Tolonium Chloride; D044465:White People
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride