Injuries/Wounds
ASSOCIATED WITH SEXUAL ASSAULT AND RAPE
This information is way too important to be lost. I am saving it by putting it on this website. I am afraid the original website will delete it.
Albino Gomes is a Forensic Nurse Examiner who posted this on September 2019 albinomanuelgomes @ gmail.com
Introduction
Every rape or sexual assault is different. The victims, perpetrators, occurrences, reactions, injuries, and every other detail are all unique to each situation. For this reason, it is hard for anyone to make a standard protocol for dealing with a victim of rape or sexual assault. Therefore, rather than have a standard protocol, it may be better to make every examiner aware of trends and know to look for anything that is suspicious, whether it is a trend or not. Each aspect named above has trends that a nurse examiner should be aware of. For example, there are a number of reactions that victims experience that appear in many cases. Because these reactions occur more often than others, it is vital for an examiner to be aware of these reactions and how to deal with them. But it is also important that examiners keep open minds to any kind of reaction, so they do not find themselves stumped when they are faced with an uncommon reaction. This same theory applies to any of the aspects above and throughout nursing in general. It may be wrong to say that any wound or injury is common for a sexual assault or rape victim to experience, but there are many kinds of wounds that are important for a nurse examiner to look for because they occur more often. If a victim has any of these wounds or other less common ones, it will be critical to document and collect evidence from them to provide a more thorough investigation. Although not all sexual assault or rape victims have physical injuries, it is important for nurse examiners to be aware of many common wounds that are associated with sexual assault and rape, so they can more easily recognize them.
When dealing with a sexual assault or rape victim, documenting injuries may not seem to be the first and most important thing to do to start to help the victim, especially since many victims appear not to be physically harmed. According to the National Violence Against Women Prevention Research Center (2000), 43.9% of victims sustained no physical injuries. However, if the victim is not examined in a timely fashion and in a thorough manner, important evidence could be lost. Often when the population thinks about rape injuries they think of injuries to the genital area. Other injuries that may be found in a larger amount of victims are injuries to the breasts, upper inner thighs, buttocks, back, head, neck, patterned injuries, and defensive injuries. Genital injuries are the first to come to mind but are often the hardest to find and document. They are hard to find because they can be so small that it sometimes takes magnification to find them, and they heal very rapidly. They are hard to document because they are so small and in such a sensitive area of the body. Today we have many tools that an examiner can use to assist them in this process. Two tools that are used in examining and documenting genitals are a magnifying unit that often has a video or still camera attached to it called a colposcope, and a dye that makes open wounds more visible called toluidine blue. “The colposcope…magnifies an area over 30 times the actual size, permitting detection of bruises, tears, or abrasions not visible to the naked eye” (Hazelwood & Burgess, 2001). Although it is very important to examine the complete genital area, there are some common sights for injury. The posterior fourchette of the vaginal area is a common site for injury when vaginal penetration has occurred, and the anus and external sphincter are common sites for injury if anal penetration has occurred. Harriette L. Hampton, (1995), reports “(genital) injuries are (usually) upper vaginal lacerations that present with profuse vaginal bleeding and pain”. A large importance may be placed on documenting genital injuries because often it can assist in proving whether penetration occurred or not. Most state laws deal with the issue of penetration, for example, Colorado laws state, “Sexual penetration” means sexual intercourse, cunnilingus, fellatio, analingus, or anal intercourse…Any penetration, however slight, is sufficient to complete the crime.”
Besides the genitals, there are some other specific areas of the body that are often injured in sexual assaults and rapes. Because of the nature of the crime and the weapon used (sex), the other more intimate parts of the body are also areas that often experience force. Injuries are often found on the breasts of women who are sexual assault or rape victims. The breasts are usually a sensitive place on a woman’s body, so a victim will often experience significant pain in the breasts as a result of being fondled, bitten, hit, or any other method of force in a violent manner. The buttocks are also an area that may experience injury. It may be slapped, grabbed, or experience any other kind of touch that is hurtful or violent. Other than the genitals, these two body parts are the next commonly thought of places to experience injury this is because they are both areas of the body that are associated with sex.
The back, thighs, neck, wrists, and ankles are also locations to be aware of injuries. Oftentimes, a victim experiences injuries in these areas, due to the perpetrator using force to restrain the victim. When doing an examination the forensic nurse examiner should identify edema, ecchymoses, abrasions, and lacerations on the face, neck, upper torso, buttocks, and extremities. The perpetrator may push the victim’s back and cause injury, or push the victim onto something, or use a weapon such as a whip on the victim’s back. Often, if anal penetration occurred or was attempted, the back side of a victim’s body will be more injured as a result of that being the more accessible side of the victim to the perpetrator. The thighs are often injured because they are used for the victim’s defense. For women more than men, but also men; even if the victim is overpowered by the perpetrator, they often try to keep their inner thighs together to prevent the perpetrator from getting to their target. The neck is one of the most vulnerable parts of the body. Serious injury can occur from just a small amount of force on the neck. Often, injuries to the neck are the result of being grabbed or strangled with the perpetrator’s hand or a foreign object. In cases like this, it is important to document the injury correctly. A common mistake is to think of that as choking, but choking is blocking the airway. Instead, it should be considered strangling, which is defined as “to compress the trachea so as to prevent the sufficient passage of air”. The wrists and ankles are often violently grabbed or tied up with a foreign object, to restrain the victim. It is important to document these injuries and even ask the victim if he or she was tied up or grabbed, so the subjective and objective data can be correlated.
Often, when a victim is forcefully grabbed, tied up, or experiences force from any foreign object, a patterned wound will be created. A patterned wound is an injury that reflects an impression of a cretin weapon (Gomes, 2014). Patterned wounds are often very beneficial to a court case because they may prove a victim’s story. Patterned wounds may identify the location of an assault, a weapon used in the assault, or even the perpetrator themselves. Patterned wounds that may define location could be wounds that have specific patterns from an object at the location. An example of a patterned wound that may define a location may be a stove burner. A burn from a coil stovetop can often be recognized and this could be evidence that the victim was at some point in the kitchen, if not assaulted in the kitchen. There are a very large number of patterned wounds that can identify a weapon. If a gun is forced against someone’s body it may leave an impression or even a bruise that could be matched to a gun barrel. If a whip was used, it could leave two parallel lines across the body called “railroad tracks”. If a victim was tied up with rope, there may be indentations of the rope braids around the victim’s body. Some of the most crucial wounds are patterned wounds that may identify the perpetrator. The classic example of this is a bite mark. “Bite mark identification is based on the individuality of a dentition, which is used to match a bite mark to a suspected perpetrator” (Thali, 2003) Often bite marks are not identified or overlooked. But by properly photo-documenting a bite wound and swabbing for DNA around it, an examiner provides two identifying pieces of evidence to the investigation. It is important to document all injuries and report them. But with patterned wounds, it could even be necessary to immediately report the findings to the investigator because it will assist them in finding the location, weapon, or suspect.
The last category of major wounds or injuries to be aware of is defensive wounds. The most common kind of defensive wound is located on the posterior side of the forearm. Injuries occur here as a result of victims trying to protect their heads or bodies by raising their hands and arms in front of them (Gomes, 2014). It is understandable that almost any wound located on the posterior side of the forearm is a defensive wound because it does not seem practical that an attacker would meaningfully aim at a person’s forearm. Another telltale sign of taking defensive is broken fingernails. It is easy to break a fingernail, especially when someone is using force to escape or get away and not thinking about their nails. Other defensive wounds to look for may be scratches on the neck. If there was anything around the victim’s neck, they may have scratched themselves in the process of trying to escape. During the examination, it is appropriate for the nurse examiner to ask the victim if they attempted to get away or block the attacker and to carefully examine the forearms, fingernails, and other areas for defensive wounds. Documenting defensive sounds is extremely important because they can prove force was used toward the victim. Defensive wounds do not have to be present though, to prove force was used. There are a number of reasons why victims may not have defensive wounds. The victim may know the attacker or perpetrator of the rape, and therefore not feel it is appropriate to violently ward off the assaulter. Victims who become stiff or pass out may not be able to defend themselves and would be less likely to sustain a defensive wound.
Conclusion
The nurse examiner needs to be thoroughly familiar with all of the types of injuries that have a recurring trend in sexual assault and rape cases. But every rape or sexual assault is unique. So it is also crucial for the examiner to be aware of the less common injuries, in order to find and properly document evidence that may be critical in the victim’s legal case.
References
1. Colorado Statutes: Title 18 Criminal Code: Article 3 Offenses Against the
Person: Part 4 Unlawful Sexual Behavior: 18-3-401. Definitions.
2. Dean G. Kilpatrick, Ph.D. Rape and Sexual Assault. National Violence Against
Women Prevention Research Center. (2000).
3. Gomes, A. Enfermagem forense. Vol. 1. Lidel: 2014. Lisboa
4. Harriette L. Hampton, M.D., “Care of the Woman Who Has Been Raped.” The
New England Journal of Medicine 332 (1995): 234-237.
5. Hazelwood, Robert R., Burgess, Ann Wolbert. Ed. Practical Aspects of Rape
Investigation. CRC Press LLC, 2001.
6. Koss, Mary, Harvey, Mary. The Rape Victim Clinical and Community
Approaches to Treatment. Ed. James Butcher. NewYork: The stehen Greene Press, Inc.
1987.
7. Thali, M.J. “Bite mark documentation and analysis: the forensic 3D/CAD
supported photogrammetry approach.” Forensic Science International 135.2 (2003):115.
EBSCO Host Research Database. University of Colorado Colo Springs, CO. 1 Sept. 2005.
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