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. He Posted this on September 2019


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 victims 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 can 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 are 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.

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.

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.
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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