Comparison of Injury Patterns in Consensual and Nonconsensual Sex: Is It Possible to Determine if Consent was Given?

Abstract

Matters of sexual consent and sexual assault are hotly debated issues among professionals and laypersons alike. A widespread misconception of sexual assault is that most victims of sexual assault sustain significant physical trauma. It is the purpose of this review article to compare the patterns of physical injury (both genital and extragenital) in victims of sexual assault and participants of consensual sex to conclude if physical injury alone can indicate whether consent was given. Interpretations of injury have great forensic significance as it can influence the outcome of sexual assault cases. Several articles indicate that extragenital injuries are commonly found in sexual assault victims (46%-82%) and that most of such injuries are deemed minor. Articles report a wide range of genital injury detection rates in both sexual assault victims (6%-87%) and consensual sex participants (6%-73%). Usage of different examination techniques may partly explain the wide range of detection rates reported. Out of all those who sustained genital injuries, only a small portion of people required hospitalization. In both consensual and sexual assault cases, genital injuries in the 6 o'clock position were most common. Studies of genital injury lacked standardization of factors that significantly influence the results, such as time to examination after sex, examination techniques, and injury severity scales. Therefore, medicolegal personnel should be aware that sexual assault victims can present with a wide range of physical trauma and should avoid relying on physical trauma alone to conclude whether consent was present.

Keywords: Consent; Forensic pathology; Sex offense; Wounds and injuries.

Figure 1

This bar graph illustrates the rates of genital injury detection in nonconsensual sex reported by authors using different examination techniques. A general trend that can be observed is that the range of rates are wide regardless of examination technique used, and that studies which utilized enhancing examination techniques (colposcopy and toluidine blue dye) had greater rates of minor genital injury detection. It is important to note that the individual bars are not weighted by the corresponding sample number, so caution is needed in interpretation. *Astrup et al. reported different rates of genital injury detection for each of the three (visual, colposcopy, and toluidine blue staining) examination methods (43), thus rates from the same study sample are represented multiple times in this graph.

Figure 2

This bar graph illustrates the rates of genital injury detection in consensual sex reported by authors using different examination techniques. Similar to studies involving sexual assault, studies involving consensual sex which utilized enhancing examination techniques (colposcopy and toluidine blue dye) had greater rates of detection of minor genital injuries compared to visual gross examination. Most studies from the literature that reported the rates of genital injury detection in consensual sex used either colposcopy, toluidine blue staining, or a combination of both methods during examination. It is important to note that the individual bars are not weighted by the corresponding sample number, and caution is needed when interpreting the graph. *Astrup et al. reported different rates of genital injury detection for each of the three (visual, colposcopy, and toluidine blue staining) examination methods (45), thus rates from the same study sample are represented multiple times in this graph.