Genital lacerations following sexual assault and consensual sexual intercourse: A systematic review and meta-analysis

The identification of genital injuries during a medical-forensic examination may impact the investigation and prosecution of sexual assault. The purpose of this meta-analysis was to compare prevalence of genital lacerations (or tears) in persons reporting consensual versus non-consensual vaginal penetration. We hypothesized there would be greater prevalence of genital injuries in the non-consensual group. We searched PubMed, CINAHL, Web of Science, and gray literature for relevant observational case-control studies. Relative risk (RR) ratios using Mantel-Haenszel method were calculated to compare prevalence of genital lacerations between patients reporting consensual versus non-consensual penetration. Mantel-Haenszel chi-square tested significance and Cochran's Q determined between-study heterogeneity. In all studies, genital injuries were observed in both groups. The overall RR of 1.26 indicated a 26% greater risk of genital lacerations in the non-consensual group compared to the consensual group (p = 0.003). Study heterogeneity was 54% (p = 0.05). Findings suggest a greater likelihood of observing genital lacerations in persons reporting non-consensual vaginal penetration. High heterogeneity reflects variations between studies regarding provider education and training, visualization techniques, patient characteristics, time between assault and examination, and documentation practices. A major limitation is the lack of observer blinding creating potential bias. Findings support the need to standardize genital visualization techniques and documentation in sexual assault medical forensic examinations. Healthcare providers conducting medical forensic examinations must understand the limitations of studies comparing non-consensual and consensual injury findings if asked to provide information or testimony on this topic.