Anogenital injuries in adolescents after consensual sexual intercourse

Objectives: To compare the types and locations of anogenital injuries occurring in adolescent females (13-17 years old) after consensual and nonconsensual sexual intercourse. Methods: The authors conducted a retrospective, matched case-control study to assess anogenital injuries in female adolescents presenting to a free-standing nurse examiner clinic during a four-year study period. Adolescents were selected for inclusion in the study if they reported consensual sexual intercourse (CSI) and agreed to a medical-legal examination. Control subjects were victims of alleged sexual assault or nonconsensual sexual intercourse (NCSI) matched to cases by age and prior sexual intercourse experience. Genital trauma was documented using colposcopy with nuclear staining and digital photography. Data were analyzed using chi-square and t-tests. Results: Fifty-one cases of CSI were identified; the age range was 13 to 17 years (mean = 15.1 years). Overall, 49% (25/51) of CSI subjects reported no prior sexual intercourse experience. CSI and NCSI were comparable in terms of race, time to physical examination, alcohol use, and frequency of genital injuries (73% vs. 85%, p = 0.069). The mean number of documented anogenital injuries in CSI subjects was 1.9 +/- 1.5. These injuries commonly involved the hymen, fossa navicularis, and posterior fourchette. CSI subjects had a greater number of anogenital injuries (2.6 +/- 2.0; p = 0.02), typically involving the fossa navicularis, labia minora, and hymen. The most common type of injury in both groups was lacerations (39% vs. 41%); however, NCSI subjects had a greater incidence of anogenital abrasions, ecchymosis, and edema (chi(2) = 10.4, p = 0.035). Conclusions: Anogenital trauma was documented in 73% of adolescent females after consensual sexual intercourse versus 85% of victims of sexual assault. The localized pattern and severity of anogenital injuries were significantly different when compared with victims of sexual assault.