Skin Color May Affect Visual Detection of Genital Trauma


BOSTON — The prevalence of genital injuries was significantly higher among white patients than black patients, based on a review of 2,234 women aged 13 years and older who were examined after being raped.

This may be misleading, though, because methods of recognizing these injuries can be ineffectual in black women, said Linda Rossman, M.S.N., of Michigan State University, East Lansing, and her colleagues.

Data from previous studies have shown that direct visualization, contrast media, and colposcopy may be less effective at identifying genital injuries in darker-skinned patients, she said.

“Color awareness may be an important component of the sexual assault forensic examination,” she said in a poster presented at the annual meeting of the American College of Emergency Physicians. The researchers reviewed data from 2,234 consecutive female patients who were referred to a community-based Sexual Assault Nurse Examiner program (SANE) from four urban emergency departments during a 10-year period. In this study, genital injury was defined as any visible tissue trauma that could be categorized using the TEARS classification system (tears, ecchymoses, abrasions, redness, and swelling).

In this community, 83% of the women were white and 17% were black, with similar demographic characteristics, and the details of the assault cases also were similar. Overall, the prevalence of documented anogenital injuries was significantly higher in whites, compared with blacks (64% vs. 54%). The pattern of anogenital injuries was similar in both groups. The injuries typically involved the fossa navicularis, followed by the posterior fourchette, labia, and hymen, the researchers said. In addition, the prevalence of documented nongenital injuries was significantly higher in whites, compared with blacks (39% vs. 26%).

Lacerations were the most common injuries in all patients, but whites had a significantly greater incidence of documented erythema, compared with blacks, the researchers noted.

Disclosures: None was reported.

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