Physical injury in men after sexual assault: An analysis of 137 cases

Background: Data on the prevalence of physical injury in men who experience sexual assault are under-represented in the literature; the aim of this study is to inform this knowledge gap. It is vital that forensic examiners have access to up-to-date information regarding the prevalence of genito-anal and extra-genital injury, specific to their examination method (i.e. with or without proctoscopy), as well as any associations with injury in order to provide optimal responsive care and accurate testimony in the context of written and oral evidence.

Methods: This is a cross-sectional study analysing the attendances of all males who attended the Dublin Sexual Assault Treatment Unit (SATU) for a forensic examination between 1/1/2017 and 31/12/2023.

Results: During the study period there were 2495 attendances. Of these, 199 (8.0 %) were male, with 68.8 % (n = 137/199) undergoing a forensic examination. Within this cohort, genito-anal injury was identified in 19.7 % (n = 27/137). Anal injury was present in 14.6 % (n = 20/137) and genital injury was present in 5.8 % (n = 8/137). For those who disclosed completed anal penetration (either penile-anal, digital-anal penetration or object-anal penetration) and who underwent proctoscopic examination (n = 53) the injury rate was 24.5 % (n = 13/53). Extra-genital injuries were present in 40.1 % (n = 55/137). Those who had a genito-anal injury were significantly more likely to have been the victim of a multiple perpetrator assault (OR2.72 CI1.05-6.97 p = 0.03). Those who had extra-genital injuries were significantly more likely to have attended within 24 hours of the incident (OR2.89 CI1.03-4.22 p = 0.03). No other incident detail was found to have an association with the presence of genito-anal or extra-genital injury.

Conclusions: Genital injuries and/or anal injuries were absent in a large proportion of men after sexual assault. Extra-genital injuries were found in a higher proportion of men. It is anticipated that these findings will better inform society, the police and also assist forensic examiners in providing accurate and informed prevalence rates for medico-legal evidence in the criminal justice system. These findings also underscore the importance of comprehensive medical examinations and timely medical intervention for assault victims, highlighting the need for targeted support and care strategies.