Nurses—Making a Difference in Global Health

Nurse Stories:  Promote gender equality

Justice not always blind

Female victims of sexual assault who have dark skin are less likely than females with light skin to have their injuries identified, documented and treated, leaving them disadvantaged in both the health care and criminal justice system, according to a study published in the November issue of The American Journal of Emergency Medicine.

According to the National Crime Victimization Survey, the rate of rape and sexual assault cases is higher among black women than white women. One of the main reasons women do not report sexual victimization is “lack of [physical] proof” that an incident occurred.

“This finding is novel and important with respect both to clinical assessment and the decisions made within the criminal justice process,” said Marilyn “Lynn” Sawyer Sommers, PhD, RN, FAAN, principal investigator of the study. Sommers is the Lillian S. Brunner Professor of Medical-Surgical Nursing at the University of Pennsylvania School of Nursing.

In her study, in which 120 volunteers—black and white—underwent a forensic examination after consensual sexual intercourse, Sommers found:

55 percent of the sample suffered at least one post-sex external genital injury (such as a tear, abrasion, redness or swelling) with injuries identified 68 percent of the time in white women but only 43 percent of the time in black women.

Significant disparities were only evident for external genitalia (as opposed to the internal genitalia or anus).

Nearly three times the number of injuries to external genitalia was identified in white women.

The effects of race or ethnicity on injury detection became insignificant when skin color values were added to a model that predicts occurrence of external genitalia injury, thus demonstrating the spurious relationship between race or ethnicity and injury prevalence.

“The novel findings from this study have clinical ramifications for those performing forensic sexual assault exams,” said Sommers. “Practitioners need to increase their vigilance when examining individuals with dark skin to ensure all injuries are identified, treated and documented.”

RNL - Reflections on Nursing Leadership - Published 2/23/2009 , Vol. 35 No. 1