The current standard of care in forensic exams of sexually assaulted patients is to use a 1% aqueous solution of toluidine blue dye to highlight areas of unhealed trauma on the external genitalia. This technique is highly effective in light skinned women, but less so in women of color, resulting in unequal adjudication of cases. The purpose of this project was to evaluate the effectiveness of a fluorescein sodium dye in non-white women which could potentially eliminate racial disparity in the detection of injury during forensic exams of sexually assaulted patients.
The researcher conducted a one-group feasibility trial using a posttest only design. Eligible women who had engaged in consensual vaginal intercourse with a male partner were recruited to undergo an external examination within 48 hours of intercourse.
Examinations were conducted in a private examination room. A tristimulus colorimeter was used to document the womens' constitutive skin color. The study participants' external genitalia were examined and a photograph taken while the examiner used gentle traction to allow visualization of all of the structures. A close-up photograph was taken if any injuries were noted on gross examination. Fluorescein sodium was placed on the external genitalia and then removed with dry gauze. The room lights were dimmed and ultraviolet light (nm 540) was used to allow visualization of injuries stained with fluorescein sodium, if present, and a photograph was taken. For certain study participants who consented (later in the trial) four standard sterile cotton swabs were inserted into the vagina to collect a sample for DNA analysis. Once the participant was clothed, a buccal swab was obtained for DNA analysis for those consented to DNA collection.
A repeat visit approximately 48 hours later was scheduled for all participants. In this follow-up visit, the participant was again examined to determine if any irritation was noted and if injuries present on the first visit had healed. No dye was placed. Patients were also asked if they had experienced any discomfort (itching, burning or other irritation) since the study visit. In addition, participants were called at a later date and asked if they had experienced any discomfort in the two weeks post exam. Participants were paid a total of $50 each.
Convenience sampling was used to recruit the study participants. Recruitment occurred by flyer, emails, and webpages. Women interested in participating contacted the researcher, who explained the study, screened for eligibility, and provided a copy of the consent form through email. Eligible women were non-white (Asian, African American or other races), had no serious health problems, were engaging in consensual intercourse with a man, were having periods regularly (or would be if they were not using birth control that suppressed menstruation) and were not pregnant. Participants contacted the researcher after having intercourse to schedule an examination. Altogether, 44 participants were recruited in 2015 and 2106.
Non-white women aged 18-45 who had penetrative intercourse with a male partner.
The data file contains 15 variables: participant ID, participant age, date and time of intercourse (two variables), date and time of exam 1 (two variables), time between intercourse and exam 1, date and time of exam 2 (two variables), skin color (CIELAB L value), type and location of injury (two variables) and whether injury was visualized with gross exam, digital photography or dye (three variables).
All women in the sample participated in the study.