Skin color plays a distinct role in the detection of and perhaps the protection from skin injury in sexual assault. We have found significant differences in ano-genital injury prevalence in Black and White females after consensual sexual intercourse and sexual assault that can be more fully explained by skin color than by race/ethnicity. Little is known about the generalizability of this phenomenon to the largest minority population in the US: Latinos. While major developments in the empirical basis of DNA and toxicology samples have occurred in the past 20 years, the development of empirically-based science in the context of sexual assault has not occurred with respect to injuries. We are proposing to study ano-genital injury prospectively through digital image analysis in 200 Latinas in the U.S. and Puerto Rico following consensual sexual intercourse, and compare their injuries to those documented in medical records of 200 Latinas following sexual assault. We will combine these data with a sample of predominantly Black and White women (n=800) and analyze approximately 36,000 digital images from consensual participants and records of sexual assault victims (N=1,200) to achieve the following aims: 1) determine prevalence, frequency, and severity of intercourse- related ano-genital injuries in consensual participants and sexual assault victims;2) determine if sexual assault victims have more discrete digital image characteristics than women who have had consensual sexual intercourse (e.g., larger area of injury, better-defined shape, more localized location, texture more distinct from adjacent areas, more redness than adjacent areas);3) determine if previously reported differences in the prevalence, frequency, and severity of intercourse-related ano-genital injury between racial/ethnic groups will be accounted for by quantification of skin color;4) investigate if ano-genital injuries significantly vary as a function of skin mechanics (skin elasticity and skin hydration) and factors that could potentially determine the overall health of epidermal tissue (age, body mass index, sun exposure, and health status);5) identify the constellation of ano-genital injury type and location, socio-demographic, and intercourse-related variables that most effectively differentiates those who experienced consensual intercourse versus sexual assault.

Public Health Relevance

Forensic documentation of ano-genital injuries influences decision-making throughout the criminal justice process, especially at pivotal gate-keeping stages from victim reporting to sentencing. The forensic exam used to collect evidence after rape needs to be equally sensitive for females with dark skin as well as females with light skin.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-HDM-A (02))
Program Officer
Aziz, Noreen M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Other Health Professions
Schools of Nursing
United States
Zip Code
Brawner, Bridgette M; Sommers, Marilyn S; Moore, Kendra et al. (2016) Exploring Genitoanal Injury and HIV Risk Among Women: Menstrual Phase, Hormonal Birth Control, and Injury Frequency and Prevalence. J Acquir Immune Defic Syndr 71:207-12
Beacham, Barbara L; Deatrick, Janet A (2015) Children with chronic conditions: perspectives on condition management. J Pediatr Nurs 30:25-35
Everett, Janine S; Sommers, Marilyn S (2013) Skin viscoelasticity: physiologic mechanisms, measurement issues, and application to nursing science. Biol Res Nurs 15:338-46
Fisher, Bonnie Sue; Kaplan, Alyssa; Budescu, Mia et al. (2013) The influence of anogenital injury on women's willingness to engage with the criminal justice process after rape. Violence Vict 28:968-83
Sommers, Marilyn; Beacham, Barbara; Baker, Rachel et al. (2013) Intra- and inter-rater reliability of digital image analysis for skin color measurement. Skin Res Technol 19:484-91
Everett, Janine S; Budescu, Mia; Sommers, Marilyn S (2012) Making sense of skin color in clinical care. Clin Nurs Res 21:495-516
Sommers, Marilyn S; Brown, Kathleen M; Buschur, Carole et al. (2012) Injuries from intimate partner and sexual violence: Significance and classification systems. J Forensic Leg Med 19:250-63