A Retrospective Study on Presentation, Patterns, and the Prevalence of Injuries in Alleged Sexual Assault Cases, Presented to District General Hospital Gampaha from July 2018 to April 2019

Introduction: Sexual abuse is an undesired sexual behavior by one person upon another. In Sri Lanka, all sexual abuse cases are expected to be examined by a medico-legal specialist before the court procedure. This study was conducted to identify the presentation, pattern, and prevalence of injuries among the sexual abuse victims presented to District General Hospital Gampaha. The findings of this study will help to improve the knowledge on different variables that can influence or affect the medico-legal opinion, and the management of victims including prevention.

 

Methodology: A retrospective descriptive study was conducted using medico-legal records of all the cases with alleged sexual abuse reported to DGH Gampaha, during the 10 months from July 2018 to April 2019.  Data were analyzed using   Statistical Package for Social Sciences (SPSS) version 26 with descriptive statistics. Bivariate analysis and multiple logistic regression model used where necessary. 

 

Results: A total of 103 alleged sexual assault cases were assessed with 85% females, and remaining 15% were male victims. The median age of victims was 15years. Almost all the perpetrators were males and the mean age is 31 years. There was 92% probability of an abuser become a known person or a relative of the victim. Ten percent (10%) (n=10) of victims sustained non-genital injuries following a sexual assault with injuries in more than one site and 11 % (n=11) victims had genital injuries. About 40% (n=40) of victims gave a history of repeated abuse with no statistically significant difference among the genders (chi-square =2.6, p = 0.105>0.05). On multiple logistics regression, those who had a history of repeated abuse and who became pregnant following the abuse were significantly associated with the length of time to reporting (Exp (B) = 3.082; 95% CI, 1.224 - 7.76; p-value = 0.017<0.05 and (Exp (B) = 17.066; 95% CI, 2.001 -145 .56, p-value =0.009<0.05) respectively). Sexually assaulted unmarried females have a 13% (95% Confidence interval, 06% - 22%) chance of getting pregnant.

 

Conclusion: Female sex, and less than 16 years of age, is the most vulnerable group. Early adolescents had comparatively higher genital injury prevalence. Also, the genital injury prevalence was almost four-fold among the victims that presented to the medicolegal examination within one week or less. All the victims, who had anal/perianal injuries, were less than 15-year-old males. History of repeated abuse and presence of pregnancy was significantly associated with the duration of time to report to the hospital.  13% of sexually assaulted unmarried females being presented with pregnancy, is an alarming finding and needs evaluation with further studies.