ORIGINAL ARTICLE

Characteristics of sex-related homicides in Alaska

Tara Henry, MSN, FNP-C, SANE-A, SANE-P
Forensic Nurse Services, Anchorage, AK

Keywords Abstract
Femicide; forensic nursing; homicide; sexual
assault. The identification and interpretation of anogenital findings postmortem is a
critical component of a sex-related homicide investigation. The use of a col-
Correspondence
poscope to assist in identifying anogenital injuries in living sexual assault vic-
Tara Henry, MSN, FNP-C, SANE-A, SANE-P,
Forensic Nurse Services, 16372 Sandpiper
tims is well established. The use of a colposcope for postmortem anogenital
Drive, Anchorage, AK 99516. examination has been briefly mentioned in a few publications, however, no
Tel: 907-227-6654; studies were found regarding the types and sites of postmortem anogenital
E-mail: thenry@alaska.net injuries identified with a colposcope in sex-related homicide cases. The pur-
pose of this study was to describe the demographic, physical examination, and
Received: April 29, 2009; accepted: July 8, 2009 victim-suspect relationship characteristics of sex-related homicides in Alaska.
Genital findings in living and deceased sexual assault victims in Alaska were
doi: 10.1111/j.1939-3938.2010.01069.x compared. Implications: Given the results of this study, postmortem sexual
assault examinations should be conducted in all suspected intimate partner
homicides. Further implications for forensic nursing practice and recommen-
dations for future research are discussed.

Sex-related homicide, sexual homicide, and rape homi-
cide are various terms used to refer to a homicide that oc-
curs in conjunction with a sexual assault or to indicate the
homicide was sexually motivated (Geberth, 2003; Meloy,
2000; Ressler, Burgess, & Douglas, 1992). Definitions of
these terms vary within the law enforcement and psy-
chology professions (Chan & Heide, 2009). Ressler et al.
(1992) defined sexual homicide as “murders with evi-
dence or observations that indicate the murder was sex-
ual in nature” (p. xiii). According to Geberth (2003), “a
homicide is classified as sex-related when there is evi-
dence of sexual activity observed in the crime scene or
upon the body of the victim” (p. 309). Meloy (2000) de-
fined sexual homicide as “the intentional killing of a per-
son during which there is sexual behavior by the per-
petrator” (p. 2). Sexual behavior by the perpetrator was
further described by Meloy as:
Sexual behavior might occur before, during, or after
the killing, or throughout the event; and the behavior
could range from only conscious fantasy, to physio-
logical arousal, to masturbation, or actual penetration
(oral, anal, or vaginal) of the victim with a variety of
objects, animate or inanimate. Sexual behavior also
may be symbolically expressed, often suffused with
anger and curiosity, through mutilation of the victim’s
genitals (p. 2).
For the purposes of this study, the term sex-related
homicide is defined as a homicide with evidence of sexual
behavior by the perpetrator, with “sexual behavior” char-
acterized using Meloy’s description previously described.
There are several indicators of sexual behavior that
may be present at the crime scene of a sex-related homi-
cide. Victims may be naked, partially clothed, or their
clothing may be positioned in a way that exposes their
breasts, genitalia, or buttocks. The position of the body
may be in a sexual manner, such as with their legs spread
open. Signs of bindings or ligatures may be present. Evi-
dence of oral, vaginal, or anal intercourse, or evidence of
substitute sexual activity, such as masturbation or foreign
object penetration of the mouth, vagina, or anus, may
be seen. There may be seminal fluid in, on, or near the
body. The breasts, buttocks, or anogenitalia may be in-
jured or mutilated (Geberth, 2003; Ressler et al., 1992).
Bite marks are not unusual in violent crimes (Freeman,
Senn, & Arendt, 2005; Pretty & Sweet, 2000); researchers
concluded that evidence of bite marks was strongly

Journal of Forensic Nursing 6 (2010) 57–65 

c 2010 International Association of Forensic Nurses 57
Characteristics of sex-related homicides in Alaska
associated with sex-related homicides (Abrahams et al.,
2008). These indicators of sexual behavior, alone or in
combination with another, are cause for a sex-related
homicide to be suspected.
Sex-related homicides generally occur during a sex-
ual assault when the perpetrator uses excessive force to
overcome the victim’s resistance, or when the perpetrator
kills to prevent the victim from identifying him to ensure
the victim will not be able to report the sexual assault
(Geberth, 2003). It is difficult to determine how common
sex-related homicides are in the United States as spe-
cific statistics are not kept on this type of crime. Accord-
ing to the FBI Uniform Crime Report (2007) data, there
were 14,831 homicides in the United States in 2007. Of
those, “rape” was identified as a factor of the homicide
circumstances only 31 times, which is roughly 0.002%.
Considering sexual assault and domestic violence rates in
the United States, it is likely that sex-related homicides
are not being identified resulting in their prevalence be-
ing significantly underestimated. Sex-related homicides
combine the two most extreme forms of violence against
women, sexual assault and homicide, yet little attention
has been given to the combination of these subjects, par-
ticularly by health researchers (Abrahams et al., 2008).
The use of a colposcope and toluidine blue dye by
healthcare providers to assist with anogenital injury iden-
tification in living victims of sexual assault is well estab-
lished (Jones, Rossman, Wynn, Dunnuck, & Schwartz,
2003; Slaughter, Brown, Crowley, & Peck, 1997;
Sommers, Fisher, & Karjan, 2005). In fact, according to
the National Protocol for Sexual Assault Medical Forensic Ex-
aminations of Adults and Adolescents (2004), the use of a
colposcope with photographic capability is strongly sug-
gested in the medical-forensic examination of living sex-
ual assault victims. Traditionally, postmortem anogenital
examinations have been performed using gross visualiza-
tion to assess for injury. Gross visualization alone may
not allow detection of the smaller, more subtle genital in-
juries that are sustained during a sexual assault (Lynch
& Ferrell, 2006). This traditional method of examination
yields the lowest rates (6%–53%) of anogenital injury
identification in living victims of sexual assault (Hilden,
Schei, & Sidenius, 2005; Lenahan, Ernst, & Johnson,
1998; Palmer, McNulty, Este, & Donovan, 2004; Riggs,
Houry, Long, Markovchick, & Feldus, 2000). The use of
a colposcope and toluidine blue dye improve the exam-
iners ability to visualize anogenital injury, resulting in
higher rates (49%–87%) of injury identification (Baker &
Sommers, 2008; Drocton, Sachs, Chu, & Wheeler, 2008;
Jones et al., 2003; Slaughter et al., 1997). Although much
progress has been made to improve medical-forensic ex-
aminations for living sexual assault victims, few advance-
ments have been made to utilize similar technology for
58
T. Henry
deceased sexual assault victims (Slaughter, 2006). Mini-
mal information is available regarding the use of colpo-
scopes or toluidine blue dye for identifying anogenital in-
jury during the postmortem examination of sex-related
homicide victims. Bays and Lewman (1992) described the
use of a colposcope and toluidine blue dye postmortem
to assist in the detection of genital and anal injuries in
four case examples of child sexual abuse. Crowley (2004)
recommended incorporating the use of a colposcope for
examining the anogenitalia postmortem due to its mag-
nification, photodocumentation capability, and peer re-
view potential. In discussing the anogenital exam during
pediatric forensic autopsies, Elder (2007) suggested the
use of a colposcope or other magnification to facilitate
the examination.
Forensic pathologists may consult or collaborate with
other professionals (e.g., anthropologist, odontologist,
entomologist) as they formulate their opinions on the
cause, mechanism, and manner of death. Some forensic
pathologists in the United States have recognized the ben-
efits of collaborating with forensic nurses who specialize
in medical-forensic examinations of living sexual assault
victims and have included these forensic nurse specialists
in their protocols for responding to sex-related homicide
cases (D. Schunn, personal communication, 2008; R. Die-
gal, personal communication, 2009; S. Mitchell, personal
communication, 2009). Such a partnership was formed
in Alaska, in 1999, between the forensic pathologists and
a forensic nurse specialist. The services of the forensic
nurse were provided for suspected sex-related homicide
cases based on the forensic pathologist and law enforce-
ment’s request. These services included forensic sample
collection; external head to toe assessment of nongenital
injury; and a detailed assessment of the anogenitalia.
The forensic nurse and law enforcement individuals at-
tending autopsies collect the forensic samples from the
body. Routine samples collected include clothing, tape
lifts, miscellaneous hairs, fibers, debris, pulled head hair,
pulled pubic hair, swabs of the neck, breasts, mouth, ex-
ternal genitalia, vagina, cervix, anus, and rectum. Swabs
are also obtained of any areas of fluorescence with an al-
ternative light source, blood spatter on the body, and ar-
eas of bruising that might yield skin cell transfer from the
suspect. Upon completion of these forensic samples, the
forensic nurse performs the anogenital examination. The
anogenitalia are first examined with gross visualization,
then with a colposcope. Collection of samples from the
anogenitalia are obtained simultaneously during the ex-
amination. Equipment used includes an alternative light
source, colposcope, speculum, anoscope, toluidine blue
dye, and camera. All injuries are documented using a
colposcope and camera prior to application of toluidine
blue dye. Toluidine blue dye is used only to highlight
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superficial lacerations and abrasions, not to search for
an injury that is not visible with the colposcope. Upon
completion of the anogenital examination and sample
collection, the body is washed, nongenital injuries are
reassessed, and the autopsy is completed by the foren-
sic pathologist. The collaboration between the forensic
pathologist and forensic nurse specialist provides Alaska’s
deceased victims a comprehensive sexual assault exami-
nation utilizing the most current technology and exper-
tise similar to what is provided to living sexual assault
victims.
The purpose of this study was to describe the demo-
graphics, physical examination, and victim-suspect rela-
tionships of sex-related homicides in Alaska. In particu-
lar, the types and sites of anogenital injury, as well as the
postmortem changes documented with a colposcope are
described.
Methods
A retrospective descriptive study design was used to de-
termine the characteristics of sex-related homicides in
Alaska. The University of Alaska Anchorage Institutional
Review Board determined the study to be exempt from
review. All postmortem medical-forensic records com-
pleted by the forensic nurse specialist are the property of
Forensic Nurse Services, a privately owned business, op-
erated by the principal investigator of this study. There-
fore, permission to access these records for their use in
the data collection and analysis for this study was not
required. The principal investigator reviewed all exist-
ing forensic nursing postmortem medical-forensic records
from 1999 to 2007. Only records of cases in which a sex-
related homicide was confirmed by law enforcement in-
vestigation were included in the study. Cases that were
not confirmed to be sex-related homicides by law en-
forcement investigation were excluded. Data extracted
from each record included victim demographics, crime
scene characteristics, physical examination findings in-
cluding postmortem changes, nongenital injury, anogeni-
tal injury, and suspect race and relationship to the victim.
All data were entered into the Statistical Package for
the Social Sciences (SPSS) version 17.0 for Mac (SPSS,
Inc., Chicago, IL). Descriptive statistics were used to de-
scribe the demographic data, crime scene characteristics,
physical examination findings, and suspect relationship
to the victim.
Results
A total of 50 cases were identified that met the inclusion
criteria for a sex-related homicide. All of the victims were
female.
Characteristics of sex-related homicides in Alaska
Figure 1. Age range of victims.
Age of victims
The age range was 6 months old to 57 years (M = 30.29,
Mdn = 29.50, SD = 14.08). Twenty percent (n = 10)
were 18 years of age and under, 68% (n = 34) were 19–
49 years of age, and 12% (n = 6) were 50 years of age
or older (see Figure 1). Over half (58%, n = 29) were
Alaska Native, and 40% (n = 20) were Caucasian. A ma-
jority (86%, n = 43) were murdered by someone known
to them. Six percent (n = 3) were murdered by a stranger,
and in 8% (n = 4) of the cases, a suspect has not yet been
identified by law enforcement. Fourteen percent (n = 6)
were killed by a relative, 39.2% (n = 17) by an acquain-
tance/friend, and 44.2% (n = 19) by their current spouse
or boyfriend. There was a known history of domestic vio-
lence in 94.7% (n = 18) of the homicides that were com-
mitted by the current spouse or boyfriend. Forty percent
(n = 4) of the victims under the age of 18 had a known
history of repeated sexual abuse by the suspect, two of
which were also known to have been physically assaulted
by the suspect within one month of being killed. In 46%
(n = 23) of the homicides, the suspect was Alaska Native,
and in 44% (n = 22) the suspect was Caucasian. These
homicides were predominantly intraracial, with 72.4%
(n = 21) of Alaska Native women killed by Alaska Na-
tive men, and 85% (n = 17) of Caucasian women killed
by Caucasian men. Over half (62%, n = 31) of the homi-
cides occurred in urban communities and 38% (n = 19)
occurred in rural communities.
Location of victims
The locations where the bodies were found included out-
door (34%, n = 17), in a vehicle (4%, n = 2), in the vic-
tim’s house (16%, n = 8), in the suspect’s house (14%,
n = 7), in a house that both the victim and suspect were
living (22%, n = 11), or in some other indoor location
(10%, n = 5) such as an abandoned structure, hotel, or
stairwell of a building. Six percent (n = 3) of the bodies
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Characteristics of sex-related homicides in Alaska
were buried in shallow graves, 8% (n = 4) were frozen
either outdoors, or in a freezer, and 10% (n = 5) had
some form of animal predation prior to being found. Vic-
tims were found naked (32%, n = 16), partially clothed
(36%, n = 18), and fully clothed (32%, n = 16). Of the
victims that were partially or fully clothed, the clothing
on the body was altered in 38.2% (n = 13) of the cases
to expose the breasts (38.5%, n = 5), the genitalia and/or
buttocks (30.8%, n = 4), or both the breasts and genitalia
(30.8%, n = 4). Clothing belonging to the victim was lo-
cated at the crime scene for 41.2% (n = 14) of victims
that were found partially clothed or naked. Evidence that
restraints were used was found in only two (4%) cases.
Two victims were found alive, but died within a few
hours. The vast majority (90%) of victims were located
within 168 hours of disappearing (M = 30.02, Mdn =
8.00, SD = 44.84) and 4 (8%) victims were found be-
tween 1 and 6 weeks after last being seen alive. All of
the autopsies and sexual assault examinations were per-
formed between 10 and 216 hours (M = 47.84, Mdn =
35.00, SD = 42.74) after the body was found.
Cause of death
The forensic pathologist determined the cause and man-
ner of death. All were determined to be homicides.
Thirty-six percent (n = 18) died from blunt force trauma,
26% (n = 13) from gunshot wounds, 16% (n = 8) from
strangulation, 10% (n = 5) from sharp force trauma, and
12% (n = 6) remain an undetermined cause of death
(COD). The sources of blunt force trauma included phys-
ical blows by the suspect’s hands or feet and/or physical
blows by objects such as baseball bats, rocks, shovels, and
logs. Of those that died from blunt force trauma, 22.2%
(n = 4) were a result of exsanguination from the anogen-
ital injuries. The two sources of sharp force trauma were
knives or hatchets. The number of stab wounds ranged
from 5 to 62 and partial decapitation occurred in 2 cases.
Of those that died from strangulation, half were manual
and half were ligature strangulations. Types of ligatures
used were articles of the victim’s clothing such as belts,
shirts, bras and panties. Gunshot wounds were caused by
shotguns or handguns. Victims whose death was unde-
termined either had no injury to the body that would
result in death or were significantly decomposed. Over
half (66%, n = 33) of the victims had positive toxicol-
ogy results for alcohol, but only 3 (6%) were positive for
drugs.
Condition of the body
Rigor mortis was present in 69.6% (n = 32) of the cases
and livor mortis was present on the body 82.6% (n = 38)
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and on the anogenitalia 19.6% (n = 9). Decomposition
was present in 12 (24%) cases with 33.3% (n = 4) of
those identified as severely decomposed. Anogenital de-
composition was present in 8 (16%) cases with 50% (n =
4) of those severely decomposed. The nongenital decom-
position present included marbling (6.5%, n = 3), green
discoloration (19.6%, n = 9), bloating (6.5%, n = 3), vesi-
cles (4.3%, n = 2), skin slippage (6.4%, n = 3), adipocere
(4.2%, n = 2), skelatonization (6.0%, n = 3), and 4
(8.5%) had freeze/thaw effect. Decomposition specific to
the anogenitalia included green discoloration (6.5%, n =
3), bloating (2.2%, n = 1), skin slippage (4.3%, n = 2),
adipocere (4.2%, n = 2), skelatonization (6.0%, n = 3),
and 4 (8.5%) freeze/thaw effect. Five (10%) of the cases
had maggots present on the body and 4 (8%) on the
anogenitalia.
Injuries noted
Injuries to the body were present 97.8% (n = 45) of the
time. The most common sites of injury were the face
(78.3%, n = 36) and extremities (73.9%, n = 34), fol-
lowed by the chest (60.9%, n = 28), head (57.8%, n =
26), and neck (56.5%, n = 26). The primary types of in-
juries were bruises (93.5%, n = 43), abrasions (78.3%,
n = 36), and fractures (40.8%, n = 20), followed by lac-
erations (28.3%, n = 13) and gunshot wounds (27.1%,
n = 13) (See Figure 2). Bruises were found most often
on the face (71.1%, n = 32), arms (67.4%, n = 31), and
legs (65.2%, n = 30). Abrasions were more common on
the face (31.1%, n = 14), neck (30.4%, n = 14), buttocks
(13%, n = 6) and legs (26.1%, n = 12). Lacerations oc-
curred to the face (20%, n = 9) and head (13.3%, n =
6) most often. The head (30%, n = 15) and face (27.7%,
n = 13) were the locations for the majority of fractures.
Cuts were most often seen on the neck (8.7%, n = 4) but
a majority of stab wounds were to the chest (8.7%, n =
4). The primary site for gunshot wounds was noted to be
the head (22.4%, n = 11) and face (10.6%, n = 5). Bite
marks were only present on 3 (6.5%) victims, however,
“hickies” were present on an additional 6 (13%) victims.
The number of bite marks ranged from 2 to 11 per case
with the majority present on the breasts and buttocks.
Anogenital injury occurred in 58.7% (n = 27) of the
cases. All of these injuries were visible prior to the appli-
cation of toluidine blue dye. The leading site of injury was
the labia minora (45.7%, n = 21), followed by the poste-
rior fourchette (30.4%, n = 14), hymen (30.4%, n = 14),
and anus (30.4%, n = 14). Types of anogenital injury in-
cluded lacerations (50%, n = 23), abrasions (28.3%, n =
13), and bruises (41.3%, n = 19). Bruises were found
most often on the labia minora (28.3%, n = 13) and hy-
men (28.3%, n = 13). The majority of abrasions were on
T. Henry
Figure 2. Types of nongenital injury.
the labia minora (17.4%, n = 8), followed by the per-
ineum (8.7%, n = 4), anus (8.7%, n = 4), and labia ma-
jora (8.7%, n = 4). Lacerations occurred most often on
the labia minora (28.3%, n = 13), anus (26.1%, n = 12),
and posterior fourchette (23.9%, n = 11) (See Figure 3).
Thirty percent (n = 7) of the anogenital lacerations were
extensive, ranging from 5 to 6 inches in length and 2 to
4 inches in depth. The peritoneum and rectum were per-
forated in one case. Foreign objects used for penetration
of the vagina and/or anus included bottles, brooms, guns,
and tree branches.
None of the victims had evidence of postmortem mu-
tilation. However, postmortem cuts were present on the
body of 2 (4%) victims and postmortem lacerations were
present on the anogenitalia of 2 (4%) victims.
Discussion
This is the first study to document characteristics of sex-
related homicides in which victims received a compre-
hensive sexual assault examination using technology and
expertise similar to what has been provided to living
victims of sexual assault for many years. Unlike previ-
ous reports in the United States and Canada (Roberts &
Grossman, 1993; United States Department of Justice,
1999–2007; Van Patten & Delhauer, 2007) that indicated
sex-related homicides were rare, this study found sex-
related homicides to be at least 17% (n = 50) of all homi-
cides and nonnegligent manslaughter cases (N = 287) in
Characteristics of sex-related homicides in Alaska
Alaska for 2000–2007. It is likely that this higher per-
centage was a result of a combination of factors: the in-
clusion of an expert in sexual assault examinations re-
sponding to homicides; the utilization of technology that
enhances visualization of anogenital injuries; and the ex-
tensive training available for law enforcement annually
in Alaska resulting in an increased awareness about do-
mestic violence, sexual assault, and homicide.
Similar to previous research (Ressler et al., 1992; Van
Patten & Delhauer, 2007) these cases were primarily in-
traracial. Unlike previous reports (Abrahams et al., 2008;
Di Maio & Di Maio, 2001; Meloy, 2000; Roberts &
Grossman, 1993) in which sex-related homicides were
most often committed by strangers, 86% of victims in
this study were killed by someone known to them, with
44.2% killed by their intimate partner. This is not an un-
usual occurence and is in line with the Violence Policy
Center study (2008) where 60% of women murdered by
someone known to them, were murdered by a spouse or
boyfriend. Of the sex-related homicide victims killed by
their intimate partner, all but one had a known history of
domestic violence with that suspect. This was comparable
to other research on intimate partner homicides and risk
factors for femicide. Moracco, Runyan, and Butts (2003)
found that more than two-thirds of the women in their
study were known to have been previously abused by the
partners who killed them. Therefore, it was not surpris-
ing that a large number of sex-related homicides in this
study were also intimate partner homicides. Mcfarlane
et al. (2005) found that 68% of intimate partner
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Characteristics of sex-related homicides in Alaska
Figure 3. Injury types by anogenital injury site.
violence victims (IPV) had been sexually assaulted during
the relationship and DeKeseredy (2007) found victims of
IPV were sexually assaulted by their partner when they
expressed desire to leave the relationship (74%), while
they were leaving (49%), and after the victim left the re-
lationship (33%). Geberth (2003) suggested a sex-related
homicide by the intimate partner was often motivated by
elements of rage, hate, anger, and jealousy and served as
the ultimate form of sexual revenge often referred to as
“If I can’t have you then nobody will have you” (p. 337).
Strangulation, blunt force trauma, and stabbing have
consistently been shown to be the most frequent cause of
death for sex-related homicides (Abrahams et al., 2008;
Di Maio & Di Maio, 2001; Roberts & Grossman, 1993; Van
Patten & Delhauer, 2007), with strangulation the leading
COD. In this study, evidence of strangulation was present
in 36% (n = 18) of the cases. Of those cases with ev-
idence of strangulation, the actual COD for 20% (n =
10) of them was attributed to some other reason. In this
study, blunt force trauma was the most frequent COD.
Unlike previous research that indicated gunshot wounds
were the least common COD in sex-related homicides,
they were the COD in 26% (n = 13) of the cases in this
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study. This finding may be related to the frequency of
firearms used by an intimate partner to kill victims and
was consistent with the leading COD in intimate partner
homicide (Moracco et al., 2003; Violence Policy Center,
2008). Also, the prominent numbers of cases with in-
juries to the face, head, neck, and chest are consistent
with other reports that injuries and COD for sex-related
homicides are more likely to be from close physical con-
tact with the victim.
Livor mortis was present in 19.6% of the cases with
other forms of decomposition present in an additional
16%. Postmortem changes to the anogenitalia visualized
with a colposcope have not previously been documented,
so it is important that forensic nurses who perform
postmortem sexual assault examinations have training
and experience in assessing normal postmortem changes
in order to prevent misinterpretation of the anogenital
findings.
This was the first study to document anogenital in-
jury in sex-related homicides with a colposcope, there-
fore comparisons with prior research were not possible.
There was, however, an abundance of literature regard-
ing anogenital injuries in living sexual assault victims.
T. Henry
Figure 4. Presence of anogenital injury in living and deceased victims.
That research has focused on the sites and types of injury
visualized with a colposcope and/or toluidine blue dye
to gain an understanding of the patterns of anogenital in-
juries sustained in victims with a history of sexual assault,
compared to anogenital injuries sustained from consen-
sual intercourse. Research was available that described
details of the presence and frequency of anogenital in-
jury found in living sexual assault victims who received
comprehensive sexual assault examinations by forensic
nurses in Alaska (Rosay & Henry, 2007). With regard to
anogenital injuries, some interesting differences and sim-
ilarities were found between Alaska’s living and deceased
sexual assault victims.
The presence of anogenital injury was increased in this
study (58.7%) compared to anogenital injury (40.9%)
found in living victims of sexual assault in Alaska (Rosay
& Henry, 2007). This study found that the labia minora
was the most common site of injury, followed by the
posterior fourchette, hymen, and anus. These sites dif-
fer slightly from Rosay and Henry’s study in which the
most common site of injury was the posterior fourchette,
followed by the labia minora, perineum, and fossa nav-
icularis. Of particular interest were the increased rates of
vaginal wall (26.1%, n = 12) and rectal (15.2%, n = 7)
Characteristics of sex-related homicides in Alaska
injury in this sample of sex-related homicides compared
to vaginal wall (4.2%, n = 61) and rectal (2.6%, n = 38)
injury of living victims (Rosay & Henry) (see Figure 4).
In addition, less than 1% of living sexual assault vic-
tims sustained anogenital injury significant enough to re-
quire emergency medical care (Rosay & Henry), whereas
anogenital injury from blunt force trauma was signifi-
cant enough to result in death for 22.2% of the sex-
related homicide victims. These findings, in conjunction
with the severity of nongenital injury, signify the sub-
stantial amount of brutality that occurred in some of
these homicides.
Limitations
This was a descriptive study only, with a small sample
size, so future research using comparative and/or corre-
lational study designs with larger sample sizes should be
completed. Another limitation was all except one victim
were of Alaska Native or Caucasian race, so character-
istics of sex-related homicide victims of other races are
not included. Finally, the data were collected from foren-
sic nursing records of cases that were confirmed to be
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Characteristics of sex-related homicides in Alaska
sex-related homicides by law enforcement investigation,
therefore, the cases that have not been confirmed by law
enforcement are not represented in this sample.
Implications for clinical forensic
nursing practice
Sex-related homicide victims deserve to have the bene-
fits of a sexual assault examination with current technol-
ogy and the specialized knowledge of an expert in sexual
assault. Forensic nurses have taken a leadership role in
improving healthcare’s response to living victims of sex-
ual assault and forensic pathologists and law enforcement
would benefit from including a forensic nurse, specialized
in sexual assault examinations, in the multidisciplinary
response to deceased victims.
Due to the lack of research, forensic nurses that
have been performing postmortem sexual assault
examinations have had to rely on anecdotal experi-
ences to guide their nursing practice for conducting
these examinations and interpreting the anogenital find-
ings observed with the colposcope, instead of relying on
evidence-based practice. It is critical that forensic nurses
and forensic pathologists begin to address these gaps in
research. This study will contribute to the profession of
forensic nursing by enhancing the understanding of char-
acteristics of sex-related homicide victims and creating
the groundwork for future research. It should be repli-
cated in other states so empirical generalizations can be
made for sex-related homicides. In addition, more re-
search is needed to describe postmortem anogenital find-
ings visualized with a colposcope in nonhomicide cases
to document “normal” postmortem anogenital variants.
This will assist with interpreting anogenital findings in
postmortem cases. Considering the frequency of sexual
assault that occurs in the escalation of violence within IPV
relationships, and the high number of sex-related homi-
cides committed by intimate partners in this study, all in-
timate partner homicides should be assessed for a possible
sexual assault around the time the victim was killed.
Conclusion
With violence against women at epidemic levels in the
United States, it is not realistic that sex-related homi-
cides account for less than 1% to 4% of all homicides
as indicated. Clearly, sex-related homicides are going
unrecognized. This study increases awareness of sex-
related homicides. It also demonstrates a need for col-
laboration between forensic nurses and forensic pathol-
ogists. Finally, this study addresses a gap in sex-related
homicide research from the healthcare perspective and
64
T. Henry
provides a foundation for future studies to be built
upon.
Acknowledgments
I would like to thank Dr. Michael Propst for inviting me to
the first case I will never forget; Dr. Franc Fallico for your
dedication and support, you are missed; Terry Davis, RN
and Jennifer Meyer, RN for preventing gaps in services;
and Detectives Howard Shore and Harry Strahle for shar-
ing your knowledge and experiences.
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