Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.

Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study

Assessment Of Physical Injuries In Survivors Of

Sexual Assault: A Retrospective Study
Haricharan A1*, Kh. Pradipkumar Singh2 , Th. Meera Devi3, Wahengbam Upendra4, Lourembam
Frieny5, Konda Kalyan Kumar6

Abstract
Objective: This study was undertaken to determine characteristics associated with physical injury in female sexual
assault survivors .
Study design: All females victims who were presenting after sexual assault to a tertiary hospital teaching institute
during a 6 years period underwent standardized evaluation. Analysis were performed by appropriate statistical
test viz. Chi-square test, Descriptive statistics like the mean used for a sociodemographic variable like age, sex,
education etc, a p-value of 0.05 or less was considered significant.
Result : Out of 250 sexual assault survivors the general body injury was found among (50.8%) of victims and no
injuries among (49.2%.) of the survivors. Bruises and abrasions were the most common injuries. Anogenital
injuries were noted in 66% of the survivors. Most incidents of sexual assault took place at victims' homes (38.8%).
Intimate partners (30%) of the survivors were the perpetrators. Use of intoxicants, mostly alcohol and seen in
16% of the cases. Resistance to sexual assaults was given by 44% of victims, who were conscious and healthy and
no resistance was given by the remaining (56%) of victims, the majority of whom were children and survivors
under the influence of intoxicants or unconscious.
Conclusion: General body injury is primarily associated with situational factors, whereas genito-anal injury is
related to victim age, marital status etc . Physical injuries require medical attention, and these injuries also help
us in estimating the severity of the crime. In recent times, an increase in the number of sexual violence cases has 655
been witnessed in a small state like Manipur. Thus, it has motivated us to study this topic as women's safety is a
major concern. An attempt has been in our study to assess the different physical injuries sustained by the survivors
of sexual assaults and the predisposing factors associated with them.

Key words: Sexual assault, survivors, physical injuries

DOI Number: 10.14704/Nq.2022.20.17.Nq88081 Neuroquantology 2022; 20(17):655-662

Introduction Forensic examinations of sexual assault cases

Sexual assault may be defined as an unwanted have two primary purposes: to search for
sexual contact with another person without physical signs and to collect trace evidence.
that other person's consent, and it may include Physical injuries need treatment so that they
attacks such as rape or attempted rape. Sexual heal without adverse consequences and the
assaults can result in different forms and pattern of injuries also has a forensic
degrees of physical trauma.1 Some of the significance in that injuries are linked to the
heinous forms of sexual assaults have resulted outcome of legal proceedings.3 So, it is
in severe trauma including death, which have necessary to assess the pattern and
led to changes in the law on sexual assaults and characteristics of physical injuries, in victims of
punishment in our country in the recent past.2 sexual assault brought for medico-legal
examination.
*Corresponding Author:- Haricharan A
1*Post Graduate Trainee Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur
2Assistant Professor ,Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur
3Professor and Head ,Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur
4,5,6Post Graduate Trainee Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur

Relevant conflicts of interest/financial disclosures: The authors declare that the research was conducted in the absence of
any commercial or financial relationships that could be construed as a potential conflict of interest.

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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
Materials & Methods attempted sexual assault were includes in the
study group. The age of the women ranged from
The present study was a Cross-sectional Study. 5 to 55 years with the majority being between
The study was conducted in record room of the age group 21-30 years ( 28.8%) (Table 1).
Department of Forensic Medicine and Two third of the perpetrators were aged
between 31-40 years (32.4 %). (Table 2). About
Toxicology, Regional Institutes of Medical
half of the survivors of sexual assault were
Sciences, Imphal. The estimated sample size married (42%).
was around 250. Study participants were all the
female victims of sexual assault brought to the Table 1. Distribution of victims by age ( N=250)
Department of Forensic Medicine and Age group ( Total Percentage
years)
Toxicology, RIMS, Imphal, for medicolegal 1-10 63 25.2
examination during January 2016 to December 11-20 23 9.2
2021. Data entry was done using windows 21-30 72 28.8
31-40 59 23.6
based statistical package for social sciences 41-50 23 9.2
[SPSS] version 21.0 (Armonk NY:IBM Corp). 51-60 10 4.0
A Pearson’s Chi-square (X2 ) test was used Total 250 100.0

to compare qualitative data and determine

Table 2. Distribution of the perpetrators by age ( N=250)
statistical significance. The level of Age group ( years) Total Percentage
statistical significance was set at p < 0.05.
Approval from the Research Ethics Board 11-20 24 9.6
RIMS, Imphal was obtained before data
21-30 74 29.6
collection. Written informed consent of the
31-40 81 32.4
participants, who fulfil the inclusion criteria 41-50 59 23.6 656
was obtained. Coding was used to mask the 51-60 12 4.8
identity of the participant and no case in the Total 250 100.0
study was identified from the data. The data
obtained was kept in the Department of Most incidents of sexual assault took place at
victims' homes (38.8%). Intimate partners
Forensic Medicine and Toxicology, RIMS, (30%) of the survivors were the perpetrators,
Imphal. Access to the data was restricted to (Table3). Use of intoxicants, mostly alcohol, at
the investigators and members of REB when the time of the assault was seen in 16% of the
they demand it. The present study was self- cases. The most common drug used was alcohol.
Resistance to sexual assaults was given by 44%
sponsored and there was no conflict of of victims, who were conscious and healthy and
interest. no resistance was given by the remaining (56%)
of victims, the majority of whom were children
Results: and survivors under the influence of intoxicants
Of the 250 victims, who reported to our Forensic or unconscious ( Table 3).
Medicine & Toxicology department during the
last 6 years having a history of sexual assault or

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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
Table 3. shows age-stratified characteristics of victims of sexual assaults
Age 1-10 11-20 21-30 31-40 41-50 51-60 Total, P-
Stratification years, years, years, years, years, years, n(%) value
n(%) n(%) n(%) n(%) n(%) n(%)
Place of assault
Victims Home 46(47.2) 0(0) 9(9.3) 34(35.05) 0(0) 8(8.24) 97(38.8)
Relative’s Home 10(31.25) 1(3.12) 17(53.12) 0(0) 3(9.37) 1(3.12) 32(12.8)
Friend’s Home 0(0) 21(72.41) 7(24.13) 1(3.45) 0(0) 0(0) 29(11.6)
Hotel 2(13.33) 0(0) 8(53.33) 4(26.66) 1(6.66) 0(0) 15(6) <0.001
Unknown Place 4(10.25) 1(2.56) 27(69.23) 6(15.38) 1(2.56) 0(0) 39(15.6)
Work Place 1(5.55) 0(0) 2(11.11) 13(72.22) 2(11.11) 0(0) 18(7.2)
Known place 0(0) 0(0) 2(10) 1(5) 16(80) 1(5) 20(8)
outside
Relation to
perpetrator

Relative 8(47.05) 1(5.88) 4(23.53) 0(0) 3(17.64) 1(5.88) 17(6.8)

Stranger 3(37.5) 0(0) 1(12.5) 4(50) 0(0) 0(0) 8(3.2)
Intimate partner 0(0) 1(1.33) 13(17.33) 43(57.33) 17(22.66) 1(1.33) 75(30)
Friend 1(1.85) 21(38.88) 30(55.55) 2(3.7) 0(0) 0(0) 54(21.6) <0.001
Accidental 1(7.14) 0(0) 7(50) 4(28.57) 2(14.28) 0(0) 14(5.6)
acquaintance
Unknown 1(16.66) 0(0) 0(0) 0(0) 0(0) 5(83.33) 6(2.4)

Others(employer, 19(59.37) 0(0) 12(37.5) 0(0) 0(0) 1(3.12) 32(12.8)

colleague,
caretaker)
Gang 0(0) 0(0) 3(25) 6(50) 1(8.33) 2(16.66) 12(4.8)
Neighbour 30(93.75) 0(0) 2(6.25) 0(0) 0(0) 0(0) 32(12.8)
Use of intoxicants
Yes 0(0) 21(52.5) 11(27.5) 5(12.5) 2(5) 1(2.5) 40(16)
No 63(42.86) 2(1.36) 61(41.49) 54(36.73) 21(14.28) 9(6.12) 147(58.8) <0.001
Unknown 23 (36) 16 (25) 4 (6.3) 10 ( 15.8) 6 (9.5) 4 (6.3) 63 (25.2) 657
Physical injuries
Yes 12(9.44) 23(18.11) 42(33.07) 26(20.47) 15(11.81) 9(7.08) 127(50.8)
No 51(41.46) 0(0) 30(24.39) 33(26.82) 8(6.5) 1(0.81) 123(49.2) <0.001

Ano-genital
injuries
Yes 40(24.24) 23(13.93) 46(27.88) 31(18.78) 16(9.69) 9(5.45) 165(66) <0.001
No 23(27.05) 0(0) 26(3058) 28(32.94) 7(8.23) 1(1.17) 85(34)

Resistance
Yes 3(2.72) 20(18.18) 38(34.54) 27(24.54) 13(11.81) 9(8.18) 110(44) <0.001
No 60(42.86) 3(2.14) 34(24.28) 32(22.86) 10(7.14) 1(0.71) 140(56)

General body injury was found among (50.8%)

of victims and no injuries among (49.2%.) of the Anogenital injuries were noted in 66% of the
survivors. Bruises and abrasions were the most survivors. In labia majora, abrasions (14.4%),
common injuries. In the head, injuries consist of bruises (29.6%) and no injuries (56 %) were
abrasions (8.4%) followed by abraded bruises seen among the victims. Details of the local
(6.8%) and lacerations (0.4%) and no injuries injuries are shown in (Table 5).
were seen in 81.2% of victims (table 4). Body
region-wise distribution of the injuries is shown
in ( table 4). Among all the injuries in the body,
abrasions were the most commonly observed
injury.

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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
Table 4. Shows general physical injuries in the different parts of the body among sexual assault survivors (N=250)
S.no Part of the body Injuries sustained Total Percentage
1 Head No injuries 203 81.2
Abrasions 21 8.4
bruises 8 3.2
lacerations 1 0.4
chop/stab wound 0 0
abrasion-bruise 17 6.8 0
abrasion -laceration 0 0
bruise-laceration 0 0
Total 250 100.0

Front of chest No injuries 194 77.6

2 and abdomen abrasions 34 13.6
bruises 16 6.4
Laceration 6 2.4
chop/stab wound 0 0
abrasion-bruise 0 0
abrasion -laceration 0 0
bruise-laceration 0 0
Total 250 100.0

3 Back of chest and no injuries 207 82.8

abdomen abrasions 42 16.8
bruises 1 0.4
lacerations 0 0
chop/stab wound 0 0
abrasion-bruise 0 0
abrasion -laceration 0 0
bruise-laceration 0 0
Total 250 100.0
4 Hands no injuries 157 62.8
abrasions 59 23.6 658
bruises 12 4.8
lacerations 0 0
chop/stab wound 0 0
abrasion-bruise 21 8.4
abrasion -laceration 1 0.4
bruise-laceration 0 0
Total 250 100.0

5 Legs no injuries 175 70.0

abrasions 11 4.4
bruises 44 17.6
lacerations 20 8.0
chop/stab wound 0 0
abrasion-bruise 0 0
abrasion -laceration 0 0
bruise-laceration 0 0
Total 250 100.0

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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
Table:5. Anogenital injuries among sexual assault survivors
S.no Part of the Injuries sustained Frequency Percentage
body
1 Labia majora No injuries 140 56.0
Abrasions 36 14.4
Bruises 74 29.6
lacerations 0 0
other injuries 0 0
Total 250 100
Labia minora No injuries 154 61.6
2 Abrasions 39 15.6
bruises 57 22.8
Laceration 0 0
other injuries 0 0
Total 250 100.0

3 Fourchette no injuries 166 66.4

abrasions 38 15.2
bruises 46 18.4
lacerations 0 0
other injuries 0 0
Total 250 100.0
4 Perineum no injuries 173 69.2
abrasions 56 22.4
bruises 18 7.2
lacerations 3 1.2 0
other injuries 0 100.0
Total 250
5 Anal no injuries 219 87.6 659
abrasions 15 6.0
bruises 16 6.4
lacerations 0 0
other injuries 0 0
Total 250 100.0
6 Hymenal tear Fresh tear 88 35.2
Old tear 140 56
No tear 22 8.8
Total 250 100.0
7 Vagina No injuries 154 61.90
abrasions 96 38.10
bruises 0 0
lacerations 0 0
other injuries 0 0
Total 250 100

Discussion assault. More than 50% of cases were below 30

Sexual assault victims seek medical care not
only for the care of injuries but also for the
collection of forensic evidence and to obtain
treatment to reduce the risk of pregnancy or
disease. From our study, we observed that
younger people are more vulnerable to sexual
years of age. This is similar to the study
Ingemann-Hansen O et al4, in which the sexual
assault survivors belonged to the younger age
group and the median age was 21 years.

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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
Most of the incidents happened at the home of
the survivors (38.8 %), especially in younger
children (47.2%). Among the adolescent age
group, the incidents took place at friends' homes
(11.6 %), relative houses (12.8%), etc. where
the majority of the sexual assaults were
committed at the victim's place of residence or a
relative’s house.5 Singh SB et al6found that 52.9
% of cases occurred in hotels or dimly lit
restaurants.
Alcohol might increase the risk of sexual assault
by its physically debilitating effects, but also by
diminishing a woman’s capacity to perceive and
respond to situations in which she is at risk. In
our study, sexual assaults occurred in 16% of
the survivors. This was similar to the study by
Bandyopadhay et al7 ( 6%) of crimes were
committed when the victims were under the
influence of drugs.
The importance of both anogenital and physical
injuries has been emphasised for many years,
but there is still no consensus on how to
document these injuries and what implications
they should have regarding the legal aspects of
sexual assault.6
The degree of resistance is an important factor
in the way the survivor and others perceive
sexual assault.(16). Our study shows that almost
half the women (56%) did not resist, either
physically or verbally, during the assault. This
shows that many of the victims were under
threat or fear or under the influence of drugs.
In our study, abrasions (21%) were the most
common injuries on the head, sustained by the
victims, followed by abrasion-bruise (17%)
combined. Even though most of the studies
showed a high percentage of injuries were
found on the face. Our study results were quite
minimal. This proves that most of the sexual acts
were not heinous in nature.
Gomes8 stated that injuries occur as a result of
victims trying to protect their heads or bodies
by raising their hands and arms in front of them.
It was understandable that almost any wound
located on the posterior side of the forearm was
a defensive wound because it does not seem
practical that an attacker would meaningfully
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aim at a person’s forearm. Documenting
defensive sounds was extremely important
because they could prove force was used toward
the victim. In our study also found lots of
injuries on hands, defensive in nature. We found
abrasions 23%, followed by bruises 4.8% ,
mostly seen over the forearms. The reason
behind this was most of the accused force to
grab and hold the forearm of the assault victims
tightly.
Injuries are often found seen on the front of the
chest and abdomen on the breasts of women
who were sexual assault or rape victims. The
breasts were usually a sensitive place on a
woman's body, so a victim will often experience
significant pain in the breasts as a result of being
rubbed, bitten, hit, or any other method of force
in a violent manner. In our study, abrasions (
34 %) and bruises (16%) were seen on the chest
and abdomen. And in the chest ( breast ) alone
lacerations ( 6%) were seen. This reflects the
heinous nature of the sexual incident.
Kindermann G et al9 , in their study, mentioned
the injuries sustained during the sexual acts on
legs and thighs around (14.2%). These include
660
abrasions, bruises and lacerations. This was
similar to our study, the victims suffered
injuries over the legs abrasions ( 4.4%), bruises(
17.6%) and lacerations (8%). Thighs and the
buttocks were the common areas that
experience injury occurred due to slapping,
grabbing, or experience any other kind of touch
that is hurtful or violent by the perpetrators.
Adams JA et al10 in the study noted that the
most common findings in the sexual assault
were posterior fourchette tears (36%) in our
study also surprisingly (33.6%) fourchette
injuries were found in that abrasions were (
15.2%) and bruises were ( 18.4%).
Erythema, thickened perianal skin folds, and a
slightly dilated anal sphincter was the all
nonspecific findings. Abrasions, contusions, and
lacerations were typical features around the
anal area in the case of sexual assault victims.
Jänisch Set al11 in mentioned that 27% of the
victims, marked anal and perineum injuries. In
our study around also, in the perineum (22.4%)
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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
abrasion, bruises 7.2% and lacerations(1.2%)
were noted. And around the anal area, 6%
abrasions and 6.4 % bruises were noted, these
injuries were mostly seen in children.
In our study, 35.2% of fresh hymenal tears and
56 % of old hymenal tears were found and 8.8 %
were intact. The reason for the increase in old
hymenal tears from our study victims were,
most of them were already married. Similarly,
the same findings seen in Sukul et al12 found
6.9% cases of recent hymenal tears and 6.9%
cases of intact hymen and Sarkar et al13 reported
hymen rupture in 85% of cases, the majority of
which were old tears.
McNair et al14 stated in their study that bruises,
abrasions, and tears (lacerations), the
components of blunt force trauma, accounted
for 4%, 15%, and 14% of the findings,
respectively. Compare to abrasions, the bruises
were more in our findings, bruises( 29.6%) and
abrasions( 14.4%) around the labia majora .
And bruises (22.8%) and abrasions (15.6%)
were around the Labia minora . No lacerations
were found in the Labial region.
Conclusion :
Physical injuries require medical attention, and
these injuries also help us in estimating the
severity of the crime. When the doctor is asked
to address findings in a legal context, the
assessment of the significant injury or lack of it
should include consideration of the survivor
and the factors examined. In recent times, an
increase in the number of sexual violence cases
has been witnessed in a small state like ours.
Thus, it has motivated us to study this topic as
women's safety is a major concern. An attempt
has been in our study to assess the different
physical injuries sustained by the survivors of
sexual assaults and the predisposing factors
associated with them.
References
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World report on violence and health.
(Geneva: World Health Organisation,2002)
[Cited 2020 Nov 22]; Available at:
https://www.who.int/violence_injury_pre
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2. The Protection of Children from Sexual
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Neuroquantology |November 2022 | Volume 20 | Issue 17 | Page 655-662 | Doi: 10.14704/Nq.2022.20.17.Nq88081
Haricharan A, Kh. Pradipkumar Singh , Th. Meera Devi, Wahengbam Upendra, Lourembam Frieny, Konda Kalyan Kumar , Assessment Of
Physical Injuries In Survivors Of Sexual Assault: A Retrospective Study
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