After a group of emergency department nurses at the University of Cincinnati decided they wanted to set up a sexual assault forensic program, they asked their colleague, Marilyn S. Sommers, an expert in the area of injury, for help in writing a grant and securing the necessary funds.

Sommers, now the Lillian S. Brunner Professor of Medical-Surgical Nursing at Penn, offered to help, and quickly realized, to her surprise, that very little research had been conducted specific to sexual assault injuries—and if health care professionals or investigators could determine whether or not a woman was raped just from observing her wounds.

That was the question she hoped to answer with her first study.
But the work ended up turning her in an entirely new direction.
As part of her research, Sommers observed as health professionals treated women for injuries related to sexual assult. And she quickly realized that it was more difficult to see injuries—bruises, scraps and scratches—on women with darker skin. She soon began to wonder how the situation might impact the outcomes of these post-assault examinations.

She examined the isssue in her most recent study. Published in the November issue of The American Journal of Emergency Medicine, the study tracked 120 women who underwent a forensic exam after having consensual intercourse.

Fifty-five percent of the participants suffered at least one post-sex external genital injury, such as a tear, abrasion, redness or swelling. In white women, injuries were identified 68 percent of the time, but only 43 percent of the time in women with darker skin. The results confirmed what Sommers suspected all along: That women with darker skin are less likely than those with light skin to have their injuries accurately identified, documented and treated.

Sommers, lead inviestigator of the study, says the situation leaves these women disadvantaged in the healthcare and criminal justice systems. She said the study is “important with respect both to clinical assessments and the decisions made within the criminal justice process.”

Due to the disparities revealed by the study, Sommers says healthcare workers must pay attention to skin color in sexual assault situations. They must be, she says, “color aware.”

“If you know someone is injured and they do have dark skin, then the healthcare provider should say, ‘This person has dark skin. I need to look extra carefully to make sure I’m not missing something,’” she says.
While training healthcare workers to more carefully treat victims of sexual assault, Sommers also hopes help arrives from technology.

A computer model is in the works that might be able to detect injuries in ways similar to how a mammogram detects signs of breast cancer, where digital images are examined by an examiner as well as a computer, which detects any signs the human eye may have missed.

Ideally, Sommers envisions a situation in which an examiner conducts a sexual assault exam, writes down all of the pertinent information, and then runs the digital images through a computer. If the computer detects four locations but the examiner only detects three, the examiner can then take a closer look at the fourth location.

“It will increase the accuracy, being able to pick injuries that may be missed on the first exam,” Sommers says.

Of course, Sommers notes injuries don’t tell the whole story of sexual assults. It is possible for a woman to be raped and have no physical injuries at all. And while forensic evidence is important, Sommers says a woman’s account of the attack is even more so.

“The prosecutor and the jury and the attorneys will have to think about what her account is, and the other people involved, and then make their decision,” Sommers says. “That’s the most important part of the evidence.”