Sensitivity of the Colposcopy Exam After Sexual Assault

全国暴力侵害妇女调查报告称，每6名美国女性中就有1人经历过强奸未遂或强奸未遂。每年有近300万妇女在强奸和性侵犯中受伤。由于在性侵犯儿童中成功地识别了微小的生殖器损伤，越来越多的从业者在成年女性的检查中使用镜。镜照片随后被用于法庭证词，以记录非自愿与自愿的性行为。这项研究的具体目的是确定专家是否能从镜照片中准确地预测两厢情愿和非两厢情愿的性行为。研究问题包括：1)专家能否区分镜照片中的女性群体：那些经历过自愿和非自愿性行为的女性？2)当被视为镜光子时，自愿和非自愿性行为后女性生殖器和/或肛门损伤的数量、类型和位置有什么不同？3)在非裔美国女性和白人女性中，镜照片在检测女性生殖器和/或肛门损伤方面的敏感性和特异性有何差异？这项研究将包括预期登记的对照受试者，他们将在双方同意的性行为后接受镜检查。从检查中获得的照片将与对身份不明的性侵幸存者的照片进行回顾比较。在三年的研究中，100名在双方同意的性行为后接受检查的对照受试者将被纳入研究。性侵幸存者的病历记录和镜照片将被回顾，并根据种族、年龄和从性侵到检查的时间与对照对象进行匹配。一个由五名妇科和法医专家组成的小组将试图区分自愿(n=100)和非自愿(n=100)的女性照片，试图区分自愿(n=100)和非自愿(n=100)性行为的女性照片。他们还将确定自愿与非自愿性行为后女性生殖器和/或肛门受伤的频率、类型和位置。将计算敏感度、特异度和其他描述评分者区分两组照片的能力的统计数据。研究结果还将支持或驳斥专家的说法，即他们可以从阴道镜照片中区分双方自愿的性行为和非自愿的性行为。归根结底，这项研究有可能改善以证据为基础的做法，提高强奸的定罪率。

The National Violence Against Women survey reported that 1 of 6 US women have experienced an attempted or completed rape. Each year almost three million women are injured during rape and sexual assault. Because of the success in identifying microscopic genital injury in sexual assaulted children, more practitioners are using a colposcope during the exam of adult females. Colposcopic photos are then used in court testimony to document non-consensual vs. consensual sex. The specific aim of this study is to determine whether experts can accurately predict consensual vs. non-consensual sex from colposcopic photographs. Research questions include: 1) Can experts differentiate between colposcopic photos of women groups of women: those who have experienced consensual vs. non-consensual sex? 2) When viewed as colposcopic photons, what is the difference in number, type and location of injury to the female genitalia and/or anus after consensual versus non-consensual sex? 3) What are the differences in the sensitivity and specificity of colposcopic photos in detecting injury to the female genitalia and/or anus in African-American and White women? The study will involve prospective enrollment of control subjects who will undergo a colposcopic exam following consensual sex. The photographs derived from the exam will be compared to a retrospective review of photographs from unidentified sexual assault survivors. 100 control subjects who are examined after consensual sexual intercourse will be enrolled over the three years of the study. Chart records and colposcopic photos of sexual assault survivors will be reviewed retrospectively and matched to control subjects by ethnicity, age, and time from assault to exam. A panel of five gynecologic and forensic experts will attempt to differentiate between the photographs of women with consensual (n=100) and non-consensual (n=100) attempt to differentiate between the photographs of women with consensual (n=100) and non-consensual (n=100) sex. They will also determine the frequency, type and location of injury to the female genitalia and/or anus after consensual versus non- consensual sex. Sensitivity, specificity, and other statistics describing the raters' ability to differentiate between the two sets of photographs will be calculated. Findings will also support or refute statements by experts that they can differentiate consensual versus non-consensual sex from colposcopy photos. Ultimately the study has the potential to improve evidence-based practice and enhance conviction rates for rape.