European Journal of Cardiovascular Medicine

Sexual assault is a serious violation of human rights and constitutes a major public health and medico-legal problem worldwide. Survivors of sexual assault may sustain a wide range of physical injuries, the assessment of which is crucial not only for immediate medical management but also for forensic documentation and legal adjudication. The presence, type, and distribution of injuries—both genital and extragenital—may provide important corroborative evidence, although their absence does not negate the occurrence of sexual assault [1]. Accurate interpretation of injuries requires careful consideration of factors such as the nature of the assault, degree of force used, resistance offered, and the time interval between the incident and medical examination [2].

In India, crimes against women continue to show an increasing trend. According to the National Crime Records Bureau (NCRB), a total of 4,45,256 cases of crimes against women were registered in 2022, reflecting a significant rise compared to previous years [2]. Sexual offences, including rape, form a substantial proportion of these cases. NCRB data further reveal considerable interstate variation in crime rates, with several northeastern states reporting rates higher than the national average. Assam, in particular, has consistently reported a high number of crimes against women, including sexual offences, underscoring the regional burden and the need for focused medico-legal research [3].

Previous forensic studies have documented wide variability in injury patterns among sexual assault survivors. While some victims present with obvious genital or bodily injuries, others may show minimal or no physical signs, especially in cases involving delayed reporting or lack of overt physical force [4–6]. These variations highlight the importance of meticulous examination, proper documentation, and an evidence-based understanding of injury patterns to avoid misinterpretation during legal proceedings.

In this context, the present study aims to analyse the pattern and distribution of injuries among sexual assault victims undergoing medico-legal examination, with the objective of contributing to improved forensic evaluation, better survivor care, and strengthened judicial outcomes.

Study type: Descriptive cross-sectional study

Study site: Department of Forensic Medicine in a tertiary centre of Assam, India

Study Period:

The study was conducted for March 2023 to February 2024 (one year).

Study Population:

The present study was conducted on the survivors of natural sexual offence, brought to the tertiary medical centre for medico-legal examination

Selection of cases:

1. Inclusion criteria: All cases of natural sexual offence     (female) cases brought for examination to the centre.

2. Exclusion criteria:

a)  Male sex crime cases

b)  Cases of unnatural sexual offence.

c)  Cases without the consent of the female for medical examination.

Sample size:

A total of 253 cases were brought for examination in the department. Out of them, 110 cases were taken up for the study after applying eligibility criteria.

Data analysis has been done by using the results tabulated and matched in Microsoft Excel.

Ethical clearance was obtained via IEC(H) Reg No. EC/NEW/INST/2020/1221

The highest frequency is seen in the 16-20 age group (39.09%), while the lowest frequency is recorded in the 36-40 age group i.e (0.9%) as shown in Table 1

Table 1. Showing Age wise distribution of cases

In our current study 94 (85.45%) cases out of 110 cases had old tear suggesting towards previous sexual intercourse and 16 (14.54%) cases had a fresh tear suggesting of forceful sexual intercourse.

The current study's findings on the location of hymenal tears show that there is a broad distribution across various clock positions. The places of hymenal tears that were most common were at 6 o'clock (74.54%) and 9 o'clock (70%), suggesting that these areas had a higher prevalence. The three o'clock (64.54%), five o'clock (28.18%), and seven o'clock (18.18%) positions were also often occupied. Eight o'clock (8.18%) and eleven o'clock (13.63%) were less popular times. At places like 2, 4, and 10 o'clock, hymenal tears were seen in fewer than 5% of cases; at some positions, such 1 o'clock, the frequency was extremely low (0.9%). These results indicate that the lower half of the hymenal tissue, particularly the areas between 6 and 9, is where hymenal tears are most frequently found.

The study results reveal that 17 (15.45%) participants out of 110 cases had injuries present on their bodies, while the majority, 93 participants (84.54%), did not have any bodily injuries. This indicates that the occurrence of bodily injuries in the sample population is relatively low, with most participants showing no signs of such injuries.

Injuries to vulva and associated regions :-Labia Majora: Injuries were present in 19 participants (17.27%), while 91 participants (82.72%) had no injuries. Labia Minora: Injuries were present in 16 participants (14.54%), with 94 participants (85.45%) having no injuries. Fourchette: Injuries were reported in 5 participants (4.54%), while 105 participants (95.45%) had no injuries. Posterior Commissure: Injuries were found in 4 participants (3.36%), whereas 106 participants (96.36%) did not have any injuries. These findings indicate that the Labia Majora and Labia Minora were the most commonly affected areas, while injuries to the Fourchette and Posterior Commissure were less frequent.

Table 2. Showing injuries to vulva and associated regions

The study results as shown in table 3 regarding tenderness or bleeding reveal that 20 participants (18.18%) had tenderness or bleeding present, while the majority, 90 participants (81.81%), did not exhibit any signs of tenderness or bleeding

Table 3. Showing tenderness or bleeding in the cases

the majority of participants (61.81%) had no injuries, while the most commonly reported injuries involved contusions in the inner thigh region (10.90%) and ecchymosis over the inner thigh and labia majora (5.45%). Less frequent injuries included contusions and lacerations of the vulva and vaginal areas.

3 cases were found pregnant in the study. The study results on treatment as shown in table 4 reveal the following: 17

(15.45%) cases received treatment for the injuries present over the body and perineum, 93cases (84.54%) had no injuries as such thus no treatment was needed and MTP (Medical Termination of Pregnancy) was advised in 3. Cases (2.72%). These findings show that a minority of participants received treatment, while most did not. Additionally, MTP was advised for a small subset of participants 

Table 4. Showing treatment status of cases

The study comprised 110 patients. With 43 cases (39.90%), the age group of 16 to 20 years old had the highest number of natural sexual offense cases. These results are consistent with research by Arif M et al. Al (38.02%) [7]and Kaushik N et al. Al[8] (41.16%).This is because women in this age range are more prone to manipulation and are therefore more easily duped.

With regards to hymenal injuries, the findings are similar with Tamuli RP, Paul B. and Mahanta P 2013[9] (86%) cases with old tear and 6‘O clock position, Rongpharpi R, Mazumder A[10] with (22%) cases of fresh tear and (28.4%) cases with tear in 3‘O clock position. In women who have been deflorated but have not given birth, the hymen may be completely ripped, allowing for total penetration but leaving no visible sign other than the presence of semen. Signs of general violence in young children are frequently minor since they may not understand or resist the abuse. As a result of its deep position, the hymen in children is usually intact.

The most common injuries, including contusions in the inner thigh and ecchymosis over the inner thigh and labia majora, could point to areas typically affected by physical contact or trauma. The relatively lower frequency of injuries such as contusions and lacerations of the vulva and vaginal areas might suggest that penetration was not a primary factor in the incidents. These findings are in accordance with a study done by , Rongpharpi R, Mazumder A[10]with (14.8%) cases with bodily injuries due to sexual assault.

While injuries to the Labia Majora and Minora are more prevalent, tenderness and bleeding are not frequent, which may reflect varying degrees of trauma and the potential for non-penetrative assaults. The results emphasize the need for comprehensive examination and evaluation in cases of sexual assault, as physical injuries alone may not fully represent the extent of the assault experienced. [11]

The current study emphasizes the medico-legal implications of the range and pattern of injuries seen   among survivors of sexual assault. The presence, kind, and distribution of injuries offer important corroborating evidence when read in the proper clinical and contextual situation, even while the lack of injuries does not rule out  sexual assault. The type of assault, the level of resistance, the application of force, and the amount of time that has passed before an examination can all have an impact on variations in injury patterns. Accurate assessment, successful legal actions, and the provision of suitable medical and psychiatric care all depend on a thorough examination, prompt documentation, and a survivor-centered, trauma-informed approach. To improve forensic and therapeutic practice and deepen our understanding of damage patterns, more extensive and multicentric research is advised.

1.       World Health Organization. Guidelines for medico-legal care for victims of sexual violence. Geneva: World Health Organization; 2003.

2.       National Crime Records Bureau. Crime in India 2022. New Delhi: Ministry of Home Affairs, Government of India; 2023.Available from: https://ncrb.gov.in

3.       National Crime Records Bureau. Crime in India 2021 – Statistics on crime against women (State/UT-wise). New Delhi: Ministry of Home Affairs, Government of India; 2022.Available from: https://ncrb.gov.in

4.       Sarkar SC, Lalwani S, Rautji R. A study of victims of sexual offences in South Delhi. J Forensic Med Toxicol. 2005;22(2):45-49.

5.       Grossin C, Sibille I, Lorin de la Grandmaison G, Banasr A, Brion F, Durigon M. Analysis of 418 cases of sexual assault. Forensic Sci Int. 2003;131(2-3):125-130. doi:10.1016/S0379-0738(02)00378-0.

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7.       Arif M, Ahmed M, Hanif F. Natural sexual offences: medicolegal assessment in Punjab.Prof Med J. 2018 Dec;21(05):980-986. doi:10.29309/TPMJ/2014.21.05.2543.

8.       Kaushik N, Pal SK, Sharma A, Thakur GC. A retrospective study of sexual assaults inSouthern Range of Himachal Pradesh. Int J Health Sci Res. 2016 Feb;6(2):342- 351.

9.       Tamuli RP, Paul B, Mahanta P. A statistical analysis of alleged victims of sexual assault - a retrospective study. J Punjab Acad Forensic Med Toxicol 2013;13(1):7- 13

10.    Rongpharpi R, Mazumder A. A study of alleged rape victim cases in Dibrugarh District. Med Sci. 2016 Nov;5(11):10-12.

11.    Reddy KSN. Essentials of forensic medicine and toxicology. 35th ed. Hyderabad: K Suguna Devi; 2023