Abstract
Background: Partial or complete failure to maintain an erection sufficient for coitus
is known to occur in a proportion of sexual assailants during the rape episode. Objective:
The purpose of this study was to determine whether the presence of coercion, physical
violence, and genital injury associated with sexual assaults is influenced by the
assailant's erectile impotence. Methods: This prospective, observational study evaluated
consecutive female patients presenting to a free-standing urban sexual assault clinic
during a 3-year study period. Sexual assault victims presenting directly to four downtown
emergency departments (EDs) are routinely referred to the clinic for evaluation after
triage and initial assessment. The clinic is associated with a university-affiliated
emergency medicine residency program and is staffed by forensic nurses trained to
perform medical-legal examinations. The primary outcome was to compare the frequency
of anogenital findings documented in women whose assailant experienced no erectile
dysfunction vs. those victims who reported erectile impotence in the assailant. Results:
During the study period, 569 sexual assault victims were eligible to participate in
the study; 47 (8.3%) reported that their assailants had experienced erectile impotence.
Except for assailant age, the two victim groups were comparable in terms of marital
status, alcohol and drug use, known assailant, and time to physical examination. In
attacks where erectile dysfunction occurred, there was a higher incidence of physical
coercion (60% vs. 32% without physical coercion, p < 0.001) and subsequent non-genital trauma (72% vs. 46%, respectively, p < 0.001). Thirty-two women (68%) had documented anogenital trauma despite the assailant
having erectile dysfunction. There was no significant difference in the overall pattern
of anogenital injury between the two groups (χ2 = 9.1, p = 0.036). Conclusion: Erectile impotence occurred in up to 8% of sexual assailants
during the rape episode. Despite this erectile dysfunction, the majority of sexual
assault victims sustained anogenital trauma. In the attacks with erectile impotence,
there was a higher incidence of intra-rape violence and subsequent non-genital injuries.
Keywords
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Article info
Publication history
Published online: February 23, 2009
Accepted:
September 27,
2008
Received in revised form:
September 17,
2008
Received:
July 19,
2008
Footnotes
Financial support was received from the Blodgett Butterworth Foundation, Grand Rapids, MI.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
