Using CO~~OSCO~Y in the Rape Exam: Health Care, Forensic, and Criminal Justice Issues In the setting of a forensic examination followiiig rupe, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved f o r victims of child abuse has been used across the lijespan and has been shown to idetitijy genital injury in up to 87% of women who have been raped. findings as evidence in court testimony, however, remains controversial. This puper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape. i The role of colposcopic Key words: co1puscopy:forenric examination; genital injury; rape, se.wal assault, forensic nnrsing Marilyn Sawyer Sommers Bonnie S. Fisher Heather M. Karjane he National Violence Against Women (NVAW) survey found that an estimated 876,000 rapes are perpetrated against women annually in the United States (Tjaden & Thoennes, 1998). Criminologists. law enforcement offi- cials, victim advocates. and health care providers have developed strategies to mitigate and respond to the epidemic of rape and hold aggressors account- able for their crimes. One strategy that shows promise is to develop protocols for a competent and objective forensic examination following rape or sexual assault. The terms “rape” and “sexual assault’’ are used interchangeably in the social and health sciences to refer to forced sexual intercourse with coer- cion with one noted exception, the National Crime Victimization Survey (US. Department of Justice, 2003). For consistency in terminology, we will use the term “rape” throughout this paper as defined in Table I (see next page). Colposcopy is a procedure that allows a health practitioner to perform a magnified visual inspection of the internal and external genitalia in the context of a standard gynecologic exam. It allows the user to identify and photograph microscopic injury as well as bruising, tears, abrasions, and lacer- ations that may occur during rape. Although long used to evaluate sexual abuse in children (Adams, Harper, Knudson, & Revilla, 1994; Hohbs, Wynne. & Thomas, I995), more recently examiners have begun using it during the forensic exam for adoles- cent and adult women (Crowley. 1999; Slaughter, Brown, Crowley, & Peck, 1997; Sommers, Schafer, Zink, Hutson, & Hillard, 2001). Many issues exist, however, in the use of colposcopy during the forensic examination, and more specifically, in its application to the United States health care and criminal justice sys- tems. For example, what differences exist in the severity and location of injuries following consensual sexual intercourse as compared to rape? What role does documented injury play in the various decision-makin2 points in the American criminal justice system’? What are the potential unintended con- sequences for the use of colposcopy for adult women who are raped when no demonstrable injury is found? What is the role of colposcopy in court testi- mony’! The purpose of this article is to analyze the role of colposcopy in the forensic rape examination of adoles- ,- --.-. ___-_~ Marilyn Sawyer Sommers, PhD, RN, FAAN, is u Pr(qessur irnd Assuciiite Dean, University ($ Cincinnati. ColleSe r$iVursiny. Cincinnati, OH. Bonnie S. Fisher, PhD, ib a Professor, (iniwrsity uf Cincinnati, Divisioii uf Criminal Justice, Cincinniiti, OH. Heather M. Karjane, PhD, is u Pruject DirectorlResearch Scientist, Education Der,elopnwnt Cenler, Inc., Center for Holerice & Injq Prevention. Newton, iMA. Note: This manuscript wus witten in conjunction with grant ROINR05352. .sponsurd by the National lnsritute of Nursing Research. Acknowledgment: The aut1zor.s appreciute the review. commentary. and critique provided bv Katherine Pridemore. Spring 2005 - Volume l/Nurnber 1