Significance of toluidine blue positive findings after speculum examination for sexual assault

• Published in: The American journal of emergency medicine Vol. 22; no. 3; pp. 201 - 203
• Main Authors: Jones, Jeffrey S, Dunnuck, Chris, Rossman, Linda, Wynn, Barbara N, Nelson-Horan, Cathy
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.05.2004; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aqueous solutions; Biological and medical sciences; Coloring Agents; Colposcopy - methods; Colposcopy - nursing; Confidence intervals; diagnosis; Digital cameras; Emergency medical care; Emergency Nursing - methods; Emergency Nursing - standards; Emergency Treatment - methods; Emergency Treatment - nursing; Emergency Treatment - standards; examination; Female; Forensic Medicine - methods; Forensic Medicine - standards; Forensic sciences; genital injuries; Humans; Injuries; Intensive care medicine; Lacerations - diagnosis; Lacerations - etiology; Medical personnel; Medical sciences; Michigan; Middle Aged; Nursing Evaluation Research; Observer Variation; Perineum - injuries; Photography - methods; Photography - standards; Pilot Projects; Prospective Studies; Rape; Rape - diagnosis; Sensitivity and Specificity; Sex crimes; Sexual assault; Skin; Specimen Handling - methods; Specimen Handling - nursing; Specimen Handling - standards; Surgical Instruments; Tolonium Chloride; Toluidine; Vagina - injuries; Victims of crime; Vulva - injuries; Michigan; diagnosis; genital injuries; Toluidine; sexual assault; examination; Intensive care; Sexual abuse; Victimology; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2004.02.010

To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 × magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury—an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.