Comparison of Methods for Identifying Ano-Genital Injury After Consensual Intercourse

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The purpose of this report is to compare consensual intercourse related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy and 3) toluidine-blue contrast application.


Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling).


Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p


The scientific community needs to continue to build information about ano-genital injury prevalence following consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic examination. It is the healthcare provider’s role to collect all possible evidence and the courts’ role to determine what evidence is admissible and to ensure a rightful conviction.