Sexual Assault & Diffuse Vaginal Wall Edema

     Since I'm still receiving emails asking me whether the Duke accuser's diffuse vaginal edema is consistent with sexual assault, I thought I write another post delving into that question a bit more. I can understand why the general public is having problems with this. Frankly, I am too.

   That's not to disparage anyone in any way. It's just that I know what I'm used to seeing and not seeing with these cases.

   Recently, I had the chance to ask a fellow colleague what she thought. She is a nationally certified forensics nurse with almost 15 years experience in this field, who hasn't been following the Duke case.

   I started out by asking her how she could recognize diffuse vaginal wall edema in a sexual assault case? She gave me this kind of dumb founded look, then asked the same question I've been asking myself all along: "How could you even see it?"

  This has been the crux of the problem for me all along. I kept asking myself how was this nurse able to see the edema? I never have - not by itself, without any redness or other signs. I kept thinking, there has to be something else, some other genital findings. Everything I've been reading though states otherwise. 

   Now I know there can be rape without any physical or genital injuries. In fact, in most rape cases there aren't any injuries.

   But the fact is, Sergeant Gottlieb specifically stated in his report that he asked if there were injuries consistent with a sexual assault and was told that the “blunt force trauma” seen in the examination “was consistent with the sexual assault that was alleged by the victim.”

   That "blunt force trauma" has apparently turned out to be only diffuse vaginal wall edema.* The media reports state that is the only genital injury listed besides rectal edema.

   Well, here's the problem: Edema, diffuse or otherwise, is not an injury. It is the body's response to an injury, an infection, or a disease or inflammatory process of some sort. It can be caused by any number of things.

   Edema is not a characteristic of blunt force trauma. Characteristics of blunt force trauma are: contusions, abrasions, and lacerations.

Localized Edema

   Localized edema is confined to an area. An example would be if you accidentally hit your thumb with a hammer. First there's going to be ungodly pain, followed immediately by redness. This redness is the first phase of the body's inflammatory response to an injury.

   Next comes swelling, then bruising. The swelling (edema) would usually be contained to the area surrounding your thumb. It's localized, easy to see, with a clear line of demarcation, separating the injured area from the non-injured area.

Diffuse Edema

   Diffuse edema is different. Diffuse means to spread out, to soften. It is poorly demarcated.  Localized edema is going to be seen much easier than diffuse edema. As I stated in previous posts, there also has to be redness first.

   I always see redness first. It's the first phase of the inflammatory response. So why was redness not listed along with the edema in the accuser's case?

   Speculum Exams

   When I do a speculum exam, I'm looking into the vagina, from the entrance, on back to the cervix at the end of this tunnel. On either side of the inner vagina are the vaginal walls.

   The cervix is a round, desensitized, dough nut shaped piece of tissue at the back of the vagina, with a teeny little hole big enough for sperm to fit through.

   Surrounding the inner vagina, are muscles that, once stimulated, provide strong contractions. Their purpose, besides pleasure during climax, is to propel the sperm up through the vagina.

   Since the vagina is acidic, sperm doesn't live too long, so it needs some help getting through the cervix and up to the uterus where it can fertilize an egg.

   The vaginal walls also have mucous cells, to lubricate, and elastin, to help it lengthen and expand. This helps in preparing a woman for intercourse, as well as aiding in childbirth.

   The normal color of the vaginal walls and cervix is pink. The color often becomes a deep cherry red if there is an infection present, along with a whitish or greyish discharge.

   In addition, the patient often complains of itching and discomfort. Actual injury to the vaginal walls, from a sexual assault, is rare. In my experience, inner vaginal pain has usually been caused by inflammation of the vaginal tissues due to infection, not injury.

  Everything I've researched, from my hardcover resources, to numerous studies and reports online, indicates that edema, alone, is not indicative of sexual assault.

   One study specifically excluded edema and redness as signs of sexual assault due to the fact that they can be caused by too many other things.

   Another study listed as causes of changes to the inner vaginal wall cells, including edema, to be such things as smoking, sex within 24 hours of the vaginal exam, tampon use, and frequent sex, stating:

"A positive association was also noted between high frequency of intercourse in the previous 2 weeks(of the exam) and the presence of a variety of atypical appearances."

   Other reports indicated that a delayed orgasm can lead to edema as well. Pre-orgasm, the blood vessels open up and the vaginal area becomes engorged.

   According to these reports, if the orgasm is delayed, then the release of the engorgement is also delayed.

    Medicines are another possible cause. The pharmaceutical information stated that delayed orgasm can be caused by Tricyclic Anti-depressants, or other medications with properties similar to them. Flexeril has properties similar to Tricyclic Anti-depressants.

   Both my esteemed colleague and I agreed that we would not have been able to see diffuse edema of the vaginal walls without some other signs as well.

   Neither one of us felt that diffuse vaginal edema, alone, without any other symptoms or injuries, would be indicative of sexual assault.

   One other thing we agreed on: Neither one of us would be willing to walk into court and state that it is. 

* Correction and clarification from earlier post   

   

   

   
   

   

   

Comments

[Mike]

it's also consistent with using a vibrator for clients before the party, and having sex with two men for a ride to the party. The whore is a slut.