Although some authors have used the term injury pattern
to describe genital injury (Olusanya et al., 1986
; Slaughter et al., 1997
), they primarily are defining injury pattern
as prevalence and location. I propose a definition of injury pattern
that is much broader and includes genital injury prevalence, frequency, location, severity, and type. To further explicate the definition of genital injury pattern
, genital injury prevalence
is defined as the proportion of women with an occurrence of injury as calculated from injury frequency. Genital injury frequency
is defined as the number of injuries counted by examiner during each aspect of the examination: visual inspection, colposcopy, and contrast medium application. Genital injury location
is defined as the anatomic site of injury and includes the external genitalia (labia majora, labia minora, periurethral area, perineum, posterior fourchette, and fossa navicularis), internal genitalia (hymen, vagina, cervix), and anus (rectum). Genital injury severity
is defined as the area and degree of injury.
Finally, genital injury types are described as tears, ecchymoses, abrasions, redness and swelling, or TEARS (Slaughter et al., 1997
; Sommers et al., 2001
are defined as any breaks in tissue integrity, including fissures, cracks, lacerations, cuts, gashes, or rips. Ecchymoses
are defined as skin or mucous membrane discolorations, known as “bruising” or “black and blue” areas because of the damage of small blood vessels beneath the skin or mucous membrane surface. Abrasions
are defined as skin excoriations caused by the removal of the epidermal layer and with a defined edge. Redness
is erythemous skin that is abnormally inflamed because of irritation or injury without a defined edge or border. Swelling
is edematous or transient engorgement of tissues. Other authors have reported injury classification systems. One group of investigators proposed a different injury typology (nonperforating soft-tissue injury, lacerations, or current bleeding) (Biggs, Stermac, & Divinsky, 1998
); however, the TEARS classification is the most commonly used and at this point is the classification most likely to provide comparable data across studies.
Why a common definition? A common definition for genital injury pattern
has the potential to guide research methods so that all investigators begin to measure genital injury using the same parameters. Thus, studies across consensual and nonconsensual populations will become comparable, and injury science will advance. Measurement strategies are available for injury prevalence, frequency, location, and type. Although further work needs to be done on injury severity, several authors have attempted to classify injury severity (Penttila & Karhumen, 1990
; Tintinalli & Hoelzer, 1985
), and our investigative team (Sommers et al., 2006
) is working on a rigorous quantification of injury severity.