Sexual assault in postmenopausal women: epidemiology and patterns of genital injury.

STUDY OBJECTIVE: Physical abuse of older women, including reports of sexual assault, has risen rapidly for the last decade. The purpose of this study was to compare a group of postmenopausal victims of sexual assault with younger adult women (18-39 years old) by examining patient demographics, assault characteristics, and patterns of physical injury. METHODS: We conducted a retrospective cohort analysis to assess epidemiology and anogenital injuries in consecutive female victims presenting to sexual assault clinics and/or emergency departments within 3 counties of Western Michigan. All patients were examined by forensic nurses trained to perform medicolegal evaluations using colposcopy with nuclear staining. Patient demographics, assault characteristics, and injury patterns were recorded using a standardized classification system. Data from 2 patient groups (women aged 18-39 years vs postmenopausal women >or=50 years) were compared using chi(2) and t tests. RESULTS: During the 5-year study period, 1917 adult sexual assault victims met the inclusion criteria and comprised the study population as follows: 84% of the victims were 18 to 39 years old, and 4% were postmenopausal women at least 50 years old. The 72 postmenopausal victims were more likely to be assaulted by a single assailant, typically a stranger (56% vs 32%, P = .008), in their own home (74% vs 46%, P < .001) and experienced more physical coercion (72% vs 36%, P < .001). In comparison, the younger control group was more likely to have used alcohol or illicit drugs before the assault (53% vs 18%, P < .001) and have a history of sexual assault (51% vs 15%, P < .001). Postmenopausal victims had a greater mean number of nongenital (2.3 vs 1.2, P < .001) as well as anogenital injuries (2.5 vs 1.8, P < .001). The localized pattern and type of physical injuries were similar in both groups, although postmenopausal women tended to have more anogenital lacerations and abrasions. CONCLUSION: The postmenopausal woman is not immune from sexual assault. The epidemiology of sexual trauma in this age group is uniquely different when compared to younger women, which may be useful in planning intervention and prevention strategies.