Racial disparity is a serious problem in the detection of injury during the forensic exam of sexually assaulted patients. Objective documentation of tears and abrasions to the external genitalia after sexual assault is an important part of the forensic exam. Victims with documented injury are more likely to have their cases moved through the criminal justice system, and these cases are more likely to result in a guilty verdict than cases lacking documented injury.
Unfortunately, the genital injuries experienced during sexual assault are often small and difficult to visualize on visual exam. The current standard of care is to use a 1% aqueous solution of toluidine blue dye to highlight areas of unhealed trauma on the external genitalia. This technique is highly effective for light-skinned women, but far less so for women of color, resulting in unequal adjudication of cases and rates of conviction.
This early stage translational research will lead to identifying a dye that will be effective on all skin colors. We plan to validate (in both mice and humans) a forensics product that deploys fluorescent dye and a widely available excitation/illumination lamp for visualizing tears and abrasion on dark skin. Two specific aims guide this study:
Aim #1: Identify a suitable fluorescent dye and validate it in a murine (mouse) skin injury model. Suitable dyes will be non-toxic, adhere to damaged epithelial cells, be easily visualized using equipment already in common use among forensic examiners, and will not interfere with subsequent forensic DNA testing.
Aim #2: Evaluate the safety, feasibility and efficacy of the identified fluorescent dye in women. Dyes identified as suitable from the first part of the study will be tested for safety in healthy women using skin on the forearm. The dyes will be applied to non-injured skin to ensure safety. They will then be used on the external genitalia of women within 48 hours after consensual penile-vaginal intercourse to test application procedures, ability to photograph injuries, ability to detect genital tears and abrasions, and safety (local skin irritation, patient reports of pain). These findings will serve to guide a subsequent, larger comparative efficacy trial of the identified dye.
The mouse component of the study will use 24 8-week old (adult) mice. For the human component, 50 women of color, aged 18 to 45, will be recruited in an attempt to obtain 34 with sufficiently dark skin for testing. ca/ncf