Genital bleeding in prepubertal girls: a systematic review.

Introduction: This systematic review aims to collate evidence of the causes of genital bleeding, other than child sexual abuse and accidental injuries, presenting in prepubertal girls. It provides an update to the 2015 Royal College of Paediatrics and Child Health publication 'The Physical Signs of Child Sexual Abuse', an evidence-based review also known as the Purple Book.

Methods: MEDLINE, EMBASE and Scopus databases were searched for studies published between March 2014 and June 2023.

Identifying the prevalence of genital injuries amongst patients attending Saint Mary's sexual assault referral centre following an allegation of digital penetration.

This study aimed to (1) add to the limited evidence base regarding genital injury associated with digital vaginal penetration and (2) identify predisposing or protective factors to the identification of a genital injury. Data collection was performed retrospectively on the paper case files of 120 female adult (>18 years) patients alleging digital vaginal penetration with no penile vaginal penetration that had an acute FME at Saint Mary's Sexual Assault Referral Centre (SARC) Manchester. Descriptive statistics were used to investigate differences in the demographics of those reporting digital penetration, with and without injuries.

Use of SARC services by victims of sexual violence: Auditing the ethnicity of Saint Mary's Sexual Assault Referral Centre's clients.

Introduction: Saint Mary's Sexual Assault Referral Centre (SARC) in Manchester provides services to adults and children who have suffered sexual assault. The ethnic composition of those who attended the centre was audited in 2001 and 2003 to measure how well it serves different ethnic groups. This paper provides an updated audit using 2019 data.

Otolaryngology contribution to the care of patients following non-fatal strangulation in the settings of alleged sexual assault.

Background: Non-fatal strangulation as a consequence of a sexual assault attack or domestic violence represents serious bodily harm. Otolaryngologists have an important role in documenting physical findings and managing airway symptoms. This study aimed to describe our otolaryngology department's experience managing patients referred from the sexual assault referral centre who suffered non-fatal strangulation.

Exploring the similarities and differences amongst service users with and without learning disabilities attending Saint Marys Sexual Assault Referral Centre.

Background: People with learning disabilities are over-represented amongst Sexual Assault Referral Centre service users. This work aims to explore the similarities and differences between service users with and without learning disabilities.

Method: Medical notes of 52 service users likely to have a learning disability were compared with 52 service users not likely to have a learning disability (according to the Learning Disability Screening Questionnaire); all of whom attended Saint Marys SARC for a forensic medical examination during a 12-month period.

The impact of COVID19 pandemic and government enforced lockdowns on levels of attendance and context of sexual assaults reported at Saint Marys Sexual Assault Referral Centre.

Globally, government enforced lockdowns were one measure introduced to reduce the transmission of COVID-19. The impact of these social movement restrictions on victims of sexual assault and their access of sexual assault services needed clarity. This study aimed to understand the impact of COVID-19 pandemic lockdowns on: Sexual Assault Referral Centres (SARC) attendance; characteristics of clients; characteristics of alleged perpetrators and nature of sexual assaults.

Top 10 priorities for Sexual Violence and Abuse Research: indings of the James Lind Alliance Sexual Violence Priority Setting Partnership.

Objectives: To establish a James Lind Alliance (JLA) Priority Setting Partnership (PSP) to identify research priorities relevant to the health and social care needs of adults with lived experience of recent and/or historical sexual violence/abuse.

Participants: Adults (aged 18+ years) with lived experience of sexual violence/abuse (ie, 'survivors') were consulted for this PSP, alongside healthcare and social care professionals who support survivors across the public, voluntary, community, independent practice and social enterprise sectors.

Methods: In line with standard JLA PSP methodology, participants completed an initial online survey to propose research questions relevant to the health and social care needs of survivors.

Identifying the prevalence of genito-anal injuries amongst clients attending St Mary's Sexual Assault Referral Centre following an allegation of anal penetration.

Background: There is a lack of clarity around the prevalence of anal injuries sustained following anal penetration. The aim of this study was to identify the prevalence of injury amongst clients attending Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK following anal penetration and identify predisposing or protective factors such as age, sex and pubertal status. This should facilitate an evidence-based approach to providing evidence statements in court for allegations of anal penetration.

Repeat attenders are disproportionately vulnerable: An exploration of revictimisation at Saint Mary's Sexual Assault Referral Centre.

Background: Being a victim of sexual assault is linked to many psychological and physical health problems. Experiencing one episode of assault is a risk factor for revictimisation. Saint Mary's Sexual Assault Referral Centre (SARC) provides aftercare for clients in Greater Manchester and Cheshire who have suffered sexual assault and rape, with physical, psychological and sexual health services.

'I thought he was going to kill me': Analysis of 204 case files of adults reporting non-fatal strangulation as part of a sexual assault over a 3 year period.

Background: There is growing awareness internationally around the prevalence and dangerousness of non-fatal strangulation (NFS). The aim of this study was to: (i) identify the prevalence of NFS in patients presenting to the Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK for an acute forensic medical examination (FME) after a report of rape or sexual assault, (ii) explore the characteristics of patients reporting NFS compared to those who did not and (iii) explore the prevalence of various symptoms and signs associated with NFS.

Method: Data from case files of all patients attending in a three year period, January 1, 2017 to December 31, 2019, were analysed.

Sex workers reporting rape: Understanding their vulnerabilities to improve their care. The characteristics of sex workers who attend Saint Marys Sexual Assault Referral Centre.

In the UK it is estimated that there are at least 70,000 sex workers, however, relatively little is known about who these people are. The Crime Survey for England and Wales estimated that 1 in 5 women have experienced sexual violence.(Flatley, 2018) 1 However, there is little known about sex workers who access sexual assault referral centres services.

Minimising trauma in staff at a sexual assault referral centre: What and who is needed?

Introduction: This study investigates staff's perspectives on the characteristics required to work in a sexual assault referral centre and the support and training they believe sexual assault referral centres should provide to minimise the negative impacts of the work and provide a supportive working environment.

Methods: Semi- structured interviews were conducted with 12 staff, and a focus group was held with a further four staff of a sexual assault referral centre. The data were examined using thematic analysis.

The high prevalence of pre-existing mental health complaints in clients attending Saint Mary's Sexual Assault Referral Centre: Implications for initial management and engagement with the Independent Sexual Violence Advisor service at the centre.

Background: The Saint Mary's Sexual Assault Referral Centre has a unique service delivery model whereby it provides an integrated physical and psychological support services to clients, women men and children, living in Greater Manchester. The service is available to those who have reported rape or sexual assault, whether this is recent or historic. Clients living in surrounding areas of Cheshire are provided with forensic and medical services at Saint Mary's Centre, with follow-up care provided locally, as appropriate.