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Author Topic: Forensics
concerned1
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Some of you may find this question disturbing, so I apologize in advance. (But I've been quite preoccupied by this concern, so I have to ask.)

...I've watched a lot of crime shows in which forensic investigators are able to establish whether sex was consensual or not, (whether rape took place) based on the presence of minor abrasions sustained by vaginal tissue (during active resistance of penetration).
Since I've undergone a vaginal delivery, I'm aware of some anatomical changes in my genitalia. Namely, that the size, shape, color, & other identifiable characteristics are drastically different now than they were prior to giving birth.
In conducting research online, I'm aware that the cervix is permanently altered by childbirth, so I suppose it makes sense that my external genitalia was altered as well.
Basically, my main concern is that if I were ever raped, my own body wouldn't leave behind any detectable evidence. That is to say that my tissue has already been so damaged (the pigmentation now being permanently darker), that I can't imagine it could be harmed, marked, nicked, or otherwise burdened by an unwelcome penis (when it has obviously endured a burden of a far more significant nature).
Am I right to be concerned? ...Could it be true that my tissue is so well acquainted with trauma (including a 3" episiotomy & subsequent surgical repair), that rape no longer qualifies as burdensome?
(My theory is that my body is not capable of recognizing forced penetration as a form of trauma since my skin/connective tissues/muscles-in-general will be far less resistant than that of a female who hasn't undergone a vaginal delivery.) And just in case it's pertinent, I'd like to add that I read online that physicians in general exclude women who've given birth from candidacy for hymenoplasty procedures (the obvious conclusion being there's medical consensus that this category of females is 'damaged beyond repair.')
I tried to find information elsewhere online about this topic before asking, & since this is a common forensic investigation technique, I'm kind of surprised I wasn't able to locate any information... perhaps others find this topic too disturbing for discussion as well?!

Thanks in advance for any insight/feedback you might be able to offer!

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Heather
Executive Director & Founder
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You know, a study just came out a week or so ago about this that showed what a lot of us who know a lot about anatomy were not at all surprised about. In a word, it collected data that showed that there wasn't any real difference between findings in exams for women after consensual sex than what tends to be found with most sexual assaults.

In other words, unless we're talking about very young victims, or highly violent assaults (which are the least common kind), childbirth or no, the vulvas and vaginas of people who had had consensual sex show similar things as those who have been assaulted, so things like moderate vaginal abrasions aren't likely sound when it comes to these kinds of forensics regardless. And you also probably don't need me to tell you that crime shows -- like any television dramas -- aren't sound sources for this kind of information in the first place.

As well, evidence collection in rape isn't about proving a rape was "burdensome" or not to a victim. It's about trying to gather things -- like semen, a far more useful bit of evidence -- to support a case.

What I'm not understanding is why you're feeling so concerned about this. Want to talk about that?

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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concerned1
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Thanks for your response.
...I guess I'm concerned because I was a bit shocked by the permanent changes to my genitalia following childbirth, and I was wondering if these changes could be detrimental to me in any way(?) (Apart from the obvious downgrade in my sex life as a consequence of friction loss, though this is not considered a medical concern.) I've come to understand that such changes are not universal, & in my case, genetic elasticity likely played a role in my poor recovery. (Btw, it's been yrs since the delivery--so this reaction is to permanent changes, not temporary ones.) As far as the television shows are concerned, I should have clarified that I didn't mean fictionalized content, but actual crime scene investigations for the discovery network & other such science-based programs. The content did clarify that it was possible to sustain abrasions through consensual sex, but that it is less likely to occur (due to relaxation, lubrication, etc.)--and that when a victim is deceased the presence of such abrasions (as opposed to their absence)--is potentially an indication that the intercourse was not consensual. (At least the opposite, lack of damage, is frequently used to conclude that intercourse was either consensual, or may have taken place after the victim was deceased & therefore less likely to sustain tissue trauma since the muscles can not actively resist.) Of course it's not foolproof, as you pointed out. But the notion that vaginal tissue is damaged every time consensual sex occurs, doesn't really make much sense. Especially given the fact that the vaginal canal is not only designed to accommodate sexual penetration, but childbirth.

To my mind, it's just common sense that my tissue will likely never be "damaged" from this point on--consensual or not, and I was curious as to whether this is the correct conclusion to make? (There's very little acknowledgement in the medical community that childbirth may cause permanent damage, apart from the tiny concession regarding hymenoplasty, & some degree of concession regarding multiple deliveries and their role in pelvic prolapse.)

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Heather
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Can I ask how old you are and how old you were with your pregnancy? One reason I ask that is that the vulva also changes a lot in puberty in ways a lot of people don't expect, and also keeps changing through life in different stages.

In other words, we'd expect things like some darkening of genital tissue, and the mons pulling back (which make the inner labia look larger), labial growth, etc. through the teens and 20s. With or without pregnancy or childbirth. That said, in OB/GYN circles, I haven't seen a denial of how childbirth and pregnancy can change bodies, including the genitals, that it sounds like you have experienced. Because of course, either or both of those things can and do sometimes create changes, too.

With television, I'd still remember TV is TV. It's not a science class, really. And like I said, that study that came out a week or so ago is very current information: not info you're likely to get on TV unless we're talking about breaking news.

The idea that vaginal tissue is "damaged" with EITHER consensual or nonconsensual sex is problematic, and that's not actually new information. Intercourse, of any kind, can cause some abrasions, especially when enough lubricant isn't used or the person with a vulva isn't fully aroused, both of which are very common even with consensual sex. But minor abrasions, whatever the cause, would not be something we'd call "damage."

So, it's tough to answer that last question there, because you're asking about a framework that isn't sound in the first place.

But again, I'm wondering what you think this concern is all about. Are you feeling very concerned you are going to be assaulted, and that the only way to prove that happened is from vaginal injury? If so, where do you think these persistent fears of assault are coming from?

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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concerned1
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I'm not super concerned about an assault, I realize the likelihood such a tragic event could occur is pretty slim.
I was 18 at the time of delivery.
As far as the medical community not acknowledging changes to genitalia, they have acknowledged cervical changes, but otherwise claim you "can not tell by looking" whether a woman has given birth or not. This is, at least in my case, absurd. (Like I said, to put it diplomatically rather than crudely, there isn't a single component of my external genitalia that remotely resembles my pre-birth state.) Secondly, ALL of the childbirth educational material I was exposed to was like a broken-record in terms of 'the vagina returns very nearly to it's pre-birth state' mantra. And lastly, online forums (like this one), regularly claim that there's essentially no such thing as delivery-induced vaginal laxity, because the vagina is a muscle designed to expand & retract & all that jazz... they seemingly conveniently forget to point out that 'muscle' is only one component of vaginal structure--you also have other sorts of tissues functioning as connective tissue, multiple superficial skin layers, etc.--all of which don't expand & contract as readily as muscle alone would. Obviously the organ has some suitability to childbirth considering the infant eventually emerges from this area--but I'm amazed at how often it's overlooked/ignored that it does so by (occasionally/frequently?) inflicting severe trauma/irreversible damage.

In any case, I suppose I am just frustrated about having been, for all intents & purposes (despite all of my pre-labor research), ill-informed & ill-prepared by the medical community for these sorts of changes. We cannot chalk them up to puberty/etc., because they are in no way, shape or form the subtle changes you would expect from growth/hormones/& the like. ...My feeling is that had I been properly informed, I would have sought termination (in the event that elective cesarean wasn't an option; & according to my physician, it wasn't)--as a means of sustaining vaginal integrity. (I suppose it's one thing if you're married for ten years & ready for this sort of permanent punch to your sex life, but given my age, my sex life had barely even begun by the time it was forever altered. Naturally, I find this terribly unjust and disturbing.)
I think we, as women, owe it to other women in general to adequately prepare them for these sorts of unanticipated events (if we've endured or witnessed them ourselves). As it stands, nobody did me that favor. I guess I had hoped by openly discussing the consequences of childbirth in a public format, other women could be more adequately prepared to accept unforeseen consequences. (Even, and especially, if those changes are going to be detrimental to her in some way.--As they would if she were no longer a viable candidate for proving non-consensual intercourse.) The presence of semen only proves sex occurred. As it stands, the only means of inferring consent vs. non-consent--in the absence of testimony--is damage to vaginal tissue. Consequently, tissue that has become incapable of sustaining further damage doesn't really benefit anyone; at least not in this (hopefully unnecessary) regard.

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Heather
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You know, this isn't really my area of focus (I do teach sexual anatomy here and elsewhere regularly, including to medical students a couple times a year, but generally do so talking pre-birth or pregnancy), and I'm not sure what, if any study has been done on this at all, but I'd make an educated guess that for pregnancy and delivery during times of life when hormonal/genital changes and/or development are already going on, the chance of there being more profound changes to the body due to pregnancy and/or delivery would be higher. Again, just a speculation, but I'd say it's a logical one.

You know, around here, what you might notice is that when people are asking about huge vulval or vaginal changes, for themselves or others, what we generally say is that SPARING pregnancy, vaginal delivery or injury, such as through very violent sexual assault, changes usually tend to be more subtle. (We do not claim childbirth or pregnancy does not have the capacity to change any part of the body, nor do our staff say vaginal changes aren't possible or aren't real.) I have no idea if that's the way any of this is talked about at other forums or not: this is the only forum I manage and it takes so much of my time, I don't look at other forums at all, really. But I know that that's also the kind of language and framing I tend to hear with my colleagues and friends in repro/sexual health, too.

That said, it sounds like my experiences as someone working in the field and your experiences as a patient have been pretty wildly different. Not a huge surprise, and I also suspect that it's possible that as happens all too often with younger/teen pregnant women, you might have experienced some discrimination, too, which can sometimes manifest in being given less information and less options. [Frown]

I also want to add that when it comes to investigating rape, something I know a lot more about than the speculations I was making up top, the idea that vaginal injury is THE big or only evidence or way to support a case strikes me as incorrect, strongly so, especially when, as I already mentioned, we know that in the majority of rapes, rape is not violent in the way that causes vaginal injuries to begin with. That -- and not just due to that study I brought up, which like I said, was likely no news at all to those working in this area -- is only one of many things that can be used to support a case, and rape cases hinging on that in 2012 would be pretty unlikely in my experience.

THAT all said, it sounds like you, very understandably, are still feeling really upset about the vaginal and/or vulval changes you've experienced over the last couple of years, which sound like are certainly related to, and possibly caused by, changes during pregnancy and childbirth, and how much so at this point likely only matters so much. Caveat: it can sometimes take people's bodies several years to recover from pregnancy and childbirth, after all, there's really no bigger change to the body any of us can experience in life, sparing death and very serious whole-body injuries or illnesses.

Do you have/have you found an OB/GYN who you DO think is addressing all of these issues with you well? As you know, this is complex stuff (including what changes this is creating in your sexual life, usually a much bigger issue than just the state of genitalia), and it sounds like you still haven't felt well-served by a healthcare provider. It also sounds to me like that's well overdue.

[ 04-08-2012, 10:50 AM: Message edited by: Heather ]

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me • Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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concerned1
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Yeah, I'd say I wasn't particularly well served... but at this point, I no longer have any recourse because all repairs to my vaginal/vulval area, barring pelvic prolapse, would be considered cosmetic. The fact that my self-esteem & sex life have been destroyed by excessive laxity is not a medical concern worthy of insurance-funded repair. The only exception would be if my organs were falling out, without that level of dysfunction (which usually takes more than one delivery), I am simply out of luck.
I did address these issues with my OB/GYN early on, but being so young I was neither articulate nor very demanding and consequently she was dismissive. When I complained about these changes, her response was to refer me to another provider for a second opinion, even though she was aware that a couple of my stitches had separated post-delivery. So rather than delving into a new surgical procedure to repair the original repair, I was given ointment in the hopes that it would aid my body in a natural recovery. By the time I met with the provider she referred me too, I was so upset by the excess laxity that I had trouble maintaining my composure. This, of course, caused that provider to assume I was psychologically unstable and that this supposed instability, rather than the shocking changes to my anatomy, was my problem. She wanted to know if I'd been raped or molested and so on because I couldn't possibly be upset that my own genitalia had been replaced by parts unrecognizable. When I insisted that I had not been assaulted in any way she proceeded to tell me that's just what happens when women give birth.

In subsequent years I've come to believe that her comments weren't fully accurate, as all of my friends have gone through multiple vaginal deliveries and do not have the kinds of problems I've endured after one. At this point, it would seem to me that the most significant factor influencing recovery outcome is the genetic elasticity of skin. Unfortunately, I did not know what my genetic proclivities were beforehand. Unlike my friends, I did not hit the genetic jackpot and I'm very disappointed that health care providers assume I deserve to suffer unpleasant consequences just because I allowed myself to give birth. It's hard to imagine that if a man's penis were suddenly 1/10th of it's original size, health care providers would brush it off. I suspect the main effort would be to help him recover his "manhood," and very few people, if any, would expect him to carry on as though nothing were wrong. However, since I belong to the gender responsible for birthing children, it's just assumed that I should be willing to suffer whatever harm those births may (or may not) inflict. Luckily, it seems unusual for women to endure harm as extensive as mine; nevertheless, I would not have consented to undergo delivery had I been properly warned.
I've thought about seeing my original OB/GYN about the problem yet again, but knowing she was unwilling to sew me up at only 6-wks postpartum, (when the damage was still recent), she certainly wouldn't be willing to undertake surgical repair after several years.
In addition, I was extensively evaluated by a urologist because my bladder was simultaneously destroyed, yet, once again, I was informed that my organs are all in place and there is therefore no medically justifiable reason for intervention. Apparently my only hope is to come up with many thousands of dollars to repair something that would not have been damaged in the first place if I'd had any say in the matter. ...I don't belong to a socio-economic class that permits this kind of expenditure, and I am therefore apparently doomed to suffer a rather miserable sex life.
It's too bad that vaginal tone, in and of itself, can't be construed as a medical concern. To my mind, I should have the right to enjoy myself in the same fashion that men are prescribed drugs and otherwise treated for erectile dysfunction (as though it were a legitimate illness). I wish I could be afforded the same respect. Oh well. Not much I can do at this point apart from making sure other women are well informed. We need to stop repeating that women's sexual organs are not permanently damaged by childbirth as though it's some kind of holy mantra. It's dishonest.
I'm just trying to do my small part to ensure other women don't throw their right to satisfying intimacy out the window while they're still teenagers.-->For anyone who hasn't given birth yet, it's not too late to avoid this life-sentence!

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Heather
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While I think we have to be very careful doing things like calling vaginal injuries -- from anything -- a life-sentence (and perhaps remember some of us have had genital injuries in life, like you, for various reasons, and that view isn't something we share or want assigned to us, if you get me), I completely understand how you're feeling, and I also am in agreement with you about what sounds like a lot of very problematic care for you throughout.

And I most certainly understand why you feel sad and angry, and that that's about more than just one thing.

While it may well be that no healthcare provider could have known you'd have these issues -- in other words, from the sounds of things so far, before your delivery, I'm pretty certain no one could have -- I, too, don't think it sounds like you've been well-served after-the-fact, and while I don't think genital injuries = a death sentence for a sex life (I say this professionally, but also quite personally), I also agree with you that a woman's sexual life and genitals are and should be seen as vital and important, not as anything to be dismissed or just assigned as unimportant once/if she's a mother. And even though we know, any of us who work in these fields, that pregnancy and delivery can pose a host of unexpected outcomes -- and hopefully you were at least given THAT message by a healthcare provider or even a basic pregnancy book when you first became pregnant -- and I certainly hope that becoming pregnant and choosing to remain so WERE choices you made yourself, rather than things you were not given a say with, that certainly doesn't mean that when any of those outcomes happen, the person they're happening to should magically be hunky-dory or that those outcomes shouldn't be thoroughly addressed with that person by their doctors.

That all said, I would make sure -- and I understand this is very loaded for you, so might not be easy -- that you have seen someone you know is a very good care provider to evaluate all of this for you before you, yourself, write it all off in terms of care. I'd sure hate to see you left feeling like this when you don't have to, whether we're talking about surgery, qualified emotional support and therapy, or both, okay?

While I don't know how much else I can do save helping you, if you want it, to find a good OB/GYN to evaluate this, which I'm happy to do, if you want to talk more, I'd be glad to do that. I'd just want to remind you if we do that yet again, for a host of reasons -- including remembering you're not the only one here with genital injuries or other issues which can pose challenges to a sex life, and a message to people with injuries, trauma or disability that those things = a miserable sex life isn't one we can get behind on the whole, nor does it represent everyone in these spots soundly -- to be mindful of being in a larger community for this discussion, okay?

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me • Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
Executive Director & Founder
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(Just a P.S. I do want to emphasize the import of that line I'm trying to hold around how you talk about this here: earlier today I got more than one email/mod alert from people in similar situations -- with sexual disability of some kind -- feeling pretty triggered by this. I'm sure we can find a way to talk honestly about these issues without assigning personal experience to others and while recognizing that not everyone with genital injuries and/or any sexual disabilities feels the same ways as one person with them.)

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me • Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
Executive Director & Founder
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One more by the way, sorry: if I'm getting right that you're in Washington state, I can absolutely help you find an excellent OB/GYN to evaluate this for you well. I'm very well-networked here with repro/sexual healthcare providers and I'm sure I could help you find someone great.

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me • Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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concerned1
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Thanks for the offer, I really appreciate it.
...But I do live in a smaller town (not Seattle), so I imagine I'd have quite the commute in store?
Secondly, so what if the problem is confirmed? ...If the medical community doesn't actually consider excessive laxity a "health risk," how on Earth can we convince an insurance company to fund the repair?
So far as I've learned, all "repairs" require problems resembling pelvic prolapse, rather than improperly stitched & poorly healed episiotomies(?)
(Those repairs are "elective.")

I'm not quite sure what to say about the fact that my writing, about my feelings, about my body, is somehow offensive to others. But I would suggest that censoring me isn't the answer. ...Self-censorship needs to be practiced by easily disturbed individuals-->perhaps they should avoid reading forums that deal with sensitive topics?
Furthermore, if the if the issue is painful to discuss/read about, imagine how painful it must be to be the actual owner of it!

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