Vaginal lacerations from consensual intercourse in adolescents

Objective

(1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.

Methods

We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock.

Results

Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall.

Conclusions

Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation.

Practice implications

Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences.     

The Relations of Parental Characteristics and Practices to Children''s Vicarious Emotional Responding

We examined the relation of parental empathy-related characteristics and emotion-related child-rearing practices to third and sixth graders' vicarious emotional responding. Children's heart rate, skin conductance, facial, and self-reported reactions to a sympathy-inducing film were assessed, as were their dispositional sympathy, empathy, and self-monitoring. Parental sympathy was positively related to low levels of personal distress in same-sex children and, for both parents, with sons' dispositional sympathy or empathy. Parental emphasis on problem-focused coping strategies when their sons were anxious was positively correlated with indexes of sons' situational and dispositional sympathy. Same-sex parental restrictiveness in regard to the control of inappropriate, hurtful emotional displays was associated with sons' and daughters' dispositional and situational sympathy, whereas maternal restrictiveness in regard to emotions that are unlikely to hurt others was correlated with nonverbal indexes of personal distress and self reports of low distress. Parental emphasis on control of the child's own negative emotion was associated with children's self-monitoring.     

Teacher verbal behavior following student success and failure

Undergraduate subjects taught identifying traits of animals (fish, reptiles, amphibians, mammals) to a fifth grade student confederate over a microphone. Subjects were randomly assigned to one of four conditions in which they failed (F) or succeeded (S) in teaching five animal comparison problems. The four conditions were (a) F, S, S, S, S; (b) F, F, F, S, S; (c) S, F, F, F, S; and (d) S, S, S, F, S. The teaching sessions were tape recorded and analyzed for Teaching Time, Word Rate, and Voice Amplitude. Analyses revealed increased Teaching Time and decreased Word Rate following failure. Voice Amplitude increased across teaching sessions independent of success or failure. Findings were interpreted as more consonant with frustration-aggression than frustrative nonreward energizing theory.     

SOURCES OF THE PUBLIC AGENDA:THE PRESIDENT-PRESS-PUBLIC RELATIONSHIP

This agenda-setting study explores ways that individuals processinformation issues by examining two potential public agendasources: the news media and the president of the USA. The researchersused a two-site study to examine the magnitude of influencefrom media exposure and perceived credibility of source. Itwas found that the higher the level of exposure to media anda presidential state-of-the-union message, the more likely thatissues were considered important. However, when both were examinedsimultaneously, media exposure was the more powerful predictor.Source credibility, both of the media and the president, wasalso found to influence how people perceived the importanceof issues.     

Semantically assisted medical bibliographic retrieval: an experimental computer system

An experimental computer-based bibliographic retrieval system has been implemented to explore how semantic (conceptual) relationships between MeSH terms might assist the retrieval process. To construct the experimental system's database, lists of abstracts were produced using MEDLINE. Each list contained papers discussing a specified pair of terms. Each abstract was then analyzed to determine the specific relationship(s) between the two terms discussed in that paper. The project then explored how these semantic relationships could be incorporated into the computer to enhance bibliographic retrieval.     

Using Multidimensional Item Response Theory to Evaluate Educational and Psychological Tests

Many educational and psychological tests are inherently multidimensional, meaning these tests measure two or more dimensions or constructs. The purpose of this module is to illustrate how test practitioners and researchers can apply multidimensional item response theory (MIRT) to understand better what their tests are measuring, how accurately the different composites of ability are being assessed, and how this information can be cycled back into the test development process. Procedures for conducting MIRT analyses–from obtaining evidence that the test is multidimensional, to modeling the test as multidimensional, to illustrating the properties of multidimensional items graphically-are described from both a theoretical and a substantive basis. This module also illustrates these procedures using data from a ninth-grade mathematics achievement test. It concludes with a discussion of future directions in MIRT research.