Overweight and the sexual assault forensic medical examination: a pressing problem

This paper examines the problems faced by forensic physicians assessing overweight victim/survivors of sexual assault, using sample cases and reviewing the literature. This under-researched area is a minefield of practical difficulties and unanswered questions, with the need for solutions becoming more pressing as overweight becomes more common. Overweight has the potential to alter injury patterns; the way forensic medical examinations are conducted; and injury and specimen interpretation. Pertinent questions include whether the "cushion effect" noted in motor vehicle accidents is relevant to sexual assault and how obesity-related comorbidities affect our ability to age injuries. Practical problems include positioning the client safely, obtaining clear views of areas of interest, and taking high-quality specimens. Although overweight victims appear to be uncommon in sexual assault services, as the obesity epidemic progresses clinicians will need to address these issues.