Vulvovaginal Lacerations Following Consensual Versus Non-consensual Sexual Intercourse

We are pleased to share the last manuscript that will be included in our Spring 2023 issue. Click the link below to see an early release of the full manuscript.

Background: The medical literature on vulvovaginal lacerations following consensual versus nonconsensual sexual intercourse is sparse and conflicting.

Objectives: To compare the predisposing factors, injury location and severity, as well as treatment of vulvovaginal lacerations sustained during consensual versus nonconsensual sexual intercourse, in adult women within a community-based cohort.

Methods: This is a retrospective comparative analysis of adult women presenting to the emergency departments of five hospitals and a free-standing nurse examiner clinic during a seven-year study period. All patients had documented vulvovaginal lacerations and reported vaginal penetration via consensual sexual intercourse (CSI) or nonconsensual sexual intercourse (NCSI) within 72 hours of presentation.

Results: A total of 598 cases were identified: 81 (14%) reported CSI, and 517 (87%) reported NCSI. CSI patients were younger (21.3 vs 25.7, p <0.001) and reported a greater incidence of penile penetration (97.5% vs 75.9%, p <0.001). While NCSI subjects had a higher incidence of vulvovaginal lacerations overall (1.7 vs. 1.0, p<0.001), their injuries were smaller (1.1 cm vs. 4.3 cm, p<0.001) and more likely to be located on the posterior vulva (83% vs. 69%, p=0.003) when compared to the CSI group. Additionally, all the lacerations in the NCSI group were superficial. In contrast, 27 (33%) of CSI subjects had lacerations sutured in the ED; six (7%) required aggressive fluid resuscitation and ten (12%) required surgical intervention.

Conclusions: In this community-based population, more severe vulvovaginal lacerations were noted in women following CSI. The predisposing factors, injury location, and subsequent treatment in this group were significantly different when compared with women reporting NCSI.

Diffusion Tensor Imaging: A Step-by-Step Guide for Radiology and Neurology Clerkship Students, Residents, and Graduate Students Using Clinical Research Examples

We are pleased to share our latest manuscript for our Spring 2023 issue. See the link below to see an early release.


Diffusion-tensor imaging has become common practice in radiology and imaging research due to its many applications in brain connectivity and neurodevelopment as well as for pathologies including tumors, ischemia, trauma, and neurodegeneration. However, its novelty compared to other neuroimaging techniques has meant that graduate programs, particularly medical schools, have not included opportunities to learn how diffusion tensor imaging can visualize the brain and interpretation of the data clinically and in research. Diffusion tensor imaging can be a challenging utility to understand for newcomers and is subject to wide interpretation. We offer for medical and graduate students as well as residents a step-by-step guide in interpreting diffusion tensor imaging results for clinical analysis using simple explanations of physics and neuroscience and its application in clinical and translational research.

Just like the simulations: Improving medical student confidence with simulated emergency medicine scenarios

Check out our latest article below.

Background: Incoming emergency medicine residents may feel unsure of their ability to handle common emergency department scenarios, even if they are well educated on the proper steps to take in those scenarios. This may not stem from a lack of skill so much as a lack of confidence in their ability to perform with skills they have. 

Objective: We look to establish a link between completion of simulation- based training in common emergency medicine scenarios and learner self-reported confidence in their ability to perform competently in those scenarios. 

Methods: Fourth-year medical students who matched into an emergency medicine residency program participated in a Transitional Educational Program (TEP) at the Interprofessional Immersive Simulation Center at the University of Toledo in April 2021. Simulations of 16 procedural skills and clinical judgement cases were carried out using high-fidelity mannequins and real medical equipment in a hospital-based setting. Subjects were given pre- and post- TEP survey questionnaires assessing their self-reported confidence to competently perform in common emergency medicine clinical scenarios, using a 5-grade Likert scale. Data was analyzed using a one-tailed Wilcoxon signed-rank matched-pairs test. 

Results: Of 19 participating subjects, 16 (84.2%) consented and responded to the pre-survey. Of those 16 subjects, 10 (62.5%) completed the surveys at the correct time and order. The pre- and post- surveys consisted of the same 14 questions. In 11 of 14 survey questions, there was a significant increase in subject self-reported confidence (p<.05) between pre- and post-survey. 

Conclusions: Simulation-based training in the setting of high-fidelity equipment and faculty guidance improved the self-reported confidence of incoming emergency medicine residents to perform in common emergency medicine scenarios.