Sexual assault constitutes one of the most serious forms of interpersonal violence worldwide. According to the World Health Organization (WHO), sexual violence includes any sexual act, attempt to obtain a sexual act, or unwanted sexual advance carried out through force or coercion, regardless of the relationship between the perpetrator and the victim [1]. It represents a major public health, criminal justice, and human rights issue due to its often long-lasting physical, psychological, and social consequences [1]. Globally, approximately one in three women has experienced physical or sexual violence during her lifetime, most often perpetrated by an intimate partner or someone known to the victim [2]. Adolescents and young women constitute a particularly vulnerable population [3]. Medical consequences include genital and extra-genital trauma, sexually transmitted infections, unintended pregnancies, and psychiatric disorders such as post-traumatic stress disorder [1][4]. From a forensic perspective, rigorous clinical examination and accurate documentation of injuries play a central role in establishing judicial evidence [5]. The assessment of Total Temporary Incapacity (TTI) is a determining factor in the legal classification of the offense and the direction of prosecution [6]. Forensic medicine services therefore represent a key observatory of sexual violence and contribute to the production of evidence necessary for the development of public policies [7]. In sub-Saharan Africa, the prevalence of sexual violence remains high in a context marked by persistent gender inequalities and socio-economic constraints [8]. Studies conducted in Nigeria have shown a predominance of adolescent victims, with most assaults perpetrated by individuals known to the victim [9]. In South Africa, medico-legal data have documented genito-anal injuries among rape survivors, although the absence of visible injury remains common [10]. Similarly, a hospital-based study in Senegal highlighted the vulnerability of young girls and the frequency of assaults occurring within socially proximate environments [11]. In Guinea, despite the presumed magnitude of the phenomenon, published forensic data remain limited. The Department of Forensic Medicine at the Regional Hospital of Conakry constitutes a key institutional observatory of sexual violence, contributing to the generation of data to inform public health policies and judicial responses. Importantly, this study does not aim to estimate the population-level incidence or prevalence of sexual violence, but rather to describe the proportion and characteristics of cases recorded within a medico-legal service.

The number of sexual assault cases recorded by the Department of Forensic Medicine increased over the study period, rising from 10 cases in 2021 to 373 cases in 2025. The proportion of sexual assault consultations among all medico-legal consultations also increased from 4.72% in 2021 to 13.41% in 2025, although it remained relatively stable between 2022 and 2024 (12.18%, 12.00%, and 11.43%, respectively). These findings reflect the trend in cases managed by the department and should not be interpreted as evidence of an increasing incidence of sexual assault in the general population. The annual distribution of medico-legal consultations and sexual assault cases is summarized in Table 1.

Table 1. Summary of the activities of the department of forensic medicine at the regional hospital of Conakry (2021-2025).

The completeness of the study variables is presented in Table 2.

Table 2. Missing data by variable.

The distribution of victims according to sex and age group is presented in Table 3.

Table 3. Distribution according to sex and age group.

The marital status distribution of victims is shown in Figure 2.

Figure 2. The distribution of victims according to marital status.

The relationship between victims and alleged perpetrators is illustrated in Figure 3.

Figure 3. Relationship between victims and alleged perpetrators, based on victims’ statements (n = 929).

The relationship with the alleged perpetrator was established from the victim’s statement recorded in the medico-legal file. The category “Noidentifiedrelationship” includes cases in which the victim was unable to identify or specify any relationship with the alleged perpetrator. The temporal distribution of sexual assaults according to the time of occurrence is presented in Figure 4.

Figure 4. The temporal distribution of sexual assault cases according to time of occurrence.

The distribution of assault locations is presented in Table 4.

Table 4. Distribution according to the location of occurrence (N = 929).

Table 5 presents victim-level prevalence, while Table 5 reports lesion-level counts, allowing multiple injuries per victim.

Table 5. Medico-legal characteristics of sexual assaults (n = 929).

The prevalence of traumatic injuries and hymenal findings is presented in Table 6.

Table 6. Prevalence of traumatic injuries among victims (n = 929).

The anatomical distribution of genital and extra-genital injuries is summarized in Table 7.

Table 7. Distribution of lesions by anatomical site.

The medico-legal and psychological characteristics of victims are presented in Table 8.

Table 8. Medico-legal and psychological parameters of victims (n = 929).

The association between consultation delay and traumatic injuries is shown in Table 9.

Table 9. Association between traumatic injuries and consultation delay (n = 929).

The relationship between age group and traumatic injuries is presented in Table 10.

Table 10. Association between age group (minors vs adults) and traumatic injuries.

The results of the multivariable logistic regression analysis are presented in Table 11.

Table 11. Multivariable logistic regression analysis of factors associated with traumatic injuries among victims of sexual assault (complete-case analysis, n = 894).

Model calibration: Hosmer-Lemeshow goodness-of-fit test: χ² = 5.28, df = 8, p = 0.728.

Characteristics of alleged perpetrators were available only for records in which this information had been documented in the medico-legal file or judicial requisition. Consequently, the denominator varies across variables and is reported for each analysis. The final multivariable logistic regression model included age group and consultation delay, which were selected a priori because of their clinical relevance and their potential influence on traumatic injury detection.

The socio-demographic, behavioral, and judicial characteristics of the alleged perpetrators are summarized in Table 12.

Table 12. Socio-demographic, behavioral, and judicial characteristics of alleged perpetrators (N = 1014).

Importantly, this study does not aim to estimate population-level incidence or prevalence of sexual violence. Rather, it describes the proportion and temporal trends of cases recorded within a single medico-legal service. Therefore, the observed increase over time should be interpreted cautiously and likely reflects changes in reporting practices, judicial referral patterns, and access to medico-legal services, rather than a true increase in population-level occurrence. This study represents one of the largest recent medico-legal case series on sexual assault in Guinea. It provides a comprehensive overview of victim characteristics, circumstances of assault, modes of coercion, medico-legal findings, and alleged perpetrator profiles in an urban West African setting. Sexual assaults accounted for 12.16% of all medico-legal activities during the study period, a proportion consistent with findings from other hospital-based African studies (10% - 20%) [12][13], highlighting the substantial contribution of sexual violence to medico-legal workload. The overwhelming majority of victims were examined under judicial requisition (94.1%), reflecting a highly formalized medico-legal pathway. The World Health Organization recommends that victims of sexual violence have timely access to standardized medico-legal examinations integrated with medical and psychosocial care, irrespective of legal proceedings [14]. However, the limited proportion of referrals from healthcare facilities or non-governmental organizations suggests restricted access to medico-legal services outside the judicial system. This finding is important because international guidelines emphasize the need for timely, comprehensive, survivor-centred medical and medico-legal care following sexual violence, including appropriate clinical management and preservation of forensic evidence [14]. The predominance of female victims (99.78%) and the concentration of cases among adolescents (mean age 16.6 years) confirm the particular vulnerability of young girls, in line with regional and international literature [13]. At the same time, male victims remain an underrecognized group, particularly in socio-cultural contexts where stigma may limit disclosure [15]. Similarly, sexual violence affecting older adults, although less frequently documented, may present specific medico-legal and clinical challenges, including delayed reporting and increased vulnerability associated with dependency or social isolation [16]. These observations underscore the need for more inclusive research frameworks addressing underrepresented populations. The high proportion of pupils and students reflects patterns of daily mobility and social dependence. Assaults occurred predominantly in private or semi-private settings, particularly at the alleged perpetrator’s residence (47.47%) or in isolated locations (27.23%), consistent with findings from other sub-Saharan African studies [12]. The temporal distribution, with a peak in late afternoon and evening hours (48%), likely reflects periods of reduced supervision and increased vulnerability. A major finding of this study is the strong association between consultation delay and the likelihood of documenting traumatic injuries. The proportion of injuries decreased markedly as the delay increased (48.2% within 24 hours, 24.2% at 24 - 72 hours, and 9.7% beyond 72 hours; p < 0.0001). Unlike analyses based solely on bivariate comparisons, the use of multivariable logistic regression allowed adjustment for potential confounding factors, thereby strengthening the robustness of these associations. Minors (≤18 years) were approximately twice as likely to present documented traumatic injuries compared to adults (45% vs 28%; OR = 2.10; 95% CI: 1.55 - 2.83). This association remained significant after adjustment, suggesting that age-related differences may reflect a combination of biological vulnerability and contextual factors. However, these findings should be interpreted with caution, as key variables such as pubertal stage, detailed sexual history, and examination conditions were not available and may have influenced injury patterns. The observed decline in injury detection over time is consistent with biological healing processes. Superficial genital and extra-genital lesions may resolve rapidly due to mucosal regeneration and rich vascularization. Previous studies have reported higher detection rates when examinations are performed within the first 24 hours [17][18]. Slaughter et al. described a progressive decrease in detectable injuries beyond 72 hours [17], while Sommers emphasized the influence of examination timing and techniques on reported injury rates [18]. In our setting, the absence of systematic colposcopy may have further limited the detection of subtle lesions. From a methodological perspective, the use of a composite variable combining genital and extra-genital injuries represents a major limitation. These types of injuries may arise from different mechanisms and contexts of violence. Genital injuries are more directly related to the sexual act and tissue vulnerability, whereas extra-genital injuries often reflect physical coercion or associated violence. Their aggregation into a single outcome may have reduced analytical specificity and diluted mechanism-specific associations. Consequently, the observed relationships, particularly those involving age and consultation delay, should be interpreted cautiously. The increased vulnerability of minors may also be related to anatomical and developmental factors, including reduced tissue elasticity, hymenal fragility, and genital immaturity, which may increase the likelihood of visible injuries in cases of forced penetration. McCann et al. highlighted that certain hymenal injuries are more readily detectable in younger individuals, while also emphasizing that the absence of injury does not exclude sexual assault [19]. Furthermore, assaults involving minors may be associated with greater physical constraint or anatomical mismatch, which may contribute to injury occurrence. The potential interaction between consultation delay and age deserves consideration. Minors may be more likely to present early following disclosure, particularly in family or school settings, thereby increasing the probability of detecting injuries. In contrast, adults may delay consultation due to stigma, fear, or economic dependence, reducing the likelihood of documenting lesions. This interaction could not be formally assessed in the present study. Extra-familial alleged perpetrators predominated (70.08%), although underreporting of intra-familial violence is likely. Verbal coercion was the main form of threat (96.12%), whereas the use of weapons or severe physical violence was uncommon. This pattern highlights the central role of psychological coercion, particularly in familiar or domestic environments [14]. The interpretation of alleged perpetrator characteristics requires caution. While some variables were derived from judicial records, others were based on victim reports and may therefore be subject to reporting bias. Distinguishing between confirmed and reported information is essential to avoid overinterpretation. From a medico-legal perspective, the absence of severe physical violence or visible injury does not invalidate the occurrence of sexual assault. Injuries were documented in 38.97% of cases, a proportion consistent with the forensic literature [5]. Genital injuries mainly involved the vulva, and recent hymenal tears were relatively uncommon (9.36%), while previous hymenal rupture was frequent (65.66%), confirming that hymenal status alone is not a reliable indicator of sexual assault [5]. Extra-genital injuries, particularly bruises, suggest mechanisms of restraint or struggle. Psychologically, anxiety was the most frequently observed manifestation (49.52%), reflecting an acute stress response following assault. However, the high proportion of cases without documented psychological assessment (43.70%) indicates a lack of standardization in comprehensive medico-legal evaluation. The integration of structured psychotrauma assessment tools would improve both documentation and victim care. Although early consultation (<24 hours) was observed in a majority of cases (67.71%), which is favorable for evidence preservation, substantial gaps remain in medico-legal documentation. In particular, TTI was not assessed in 79.33% of cases, representing a major limitation in medico-judicial evaluation, as TTI is a key element in legal classification and sentencing. These deficiencies likely reflect operational constraints, including limited resources, time pressure, and insufficient specialized training. Alleged Perpetrators were exclusively male and predominantly young adults (18 - 30 years: 60.2%), most often acting alone (90.33%), in line with findings from other African studies [12]. Although low educational level and informal occupations were common, these characteristics should not be interpreted as causal factors. Most alleged perpetrators had no reported substance use (77.2%), suggesting that substance use is not a systematic determinant in this context.

This study has several limitations. First, it is based on data from a single medico-legal center and does not capture unreported cases or those not referred through judicial pathways, limiting the generalizability of the findings. Second, the use of a composite injury variable and the absence of key clinical parameters restrict the interpretation of lesion patterns. Third, the high proportion of missing data for variables such as TTI and psychological status may have introduced information bias. Finally, some alleged perpetrator-related variables were based on reported information and could not be systematically verified, potentially affecting the accuracy of alleged perpetrator profiling. Despite these limitations, this study provides valuable insights into medico-legal practices in a resource-limited setting and highlights critical areas for improvement, including standardization of examinations, systematic documentation of medico-legal findings, and improved access to care independent of judicial procedures.

This study demonstrates that sexual assaults constitute a significant and increasing component of medico-legal activity in Conakry. They primarily involve adolescent girls and young women, predominantly from central urban areas, and are committed by young male alleged perpetrators who most often act alone. The assaults mainly occur in private or isolated settings, with penile penetration predominating and condom use being almost absent. The high proportion of early consultations represents a favorable factor for forensic documentation and post-exposure prophylaxis. However, the incomplete assessment of Total Temporary Incapacity (TTI) highlights the need for greater standardization of medico-legal practices. These findings underscore the importance of targeted preventive strategies focused on adolescent girls, strengthening medico-legal expertise capacity, and systematically integrating structured psychological care. Improved harmonization of procedures could enhance evidentiary quality and the judicial response to sexual violence in urban Guinea.

This study was approved by the National Ethics Committee for Health Research of Guinea (Comité National d’Éthique pour la Recherche en Santé, Guinea). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants and/or their legal guardians prior to inclusion in the study.