This was a prospective descriptive cross-sectional study conducted between 1 January and 31 August 2023. The study was carried out at the Prefectural University Teaching Hospital of Borgou (Centre Hospitalier Universitaire Départemental du Borgou, CHUD-B), within the Department of Obstetrics and Gynecology and the Integrated Care Center for Victims of Gender-Based Violence (Centre Intégré de Prise en Charge des Victimes de Violences Basées sur le Genre, CIPeC-VBG), located in Parakou, Borgou Department, northern Benin.

All girls and women presenting to CHUD-B with a complaint of alleged sexual assault during the study period were eligible for inclusion.

An exhaustive sampling strategy was used, whereby all complainants meeting the inclusion criteria during the study period were consecutively enrolled.

The study variables included the sociodemographic characteristics of the complainants, the characteristics of the alleged perpetrators, the circumstances of the alleged sexual assaults, clinical and laboratory findings, care provided, and self-esteem.

Self-esteem was assessed using the Rosenberg Self-Esteem Scale [16] among participants who were old enough to understand and complete the questionnaire independently. The scale consisted of ten items scored on a Likert scale, yielding a total score ranging from 10 to 40. Scores were categorized as follows: <25, very low self-esteem; 25 - 30, low self-esteem; 31 - 34, moderate self-esteem; and 35 - 40, high self-esteem [16].

For children who were not able to complete the questionnaire independently, only anamnestic information was collected from a parent or legal guardian. The Rosenberg Self-Esteem Scale was administered exclusively to participants considered capable of understanding and answering the questionnaire autonomously.

Data were collected through a structured face-to-face interview conducted by the investigators after the clinical examination. Before the interview, participants were reassured and placed in a supportive environment to facilitate accurate reporting of information. Data were collected using a standardized structured questionnaire.

Completed questionnaires were reviewed to ensure completeness of the collected information. No missing data were identified. Data were entered using EpiData version 3.1 (French version) and analyzed with IBM SPSS Statistics version 21. Categorical variables were summarized as frequencies and percentages. Continuous variables were described using means and standard deviations (SD), together with their minimum and maximum values.

The study was conducted in accordance with accepted ethical standards. Ethical approval was obtained from the Local Biomedical Research Ethics Committee of the University of Parakou (Comité Local d’Éthique pour la Recherche Biomédicale de l’Université de Parakou; reference No. CLERB-UP076/2022), and the principles of the Declaration of Helsinki were respected. Administrative authorization was also obtained from the Director of the CHUD-B.

Confidentiality of participants’ information was strictly maintained throughout the study. Written informed consent was obtained from all adult participants. For minors, written informed consent was obtained from a parent or legal guardian, together with assent from minors who were considered capable of providing it.

Between January and August 2023, a total of 846 women sought care in the emergency section of the obstetrics and gynecology department. These included women presenting with obstetric and gynecological emergencies, as well as women referred from the Center for the Integrated Care of Gender-Based Violence Survivors.

Among them, 102 presented with a complaint of alleged sexual assault, corresponding to a hospital-based frequency of 12.06%.

The mean age of the complainants was 14.62 ± 3.61 years (range, 3 - 24 years). The 15 - 20-year age group was the most represented (56.9%). High school and Secondary school students accounted for the largest occupational group (55.9%). Overall, 38.2% of the complainants had attained secondary school education level, and 99.0% were unmarried.

Among the complainants, 74.5% reported previous sexual intercourse. Of these, 85.5% reported having had their first sexual intercourse before the age of 15 years.

The mean age of the alleged perpetrators was 26.65 ± 8.29 years (range, 12 - 54 years). The 15 - 24-year age group was the most represented (45.1%). Artisans and manual workers constituted the largest occupational category (39.2%). Primary school education level was the highest educational level attained by 40.2% of the alleged perpetrators, while 79.4% were unmarried (Table 1).

Table 1. Characteristics of the alleged perpetrators.

Nearly half of the alleged perpetrators (48.0%) were reported to have been in an intimate (romantic) relationship with the complainant, whereas 21.6% were neighbors (Figure 1).

Figure 1. Distribution of complainants according to their relationship with the alleged perpetrators.

A single alleged perpetrator was involved in 98.0% of complaints. The alleged assault reportedly occurred during the evening in 57.8% of cases and most frequently took place at the alleged perpetrator’s home (55.9%) (Table 2).

Table 2. Distribution of complainants according to the number of alleged perpetrators, timing, and location of the alleged assault.

Overall, 98.0% of the complainants reported that they had not consumed alcohol at the time of the alleged assault, and none reported the use of illicit drugs or other psychoactive substances. The use of force or coercion was reported in 37.3% of cases.

Penetration was reported in 93.1% of complaints, exclusively involving vaginal penetration. Among the 95 cases involving penetration, the penis was reported as the penetrating object in 90.5% of cases, while digital penetration was reported in 9.5%. Among the 86 cases involving penile penetration, condom use was reported in 15.1%. Ejaculation was reported by 77 participants (75.5%); among these, ejaculation was reported to have occurred intravaginally in 83.1% of cases (Table 3).

Table 3. Circumstances of the alleged sexual assault.

Overall, 67.9% of the complainants presented more than 72 hours after the alleged assault. Most participants (95.1%) had been referred by police authorities with a medical requisition. Intimate washing before hospital presentation was reported by 99.0% of participants.

All complainants were in a stable general condition and fully conscious at presentation. No participant had extra-genital physical injuries. The hymen was not intact in 87.3% of participants. Among these, the hymenal tear was considered old in 85.4% of cases. Speculum examination was normal in 98.0% of participants with a non-intact hymen, while vaginal examination was normal in 85.4% (Table 4).

Table 4. Findings on physical examination of the complainants.

Initial screening for HIV, hepatitis B, hepatitis C, and syphilis (TPHA-VDRL) was negative in all participants. Pregnancy was diagnosed in 16 participants (15.7%) during the initial consultation. Seven participants were eligible for emergency contraception, and three were eligible for HIV post-exposure prophylaxis. All seven eligible participants (100%) received emergency contraception, and all three eligible participants (100%) actually received HIV post-exposure prophylaxis.

Of the 102 cases, 100 participants who had a good understanding of French and were over the age of 15 completed the Rosenberg Self-Esteem Scale.

The mean Rosenberg Self-Esteem Scale score was 33.47 ± 6.37 (range, 14 - 40). According to the predefined categories used in this study, 57.2% of participants had high self-esteem following the alleged sexual assault (Figure 2).

Figure 2. Distribution of participants according to their Rosenberg Self-Esteem Scale category.

The hospital-based frequency of complaints of alleged sexual assault observed in this study (12.06%) represents the proportion of women attending the Department of Obstetrics and Gynecology who presented with a complaint of alleged sexual assault during the study period. This figure should not be interpreted as an estimate of the true incidence of sexual assault in the population served by the hospital. A complaint of alleged sexual assault constitutes the initial reason for seeking medical, social, and legal assessment but does not, by itself, establish that the alleged events occurred. Judicial outcomes were not available, and the study did not make it possible to determine the outcome of the legal proceedings.

The frequency observed in our study (12.06%) was similar to that reported by Mbassa et al. in Cameroon (10.7%) [9]. By contrast, Dembélé et al. reported a lower frequency (2.1%) among patients attending Fousseyni Daou Hospital in Kayes, Mali [10], whereas Ajayi et al. reported a substantially higher prevalence (25.3%) among adolescent girls and young women in South Africa [11]. These differences may reflect variations in study populations, recruitment strategies, reporting systems, healthcare-seeking behavior, and sociocultural contexts. Comparisons across studies should therefore be interpreted with caution because of differences in study design, case definitions, and methods of data collection. Furthermore, most published studies are based on reported complaints rather than judicially confirmed cases, making direct comparisons difficult. Future studies linking hospital records with judicial outcomes would provide a more accurate assessment of the burden of confirmed sexual assault.

Adolescents constituted the majority of complainants in our study, with a mean age of 14.62 ± 3.61 years. Similar findings have been reported in other studies conducted in sub-Saharan Africa. Faye Dieme et al. reported a mean age of 14 years among complainants in Dakar [12], while Cissé et al. found a mean age of 12.3 years among minors evaluated for sexual abuse [13]. The predominance of adolescents may reflect their particular vulnerability to sexual violence. Factors that have been proposed include psychosocial immaturity, economic or family dependence, limited ability to negotiate or refuse unwanted sexual activity, unequal power relationships, and insufficient knowledge of sexual and reproductive rights and consent.

An important finding in our study was that most complainants reported previous sexual intercourse before the alleged assault. This observation should be interpreted within the local context, where early sexual debut is relatively common among adolescent girls. Our findings are consistent with those of Hounkponou et al. [17], who reported that 37.2% of adolescent girls in Parakou had initiated sexual intercourse before the age of 15 years, with most first sexual experiences reported as consensual. Under Beninese law, however, individuals below the legal age of consent are not legally recognized as capable of consenting to sexual intercourse [14]. This discrepancy raises important questions regarding the effectiveness of existing legal protection mechanisms and their ability to prevent early sexual activity among minors. It may also reflect broader challenges related to communication about sexuality within families in settings where discussions of sexual health remain culturally sensitive.

Importantly, the high proportion of complainants reporting previous sexual intercourse should not be interpreted as influencing the credibility of the allegations. Previous sexual experience neither explains nor excludes the possibility of sexual violence. The determination of sexual violence depends on the absence of valid consent or the legal inability to provide consent under the relevant circumstances, irrespective of previous sexual activity.

A major finding of this study was that most alleged perpetrators (91.2%) were known to the complainants, most commonly as intimate partners or neighbors. This observation is consistent with several studies conducted in sub-Saharan Africa reporting that alleged sexual assaults frequently involve individuals known to the complainant. Similar proportions have been reported in Togo by Adama-Hondégla et al. and in Senegal by Cissé et al. [13][18]. Likewise, Faye et al. found that most complainants lived in the same neighborhood as the alleged perpetrator [12]. In contrast, Foumane et al. reported that the identity of the alleged perpetrator was unknown in the majority of cases [19]. These discrepancies may reflect differences in study populations, sociocultural contexts, reporting practices, or definitions of the relationship between complainants and alleged perpetrators. These findings should nevertheless be interpreted cautiously. The existence of a prior relationship between the complainant and the alleged perpetrator neither establishes nor refutes the occurrence of sexual violence. Rather, it represents contextual information that should be considered alongside the medical, forensic, social, and judicial findings.

The high proportion of intimate relationships observed in our study also highlights that the existence of an intimate relationship should never be interpreted as implying ongoing consent to sexual activity. Conversely, being in an intimate relationship does not exclude the possibility of sexual violence. The assessment of consent must always be based on the specific circumstances of each individual case.

In this study, data were collected prospectively using exhaustive recruitment of all eligible complainants during the study period, and information was obtained using a standardized data collection instrument. In addition, the study provides a comprehensive description of the sociodemographic, clinical, and psychological characteristics of complainants presenting to a specialized referral center in northern Benin.

However, several limitations should be acknowledged. First, this was a single-center hospital-based study, which may limit the generalizability of the findings. Second, the study population consisted of individuals presenting with complaints of alleged sexual assault and therefore does not allow estimation of the incidence of confirmed sexual assault in the general population. Third, judicial outcomes were not systematically available, precluding differentiation between confirmed, unconfirmed, or dismissed allegations. Finally, several variables relied on self-reported information and may have been influenced by emotional, social, or legal factors.

Our findings highlight the importance of strengthening integrated responses involving healthcare, social, and judicial services. Future multicenter studies incorporating judicial outcomes would improve understanding of the trajectories of complaints, identify factors associated with case confirmation, and ultimately contribute to strengthening both the protection of victims and the safeguarding of the rights of individuals accused of sexual assault.