Clinical assessment and diagnostic features of fellatio-associated palatal lesions in forensic sexual abuse investigations: a systematic review.

Abstract

Objective: Sexual abuse is a global public health crisis impacting millions across all demographics. In forensic evaluations, relying only on anogenital injuries may create a diagnostic gap, as their absence does not exclude abuse. This highlights the importance of including a comprehensive intraoral assessment. Even though palatal lesions do not exclusively indicate sexual trauma, they remain a crucial yet frequently overlooked component when evaluating suspected oral sexual contact. Clinically, fellatio-associated trauma typically manifests at the junction of the hard and soft palate as erythema, petechiae, or purpura. These lesions are forms of vascular alterations caused by a combination of localized negative pressure and direct mechanical trauma, and they generally resolve spontaneously within 48 h to two weeks.

Methods: To investigate, a systematic literature review, registered on PROSPERO, and following PRISMA 2020 guidelines, was conducted across databases including PubMed, Science Direct, Wiley Online Library, Scopus and Google Scholar.

Results: The initial search yielded 480 records, resulting in 30 studies for final qualitative synthesis. The analysis focused specifically on clinical examination of the victim of sexual abuse, clinical findings in fellatio-associated palatal erythema, and diagnostic considerations for these lesions.

Conclusions: This review suggests that palatal lesions are potentially important yet frequently overlooked in sexual abuse evaluations. Therefore, a systematic and well-documented oral examination may provide additional clinical information within the overall forensic assessment of vulnerable individuals.