Patterns and Determinants of Sexual Assault Cases Undergoing Medical Examination: Evidence From a Tertiary Care Center in Rajasthan, India

Background: Sexual assault is a major public health and medico-legal concern, particularly in low- and middle-income settings where underreporting and sociocultural barriers limit timely access to care and justice. Objective: To analyze the socio-demographic, clinical, and contextual determinants of sexual assault cases undergoing medico-legal examination at a tertiary care center in Rajasthan. Methods: A retrospective observational study was conducted using medico-legal records of 905 cases examined between 2023 and 2025. Data on victim characteristics, assault circumstances, clinical findings, and legal variables were extracted and analyzed. Descriptive statistics were used to summarize findings, and multivariate logistic regression was applied to identify predictors of delayed reporting (>72 hours). Results: Adolescents aged 12-18 years constituted the majority of victims (468/905, 51.7%), with a predominance of unmarried individuals (677/905, 74.8%) and those from lower socioeconomic strata. Delayed reporting was observed in 516/905 (57.0%) cases. Most assaults were perpetrated by known individuals (779/905, 86.1%) and occurred predominantly during nighttime (579/905, 64.0%). Physical injuries were absent in 842/905 (93.0%) cases, while semen detection was reported in 217/905 (24.0%). Multivariate analysis identified rural residence (adjusted odds ratio (AOR): 1.9; 95% confidence interval (CI): 1.3-2.7; p = 0.002), known assailant (AOR: 2.5; 95% CI: 1.7-3.8; p < 0.001), family pressure (AOR: 3.2; 95% CI: 2.1-4.9; p < 0.001), and minor age (AOR: 1.6; 95% CI: 1.1-2.3; p = 0.01) as significant predictors of delayed reporting. Conclusion: The findings demonstrate a complex interplay of demographic vulnerability, interpersonal relationships, and sociocultural factors influencing sexual assault dynamics. The study provides a multidimensional perspective by integrating clinical, behavioral, and legal variables with analytical modeling. Strengthening early reporting, improving access to trauma-informed care, and addressing sociocultural barriers are essential to enhance medico-legal outcomes and survivor support.