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Zack, F.; Zinka, B.; Beckmann, M. W.; Banaschak, S.; Fischer, H.; Gabriel, P.; Gerber, B.; Costa, S. D.; Ledwon, P.; Schwenzer, T. and Buettner, A. (2019): Venöse Luftembolie bei vaginalen Verletzungen durch Geschlechtsverkehr. Kritische Analyse und Literaturübersicht zu Häufigkeit und Diagnosestellung. In: Rechtsmedizin, Vol. 29, No. 1: pp. 21-29

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BackgroundIn acriminal trial in Germany in 2013, amedical expert nominated by the defence stated in the appeal trial the controversially discussed opinion that awoman had died from an air embolism due to vaginal intercourse with exclusively penile penetration and injury to the vaginal wall. This diagnosis had been established by the expert based on histological examination of the lungs and vaginal injuries years after the womans death.ObjectiveThe frequency of the diagnosis air embolism as a result of vaginal injuries due to intravaginal intercourse and the modality of the diagnosis were reviewed.Material and methodsAselective literature review was performed. Furthermore, questionnaires were sent to all forensic medical institutes and to directors and chief physicians of gynecological clinics of large cities in Germany.ResultsIn the literature two case reports could be found, which by critical analysis showed significant errors in the diagnosis according to the state of science at the time of publication. In over 300,000 autopsies performed between 1990 and 2016, the 26forensic medical institutes in Germany, which had answered the questionnaire, had never diagnosed air embolism as a result of vaginal injuries due to intravaginal intercourse. All 32professionally experienced gynecologists who responded to the questionnaire had never in their career treated survived or fatal cases of air embolism after vaginal injuries through sexual intercourse or had knowledge of them.ConclusionAccording to the survey and critical analysis of the very few published case reports, there is no evidence for adiagnosis of the cause of death as air embolism after vaginal injuries. When diagnosing a fatal venous air embolism, scientific standards should be strictly followed. Adiagnosis made solely by histological examination was and is not possible according to the state of the art in forensic medicine and thus violates the principles of expert medical opinions.

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