Categories
Child Abuse Sexual Assault

How to Prevent Sexual Violence Against Children — 7 Days of Ideas

Here’s a cool-looking offering: Apolitical is offering a micro-course called How to Prevent Sexual Violence Against Children — 7 Days of Ideas. I know nothing about it beyond what’s on their site, but I am thoroughly intrigued:

On November 20, 1989, the UN General Assembly adopted the Convention on the Rights of the Child. 30 years on, major strides in children’s rights have been made, but the nature of sexual abuse and exploitation of children is evolving. Increasingly, abuse and exploitation are happening online — and often governments are ill-equipped to address these new threats.

We’ll walk you through practical approaches to addressing the issue, highlighting the most innovative tools, technologies and techniques which are working to prevent sexual violence against children. You’ll get:

  • Bite-sized activities or articles, taking 10 minutes or less per day, for 7 days
  • A practical introduction to evidence-based interventions for preventing child sexual violence – and how to apply it to your work
  • Global case studies and reading lists highlighting best practices and innovations in the field

You can complete as many or as few as you like, and you’ll have opportunities to connect with peers and experts applying these concepts globally.

To participate you must register by 15 November. See all the details here.

____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
DV/IPV

How State/Territory, Tribal, and Federal Health Policies Can Promote Survivor Health, Preserve Autonomy, and Protect Confidentiality

This is a very last minute post, but, it’s worth it for two reasons–so please keep reading. Futures Without Violence has a webinar tomorrow, October 30th at 1pm ET, How State/Territory, Tribal, and Federal Health Policies Can Promote Survivor Health, Preserve Autonomy, and Protect Confidentiality. It will be archived, so no worries if you cannot attend with so little notice. From the website:

Health and insurance policies at the state/territory, tribal, and federal level have the potential to promote health, preserve autonomy, and protect confidentiality for survivors of domestic violence and state/territory policymakers have an opportunity to build on federal policies for further protections for survivors. In addition, health care providers can play an important role in addressing survivors’ health, and providing a warm referral to a domestic violence agency but sometimes lack of clarity about existing laws and policies prevent them from doing so. While laws and policies vary state to state, most U.S. states have enacted mandatory reporting laws, which require the reporting of specified injuries and wounds (i.e. gunshot and knife wounds), and very few have mandated reporting laws specific to suspected abuse or domestic violence for individuals being treated by a health care professional. During this webinar we will sharing our updated compendium on these policies (see below) and hear from key partners who’ve worked to clarify laws and policies and where needed create reporting exceptions for domestic violence survivors, to ensure that patients have knowledge of appropriate resources for intervention, safety, and access to health care.

This webinar will also launch our newly updated resource, The Compendium of State/Territory Statutes and Policies on Domestic Violence and Health Care, an at-a-glance summary of state and U.S. territory laws, regulations, and other activities relevant to addressing domestic violence in health care settings. Also newly updated, Insurance Discrimination Against Victims of Domestic Violence (PDF report): authored by webinar speakers Terry L. Fromson, and Nancy Durborow, highlights the discriminatory practices of some insurance companies that penalize domestic violence victims who seek coverage and the recent changes to state and federal law. We will also hear a case example from Colorado in repealing a mandatory reporting law and putting in place legislation which better supports survivors and their health. Futures Without Violence has these tools available for professionals to best serve their clients and patients.

Those links in the description above are the other reason I wanted to post this session–particularly the new Compendium. It’s definitely a worthwhile resource to have for forensic healthcare clinicians of all stripes.

Register for the session here.

_________________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Sexual Assault

Medical-Forensic Exam Payment Webinar Series from IAFN

A very excellent webinar series is coming up, courtesy of IAFN’s new medical-forensic exam billing and payment project. There are three, the first of which will be November 26, 2019 at 12pm ET: When Things Don’t Go Right: Sexual Assault Exam Billing and Payment – It’s TIME for Change! From the website: Come be apart of the solution: 10+ years post VAWA, barriers exist for victims who were guaranteed free exams, including being billed for exams and being pursued by debt collection agencies. 

Following that:

nPEP Costs HOW MUCH for the Sexual Assault Patient? December 3, 2019 at 2:30pm ET (Description: The National SAFE Protocol and the CDC recommend that every sexual assault patient be evaluated for HIV risk. However, nurse examiners are often unaware of the actual cost of HIV nPEP, and options for providing nPEP which can affect patient access to medications that may be lifesaving. At the conclusion of this webinar and with the help of four-panel members from three different states and the District of Columbia, the participants will be able to identify the current recommended guidelines for the administration of HIV nPEP to patients in the acute phase post-sexual assault. They will be able to recognize the estimated cost for HIV nPEP, articulate various HIV nPEP billing and payment coverage options, and describe various gaps in HIV nPEP coverage for sexual assault patients across the nation.)

Billing and Coding 101: Learn the Anatomy of Billing and Coding for Sexual Assault Patients like a Pro. December 19, 2019 at 2pm ET (Description: SANE program managers and hospital billing departments are unprepared to properly code requests for payment to state-designated payers for the sexual assault medical forensic examinations which can result in payment denials and patients potentially receiving bills for service, violating VAWA. With the guidance from Shelley Voci, a coding specialist, at the conclusion of this webinar, the participants will be to articulate the history of ICD-10-CM, as well as identify and describe common ICD-10-CM for sexual assault patients, and interpret an example bill for services rendered status post-sexual assault medical forensic examination.)

CEs will be available for IAFN members. The sessions will be archived, in case you can’t make the live session. Register for all the webinars here.

______________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
DV/IPV

Strangulation and Imaging–New Research

Last Week’s Articles of Note contained a new study that I want to highlight: Evaluation of Nonfatal Strangulation in Alert Adults. Along with CT angiograms of the neck in strangulation victims: Incidence of positive findings at a level one trauma center over a 7-year period it represents new research that challenges some of the thinking about our response to strangulation patients. Specifically the notion that we should be ordering some type of imaging (e.g. CT angio) on everyone.

This is not to say you should abandon your current protocols, or stop imaging strangulation patients altogether (please don’t do that), but once again, I’d like to point out that there is no evidence base, regardless of what anyone claims, supporting routine imaging of every strangulation patient. And in fact, there are problems with that approach:

  1. Cost, obviously–at least here in the US, assuming people have insurance that will cover it or that it will be paid for by crime victims compensation funds assumes *a lot* about people, their situations, their safety, their willingness to work with law enforcement, and the immense variations in hospital billing practices across the country.
  2. Unnecessary exposure to radiation–particularly to an area of the body that is very sensitive to radiation (for example, please consider the impact of radiation on the thyroid, even more so for pediatric patients).

The bottom line is we should be having thoughtful conversations at the local and national level about how to approach these patients; we should be working toward funding more research to create a more substantial evidence base to establish clinical protocols; we should be disseminating existing research widely as it becomes available and talking about what it does (and doesn’t) mean for our practices; we should be developing a national protocol on the assessment and treatment of strangulation patients similar to what we have for sexual assault; and we definitely should be cautious about claiming anything is a best practice or gold standard without actual scientific support.

____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Since Last We Spoke, 10-21-19

Good morning from Michigan State University, where I am working for most of the week. Happily, I am home the remainder of the month after this trip, so a bit of a travel reprieve, although not a work one (not a complaint). Thanks to those of you who participated in Journal Club, but it was not enough to sustain the amount of effort it requires for me to prep, monitor and sustain the process, so I have discontinued it and removed the posts (leaving them lingering half-finished felt–well, unfinished). I tried, people–it’s up to you in your own jurisdictions to make it happen, because clearly doing it online is not working. We tried.

It’s a heavy writing week month for me, so I am surfing less and researching more. But there were a few things that caught my eye since last we spoke:

The physical impact of racism

Traumatic stress linked to stroke

The financial cost of domestic violence

An excellent conversation between Morgan Jerkins and MeToo Founder Tarana Burke

What a loss to our country–I hope to be able to pay my respects on Thursday

We don’t pay teachers enough

Your feel-good story to start your week off right

_________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Articles of Note Child Abuse DV/IPV Elder Abuse/Neglect Sexual Assault Testimony

Articles of Note: October 2019 Edition

It’s time once again for Articles of Note, our monthly romp through the newly published peer-reviewed literature. There is *a lot* of choice material to sort through this month, so I hope you will spend some quality time with the list. As always, links lead to PubMed abstracts.

Loader Loading…
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [137.74 KB]

__________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Child Abuse Sexual Assault

2018 STD Surveillance Report

(1st week of Journal Club is live, so feel free to jump in; we’ll pose new questions each Tuesday.)

The CDC just released its 2018 STD Surveillance Report and it is grim. They’re reporting increases in chlamydia, gonorrhea, and syphilis (including congenital syphilis, which is up 185% since 2014). Helpful to know as you are considering what services to provide, including testing vs presumptive treating, medication choices, etc. As always, consult your local health department as well to get an accurate picture of the incidence and prevalence in your own community.

Read the full report here.

Table of contents if you want to jump around or are interested in specific data.

Here are your state ranking tables.

And for those of you looking for PPT slides, you can find the full downloadable list here.

__________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Since Last We Spoke, 10-7-19

[There’s still time to join us for our first Journal Club–get all the details here.]

I am happily at home and looking forward to what should be a great week here at FHO headquarters. We will kick off Journal Club tomorrow (and keep it going each Tuesday for 6ish weeks depending on how things go). Plus, tomorrow night is Kol Nidre, my favorite service of the year, leading off Yom Kippur, a day of fasting and reflection for my people. In our household it will be concluded by breaking the fast with friends–please note there will be no post on Wednesday in honor of the holiday.

I tried very hard to do almost no work whatsoever this weekend, and focused on being unplugged for much of it. Still, there were a few things that caught my eye since last we spoke:

Reproductive coercion continues to be a lesser discussed form of intimate partner violence; glad it’s getting some mainstream attention here

Related.

What if your abusive husband is a cop?

Facing history for the future of nursing

More voices coming forward

I loved this piece on soulmates

______________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
DV/IPV

Domestic Violence High-Risk Teams

[There’s still time to join us for our first Journal Club–get all the details here.]

OVC TTAC is hosting an Expert Q&A on October 16th focusing on domestic violence high-risk teams. The session will be held from 2-3:15pm ET. From the website:

The Domestic Violence High-Risk Team (DVHRT) Model was born from one community’s tragedy and has gone on to national recognition and replication as a leading strategy for intimate partner homicide prevention. This presentation will provide a comprehensive understanding of the DVHRT Model, with an overview of the research at its foundation, and include a discussion on the function and structure of key partners in this multidisciplinary approach. Participants will learn how team members work together to identify high-risk cases and mobilize risk management strategies.

The session will be recorded for those of you who cannot participate live.

________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Child Abuse

WHO Guidelines for the Health Sector Response to Child Maltreatment

[There’s still time to join us for our first Journal Club–get all the details here.]

WHO has a new guideline for the health sector response to child maltreatment. From the site:

Every year up to 1 billion children experience physical, sexual or psychological violence. These new WHO guidelines aim to help frontline healthcare providers to recognize children who have suffered from violence and neglect and provide evidence-based first line support. Specifically, the guidelines focus on:

  • Identification of children who are exposed to abuse or neglect
  • Supportive communication with children suspected to be victims of abuse or neglect
  • Assessing and addressing the safety of the child
  • Interacting with caregivers in suspected cases of child maltreatment
  • Providing immediate medical and psychosocial support for children exposed to child maltreatment
  • Collecting medical history, conducting physical exams and appropriate documentation of findings

These new guidelines complement Responding to children and adolescents who have been sexually abused: WHO clinical guidelines which were published in 2017.

Download the full report here (PDF).

______________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Since Last We Spoke, 9-30-19

I am at Ft Benning this week in Georgia, and is often the case, my time is not my own, so posting here likely will be light. I know I said we were going to start Journal Club this week, but I think it would be more fruitful to wait until I am back in the office next week to kick things off–that way I can get posts approved quickly and engage in real(ish) time. So all of you wanting to participate, you have one more week to obtain and read the article (get all of the details here, and please contact me if you can’t get a hold of the article since we now have a source for you). The first Journal Club will be held here, October 8th. Look for the first set of questions about the article then.

May I also add: shana tovah to all who are celebrating, however you are observing the holiday this year. May it be a sweet and gentle new year for us all.

And now, here’s what caught my eye since last we spoke:

This article on images of child abuse was startling, even doing the work that I do

Silencing women is bad for our health

Wow–Was It Worth It?

Making meaning out of a massacre

Sadly, this is not an isolated story

Finding and losing your brother on the streets

Canada’s domestic violence crisis

This was an incredibly compelling series in the Cleveland Plain Dealer: Case Closed

Finally, in case you need to remember our patients are not a crime scene, they are not that one terrible thing that has happened to them:

____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Want To Reduce Suicides? Follow The Data

Here’s something for our death investigator colleagues–an article from Kaiser Health News I found incredibly fascinating: Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters. Among other interesting nuggets in it is the introduction (to me at least) of the suicide fatality review. Not surprising that systems-level examination of a problem like suicide would be beneficial.

Even if you’re not actively working in the field of death investigation, this piece is pretty thought-provoking. Especially if you’re a data nerd. Read the whole thing here.

_________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Child Abuse DV/IPV Sexual Assault

What We Know About the Polyvictimization of Youth

The Center for Victim Research has a webinar coming up next week, What We Know About the Polyvictimization of Youth. The session will be held on September 30th at 2pm ET. From the site:

This webinar will focus on poly-victims, the subgroup of youth that endure the highest burden of victimization. We will cover how it has been studied, how often it occurs, what we know about its adverse effects and what we can do to respond to the needs of this highly victimized group of children. 

Register here.

_______________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Since Last We Spoke, 9-23-19

I got home a little earlier than expected last week, so I had a more relaxing weekend than planned. The girlchild came home from college, which was divine, and while Sasha worked all weekend, it was from home, also not planned. So all in all, an improvement on what I thought the weekend would initially be. Plus I was very pleased at your feedback about virtual journal club, so we are going to give it a go–Option #1 (a weekly series of facilitated questions on the site with a wrap-up digest available at the end). Come back tomorrow for the announcement of the article and a few details on how we will proceed.

I am off to New Hampshire to talk about my favorite topic (testimony, of course) with what I have been told is a fantastic crew of nurses (looking forward to meeting everyone!). But before I leave, here’s what caught my eye since last we spoke:

I do believe I spy one of our own in this article on exonerations

Rape is not a punishment for getting drunk.

Is domestic violence in the military getting the attention it deserves?

Women describe how Jeffrey Epstein controlled them

An argument for nursing presence in the twittosphere

Somewhat related: nurses not “staying in our lane” (spoiler: it is our lane)

Keeping it professional when the wine is flowing

This lovely, but difficult essay about stillbirth

If you haven’t read this amazing profile on Queer Eye’s Jonathan Van Ness, please do

I do love a good booklist

And finally, standup that rings pretty true:

_____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
DV/IPV Sexual Assault

Succession Planning within Domestic Violence and Sexual Assault Organizations, Part 2

Futures Without Violence has a great management session coming up, a follow-on to its original session on this topic last year. Succession Planning within Domestic Violence and Sexual Assault Organizations, Part 2 will be held October 3rd at 2pm ET. From the website:

Leadership transitions can be challenging.  For non-profit organizations to succeed, it is essential to think critically about the long-term leadership needs of the organization and to prepare for leadership transitions.  Presenters will discuss key elements of a departure defined (planned) succession plan, and describe a process to plan for leadership transition within a domestic violence/sexual assault organization.  The webinar will also showcase the experience of succession planning and on boarding process of an executive director in an organization that serves survivors of gender-based violence.  We will share planning tools and resources and provide a question-answer period.

As a result of this webinar, participants will be better able to:

  • Identify key elements of a departure defined (planned) leadership succession.
  • Apply lessons learned from a real life example of succession planning to your own organizational decision-making.
  • Utilize critical tools and resources for succession planning.

Register here.

Succession planning is more important than we typically discuss in forensic healthcare. Many clinical programs tend to hinge on the energy and vision of a single person, and when that person leaves, there is significant peril that the program can fail or end up diminished in a variety of ways. Thinking about the transition of leadership, both as someone comes on board and as someone leaves, is critical. This is a great topic for anyone interested in management or sustainability of clinical programs.

_____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Virtual Journal Club?

I have had many requests for a virtual journal club. I am happy to host one. We tried to do one via Twitter several years ago with *very* limited participation, so I am hesitant to jump back in again. That being said, if folks want to try it out, I would be game to give it a go. Only this time using a different medium.

FHO readers have historically been very shy about public engagement. You all are far more likely to contact me offline than comment On Here. So we can do this one of two ways, I think–either use the site to host a series of ongoing questions about a particular article (that I can then digest for everyone at the end of the series so it’s all in one place) OR if people are feeling more reserved about putting themselves out there, have folks submit written responses about a chosen article and compile the responses for readers afterward. I would prefer the 1st option since it feels more akin to actual journal club, but I am open to the 2nd (or another) option.

So what say you, dear FHO readers? Shall we try journal club again? And if so, how should we make it happen? Because I have the perfect article to start us off if we do…

_____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Child Abuse

Children in Detention: Critical Clinical, Legal, Policy, and Human Rights Issues for Health Professionals

The National Health Collaborative on Violence and Abuse (NHCVA) is hosting a webinar, Children in Detention: Critical Clinical, Legal, Policy, and Human Rights Issues for Health Professionals. It will be held on September 25th at 2pm ET. From the website:

Thousands of children seeking refuge from life-threatening danger in their home countries have been detained by U.S. immigration authorities, and in some cases, separated from their parents and caregivers. This urgent webinar, sponsored by the National Health Collaborative on Violence and Abuse (NHCVA) and presented by colleagues from the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Pediatrics (AAP) and Kids in Need of Defense (KIND) addresses the clinical, mental health, policy, legal, and human rights issues faced by detained migrant children and their caregivers. Particular attention will be paid to how participants can harness their own professional training and standing to become more involved in both direct service and advocacy, in order to address what many consider to be an urgent humanitarian crisis and a deliberate assault on human rights.

Register for the session here.

__________________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Welcome New Subscribers!

Welcome to all of you (wow!) that have subscribed to FHO following the IAFN conference. Just a reminder that you need to verify your email via the Feedburner link that went to the email you used in order to activate the subscription. If you don’t see it, please check your spam filter–it often ends up there. I cannot activate your subscription manually.

Thanks for reading FHO!

________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Uncategorized

Since Last We Spoke, 9-16-19

It was so good to see so many of you in New Orleans last week. We had lively, packed sessions, which makes my heart happy. Lots of great discussions. I look forward to keeping that going here.

If you’re playing along at home, I’m at Ft. Bliss this week in El Paso, and as usual, my time is not my own. I will try to get a few posts up this week, but it may be pretty quiet. I had a very short turn around between trips, so I didn’t even get much chance to catch up on my feeds, but a few things caught my eye since last we spoke:

Rape as a woman’s first sexual experience

This beautiful piece about fear

After 9/11

Why don’t doctors trust women?

Related: reading this right now (it’s good)

Native women say police ignored rapes

Love this quote

Six men tell their stories of sexual assault in the military

_____________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.

Categories
Testimony

IAFN Handouts: Words Matter

Leslie and I tweaked our session, Words Matter: The Art and Science of Trial Testimony at the 11th hour, so the handout on the conference app is not as robust as the session ended up being. An improved handout can be found here for those who would like the additional FRE702 and research content. It still doesn’t have all the case law and testimony examples we use, but the remaining content is there. Thanks to everyone who came and participated. I love a standing-room-only crowd 🙂

___________________________

Have you checked out the FHO store lately? You can find the newest research brief, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims. Or purchase the complete set of three (Strangulation, Aging Bruises, and Consensual Sex Injury) for a special price.