best. For example, providers independently deciding whether or not to collect images based on their opinion of how it “will help” the legal case thereby allowing legal outcomes to define clinical practice or even based on opinions about photographing genital anatomy with rationales that are reflective of societal taboo surrounding the genitalia. Forensic nurses have referred to these images as “graphic” or “too sensitive” and treated collection, storage, security, use and transfer of these images differently than other images and clinical documentation. However, they first should provide a defensible 55 argument on exactly how or why these images are different than other clinical images involving the genitalia (e.g., pre- peri-, and post reconstructive genital surgery). Background The earliest documented use of photography for forensic purposes traces back to a courtroom proceeding in 1839. Shortly thereafter, in the 1840s, application of photography to medicine was documented. Early medical photography was primarily used for educational purposes including illustrations in medical publications (Burns, 1979; Gernsheim, 1961a; Hansell, 1946). The earliest known documented clinical use of photography, now known as photodocumentation, occurred in 1856 and involved case presentations and case consultations (Burns, 1979). Although the use of photography as evidence of physical abuse of a person occurred in 1859 (Green & Schulman, 2010), it did not involve medicine or a health care provider. An extensive review of the literature revealed the developing use of both clinical medical photodocumentation and legal or investigative forensic photography; however, it is not clear when photodocumentation was first used within clinical forensic practices. Prior to the 1980s, the use of clinical forensic photodocumentation for assessing and documenting the effects of violence was variable at best. In the mid 1980’s initial reports began to appear in the medical literature related to the use of photodocumentation in evaluating and documenting child sexual abuse. Clinical forensic photodocumentation has since served to: · improve medical diagnoses through case consultation and peer review processes; · provide a means for standardizing terminology related to clinical findings including anatomical variations, injury, and pathology; · inform research surrounding clinical findings related to various types of intentional and unintentional injury; and, 56 · enhance education of clinical forensic medical providers. Photodocumentation has become both a standard of care and best practice for clinical documentation of interpersonal violence, abuse of older persons, child maltreatment and sexual assault (Brennan, 2006; Green & Schulman, 2010) among clinical forensic specialists and nonforensic providers (e.g., emergency department staff) (Smock, 1994; Smock & Besant-Matthews, 2007). As with their physician counterparts, clinical forensic nurses use photodocumentation within their practices for the same purposes of evaluation, documentation, case consultation, case/peer review, research and education related to physical abuse and assault, sexual abuse and assault, neglect and other forensic medical patient encounters involving intentional and unintentional injury. In 2010, members of the International Association of Forensic Nurses (IAFN) began to formally inquire about a position statement or guidelines on the use of photodocumentation, especially related to images of the genitalia among adolescent and adult patients reporting sexual abuse or assault. Since the IAFN did not have a position statement or guidelines addressing photodocumentation, organizational leadership turned to the literature and membership for further inquiry. In reviewing the literature, they found an inadequate research base for developing evidence-based position statements and guidelines. An informal member survey (Fuller, 2011) revealed great variability in existing practice among the 1,020 survey respondents with the greatest variability involving informed consent for photography, release of photographs, and security of images. To engage in a more formal discourse on the subject, a forensic photography symposium was convened in March 2011. Several themes emerged from the 2011 symposium including concerns surrounding role conflict, informed consent, lack of 57 protocols, and lack of evidence-based practice related to clinical forensic photodocumentation involving certain populations (Fuller, 2011). In the 1980s, tools for clinical forensic-medical photodocumentation included colposcopes, Polaroid cameras, and 35mm film cameras. Since that time, the advent and integration of digital imaging technology into photodocumentation practices have occurred. Digital imaging technologies provide higher quality images and the ability to immediately view, store and transfer the captured images to other people easily. Hence, these advancements brought forth new questions and concerns and gave a new perspective to forensic nursing discourse related to photodocumentation practices. However, a review of the literature revealed a lack of knowledge about the appropriate use of this new technology, digital imaging, by forensic nurses. Discussions about the use of digital imaging technology for photodocumentation in forensic