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Objective: To describe the epidemiology and forensic management of suspected rape homicide in South Africa, with the aim of promoting the recognition of this form of violence against women amongst forensic pathologists during post-mortem examination., Methods: A retrospective national study in a proportionate random sample of 25 medico-legal laboratories was carried out to identify all homicides in 1999 of women over the age of 13 years. Data was collected from the mortuary file, autopsy report, police record and during interviews with police., Findings: A rape homicide was suspected in 16.3% (95% confidence intervals (CI): 10.6-22.3) of the female homicides which gave a rape homicide rate of 3.65/100,000 women over 13 years. Rape homicides were more likely to than other female homicides to be crimes where the perpetrator and victim were strangers, where the crime happened in public spaces and the victim older than the perpetrator. In addition to genital injuries, injuries associated with this crime included those of head and face, legs, neck and injuries caused by bites. Victims had larger numbers of injuries, and more often a mechanism of death due to strangulation asphyxiation, or blunt trauma, rather than gunshot., Conclusion: Rape homicide is an extreme form of violence against women and the prevalence in South Africa is higher than that of all female homicides in the United States. The particular pattern of injury found in these cases should be used to develop protocols for autopsies on murdered women to ensure that crucial evidence is not lost and the victims' and their families claim to justice is not compromised.