Anogenital injury is often seen as the ultimate evidence in sexual assault cases. However, the reality is that anogenital injury evidence has significant limitations. Specifically, in the vast majority of cases we are limited in our ability to distinguish between injuries resulting from a sexual assault and those sustained during consensual sexual activity. This article discusses how these points may not be well understood by legal practitioners and clinicians alike, resulting in a portrayal of anogenital injury as having clear and unambiguous significance. Understanding the emerging research on consensual sexual activity injury can therefore help us provide more accurate information to attorneys, judges, and juries in adult sexual assault cases.