Sexual femicide, an abhorrent crime, is not well described and reported. The aim of the study was to describe sexual and non-sexual femicide in South Africa and compare the 2009 with the 2017 study presenting sociodemographic characteristics of victims, perpetrators, crime and forensic findings. The same retrospective study design using proportionate random sample of medico-legal laboratories were used. Sexual femicide was identified from autopsy and police reports. Findings show sexual femicide is not rare in South Africa. We estimated 451 (95% confidence interval: 366–533) sexual femicides in 2009 and 210 (95% confidence interval: 176–244) in 2017. Sexual femicides decreased by more than half from 19.1% in 2009 to 8.7% in 2017. We show an increase among younger women, those living in rural areas and strangers as perpetrators. Our dedicated studies show the value of documenting sexual femicides over time in a country with high levels of gender-based violence to assist development of theory-based prevention interventions.
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