Injury patterns and interpretation of injuries in homicidal deaths are important components of medicolegal autopsies. The objective of this article is to describe the incidence of female homicides and their related injury patterns with reference to autopsy practices in South Africa. A national retrospective mortuary-based study of homicides in women of 14 years and older in 1999 was conducted. Data were gathered from medical legal laboratory records, autopsy reports, and police interviews from a stratified multistage sample of 25 mortuaries. The most common cause of homicide was a gunshot wound injury, with a firearm mortality rate of 7.5/100,000 women, 14 years and older, in 1999, followed by sharp force injury (6.8/100,000) and blunt force injury (6.1/100,000). Gunshot victims were more likely to be African, and those killed by sharp force injury were more likely colored. Significantly, blunt force injury deaths occurred predominantly in intimate partner homicides. A full autopsy was performed only in 70% of cases. An assessment of postmortem reports revealed poor descriptions of the anatomic location of injuries and the specifications of wound dimensions. South Africa has a high female homicide rate that exceeds reported rates with the cause of homicide varying by social group. Assessment of injury description suggests weaknesses in the documentation of injuries at autopsy. This weakens the forensic investigation and undermines the strength of evidence presented in court. Further measures are needed to strengthen forensic pathology services in South Africa.