Sexual assault
[Link]
Azad Hassan
Forensic
pathologist
Sit Dolor Amet
At the end of this lecture, you will be able:
-define sexual assault
Out lines -summarize types of assaults.
-using of sexual assault kit.
-connect sexual assault to the law .
Adults and children, males and females
may all be victims of sexual assault.
Most victims are female but a large
minority, perhaps 10%, are male.
introduction Sexual
assault occurs within families or may be
by strangers and may be associated
with crimes against humanity, war
crimes and genocide.
definition of the act of ‘rape’
A person (A) commits an offence [of rape] if:
● he intentionally penetrates the vagina, anus or mouth of
another
Definition of
person (B) with his penis,
“Rape”
● B does not consent to the penetration, and
● A does not reasonably believe that B consents.
A person found guilty of rape under this section is liable, on
conviction on indictment, to imprisonment for life.
It is important the complainants of sexual
assault are examined by competent,
sympathetic sexual offence examiners; these
Examination are generally physicians with a special
requirements interest in forensic aspects of medicine.
Complainants (and suspects of sexual assault)
should be offered the choice of a doctor of
their own gender.
Sexual Assault Referral Centres (SARCs) – They provide
appropriate assessment and sampling following the initial
assault, and post-assault care regarding issues such as
genitourinary health, contraception and counselling.
Examination Emergency contraception may involve use of the oral
requirements contraceptive or insertion of an intrauterine device. Prevention
of sexually transmitted infection, for which there is a huge
range of potential risk, will require appropriate prescribed
medication for which standard prophylactic/therapeutic
regimens will apply.
Many SARCs also allow complainants who do not
wish to involve the authorities immediately to provide
Examination
anonymized assessment and collection of samples, so
requirements
that a complainant may later proceed with police
investigation if they change their mind.
Medical assessments of sexual assault
complainants and suspects are to identify and
treat injury or other risk issues (e.g.
assessment
infection), and to identify and collect evidence
that may assist the courts to establish the
facts of the case.
An assessment requires a detailed history and
examination. The history of the alleged assault from
Assessment the complainant is an extremely important part of
the assessment.
The doctor should ensure that they record the briefing details
from the referring police team, and then record verbatim the
account of the complainant themselves, as discrepancies may
become very significant at a later stage of any legal
proceedings. Apart from a general medical history, detail of the
Assessment
full history of events and any specific physical contacts must be
identified (e.g. penis to mouth, mouth to genitalia, penis to
anus, penis to vulva/vagina, ejaculation, object/implement
penetration of mouth/vulva/vagina/anus,
kissing//biting//spitting). Recent drug and alcohol intake
Recent drug and alcohol intake must be
recorded in as much detail as possible, and
this may be relevant in terms of ability to
assessment recall events appropriately or if there is a
possibility of drugs or alcohol having been
administered in possible cases of drug-
facilitated sexual assault.
Specific questions are also asked about events after the
assault as these may affect subsequent findings or
recovery of evidence. Such questions include ‘Since the
assault have you... noted pain... noted bleeding... brushed
assessm teeth... passed urine... defaecated... douched?’ A full
ent medical history must include past medical history, past
surgical history, past gynecological history, menstrual
history and past psychiatric history so that, if necessary,
any influence of these on examination findings can be
considered.
The following should always be documented: weight,
height, general appearance, skin abnormalities of
changes (e.g., scars, tattoos, piercing) and appearance of
the hair (e.g., dyed, shaved). A standard general physical
examination will be done and a detailed physical, external
assessm examination
recording
identifying
absence of
injury
injury
or
and
abnormality
abnormality.
and
This
ent examination will be documented on body diagrams and
images of abnormalities should be taken. The external
exam-nation will focus on those areas that the history
indicated as having been in general or physical contact,
as these are areas where trace evidential materials that
may provide DNA or other links may be found.
The Genito-anal examination may be undertaken by naked eye,
or with the assistance of specialist lighting, magnification or
colposcopes. Examination of a female complainant (dependent
assessm in part on the history) will record the presence of any
abnormalities or the absence of any findings in the following
ent anatomical sites: thighs, buttocks and perineum; pubic area;
pubic hair; labia majora; labia minora; clitoris; posterior
fourchette; fossa navicularis; vestibule; hymen; urethral
opening
Appropriate samples in sexual assault will assist in
documentat determining the nature of sexual contact, the gender
ion and possibly identity of the assailant and possible
links with other offences
Samples that may be required include blood (for
Documentat DNA and drugs and alcohol), urine; hair (head and
ion pubic), nails and swab samples from body orifices,
mouth, ears, nose and genitalia, including vulva,
vagina, cervix, penis, anal canal and rectum.
If there is any doubt whether a particular sample
may be relevant it is better to take a sample and
retain it for later analysis. In the case of a suspect the
doctor should advise the police investigators
documentat
ion regarding samples as legal requirements will need to
be observed in order to appropriately request
samples. Control swabs may be required, depending
on local laboratory protocols and standard operating
procedures.
In general, foreign biological fluids (e.g., semen) can
documentat be detected in the mouth up to about 48 hours after
ion contact, in the anus or rectum up to about 3 days and
in the vagina or endocervix up to about 7 days.
As with all forensic assessments, documentation should be
thorough, legible and meticulous, recording relevant positive
and negative findings. Documentation of finding should be in
documentat written form (ideally using standardized proforma), with body
ion diagrams accompanying all written notes. Wherever possible,
photographic images should be taken of all abnormalities,
under the direction of the doctor, with color bars and rules in
all images
Interpretation of findings, unlike the assessment and
Medical findings documentation of findings, should only be undertaken by a
after doctor experienced in such assessments and fully aware of
sexual contact current research concerning physical findings after sexual
assault.
It is incorrectly assumed by many that sexual
Medical assaults will result in injury to the victim whether
findings
adult or child. This is incorrect and, in most cases,
after
sexual medical abnormalities (in both adults and children)
contact will be absent. Conversely, consensual sexual activity
can result in injury to the body and genitalia.
Many factors may affect the severity of injury in the female.
Similar injuries may be seen in both consensual and non-
Medical findings consensual sexual contact. Some of the factors that may
after influence the possibility of genital injury are age of the
sexual contact complainant, type of sexual activity, relative positions of the
participants and degree of intoxication of either or both
participants.
Consensual insertion or attempts at insertion of a
Medical findings finger or fingers, penis or any other object into the
after vagina may result in bruises, abrasions and
sexual contact
lacerations of the labia majora, labia minora, hymen
and posterior fourchette.
Non-genital injury of even a minor nature can often be very
Medical findings significant evidentially and corroborate accounts of assault.
after Marks of blunt contact (e.g., punches, kicks), restraint (e.g., ties
sexual contact around wrists) and bite marks are all ex ample of non-genital
injuries seen in sexual assault complainants
Consensual anal intercourse can (in the same
way as vaginal sex) be pain and discomfort free
and would not normally leave any residual
Medical findings injury. Non-consensual anal intercourse if done
after without force, with or without lubrication and
sexual contact without physical resistance on the part of the
person being penetrated may leave no residual
injury and may be pain free. The effects of
drugs and alcohol may make penetration easier
The likelihood of pain or injury in non-consensual anal intercourse
may be increased:
1. in someone who has not experienced anal intercourse.
Medical findings 2. in the absence of lubrication.
after 3. if force is used.
sexual contact 4. if there is great disparity between the size of the.
5. anus (which varies little in the adult) and the penis (which may vary
a lot).
The types of injury include bruises, fissures or tears.
In the absence of repeated trauma, any fissures, tears or lacerations
Medical findings would be expected to heal within 2 weeks or so and leave no residual
after marks. It is important for any examining doctor to be aware of, or to
sexual contact be able to distinguish, abnormalities caused by medical conditions
that may mimic, or be mimicked by injury after sexual contact.
Care of those who have been sexually assaulted is most
appropriately managed by those with specialist skills such as
genitourinary medicine specialists who can provide the most
Care after appropriate and up to date post-assault treatment and advice. It
sexual assault should be the responsibility of the examining doctor or healthcare
professional to ensure that appropriate post-assault prophylaxis
against pregnancy, or HIV or other genitourinary conditions are
anticipated.
Counselling or psychological support may also be required to
support victims. Proactive support should be offered, and
Care after
follow-up should be provided so that vulnerable individuals do
sexual assault
not have the problems associated with the initial assault
compounded by poor or absent care later.
Sexually assault is illegal act that leave on the person
and family very bas effect.
Need examination by special examiner.
summary
Documentation is very important.
There is different type of sexual assault.
Simpson’s forensic medicine.
refrences Knight’s forensic pathology.
Handbook of forensic medicine.
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