Forensic Exam

"Successfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement" Develo e!
"y t#e National Center for Women & Policing $ wit# su ort rovi!e! "y t#e %iolence Against &omen 'ffice$ 'ffice of (ustice )rograms *+rant ,-./&E/%0/12234 55555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555
Forensic Examination
Most of the content in this module was adapted from: Sexual Assault Nurse Examiner (SANE): Development & peration !uide ("###)$ %ritten &' (inda E$ (edra'$ of the Sexual Assault )esource Service of Minneapolis* Minnesota$ +roduced &' the ffice for ,ictims of -rime* .$S$ Department of /ustice (!rant 0#12,32!42 56"7)$ ri8inal contri&utions provided &' Detective Ser8eant /oanne Archam&ault of the San Die8o +olice Department$
Additional content was developed on the &asis of material from the followin8 sources$ +olice )esponse to -rimes of Sexual Assault: A 9rainin8 -urriculum$: %ritten &' Sharon M$ ;unter* <onnie )$ <entle' -rewe* and /amie ($ Mills$ +roduced &' the -onnecticut Sexual Assault -risis Services* =nc$ 3unded &' +olice fficer Standards and 9rainin8 -ouncil and S9 + ,iolence A8ainst %omen !rant 0,A%#161$ Model !uidelines and Sex -rimes =nvesti8ation Manual for =llinois (aw Enforcement$: +roduced &' the =llinois (aw Enforcement 9rainin8 and Standards <oard and =llinois -oalition A8ainst Sexual Assault$ 9he Medical Examiner>s )ole in Sexual Assault )esponse$: 9rainin8 pro8ram developed &' Dr$ %illiam !reen and Dr$ Maril'n 5aufhold of the -alifornia Medical 9rainin8 -enter$ 3unded &' the -alifornia ffice of -riminal /ustice +lannin8$ +romisin8 +ractices: =mprovin8 the -riminal /ustice S'stem>s )esponse to ,iolence A8ainst %omen$: %ritten &' Mar' <$ Malef't* 5ristin M$ (ittel* and Alexandra ;$ %al?er$ Edited &' /oan 5urians?'$ +roduced &' the 9echnical Assistance +ro@ect of the S9 + ,iolence A8ainst %omen !rant +ro8ram$
9he National Center for Women & Policing would li?e to 8ratefull' ac?nowled8e the assistance of these individuals and or8aniAations$ Dr. Kimberly A. Lonsway, Research Director, National Center for Women & Policing
"Successfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement" Develo e! "y t#e National Center for Women & Policing $ wit# su ort rovi!e! "y t#e %iolence Against &omen 'ffice$ 'ffice of (ustice )rograms *+rant ,-./&E/%0/12234 55555555555555555555555555555555555555555555555555555555555555555555555555555555555555555555
9oo often* sexual assault results in a case of one person>s word a8ainst another in court B essentiall' a le8al he said* she said: with little or no ph'sical evidence to corro&orate the victim>s stor' of what happened$ .nfortunatel'* this situation increases the alread' existin8 tendenc' to focus solel' on the victim>s credi&ilit' when ma?in8 @ud8ments a&out the assault$ Althou8h the techniCues we>ve alread' descri&ed will 8o a lon8 wa' toward overcomin8 challen8es to the victim>s credi&ilit'* there is nothin8 so powerful as ph'sical evidence in corro&oratin8 the victim>s account of events$ 3or example* one stud' has demonstrated that sexual assault cases are approximatel' twice as li?el' to &e prosecuted if a forensic examination was conducted with the victim$" 9his demand for ph'sical evidence is certainl' not uniCue to sexual assault$ =n a &ur8lar' case* evidence will &e collected at the crime scene as officers attempt to document the event and identif' the perpetrator$ =n a sexual assault case* however* the victim>s &od' is the most important source of ph'sical evidence$ 9he victim is* in essence a wal?in8 and tal?in8 crime scene$: ften* the onl' thin8 standin8 &etween an officer and another case of he said* she said: is the evidence recovered from the victimDs &od' durin8 a forensic examination$ Another uniCue aspect of the forensic examination is that medical personnel act as an a8ent of the police investi8ation$ A medical professional will collect the forensic evidence in a sexual assault case* &oth &ecause of the intimate nature of this evidence and &ecause a 8reat deal of special expertise is reCuired to conduct a thorou8h* meanin8ful examination$
%e>ll tal? in detail a&out the evidence that is collected durin8 the forensic exam B as well as explorin8 what can and cannot &e concluded on the &asis of this evidence$ =n 8eneral* however* evidence collected in the forensic exam can &e used for four primar' purposes: 9o identif' the assailant 9o confirm recent sexual contact 9o esta&lish force or threat 9o corro&orate the victim>s stor'
Most of the evidence collected in a forensic examination serves to identif' the assailant$ 3or example* DNA evidence collected from &lood* saliva* semen* and other &iolo8ical samples will identif' the suspect with a 8reat deal of certaint'$ =n addition* other associative evidence such as hair or fi&ers can serve to assist in the identification of a suspect$
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(indsa'* "##E
+roof of sexual contact includes the examination of all orifices that the victim indicates were involved in the assault$ =n specific* the forensic examiner will loo? for redness* soreness* or other si8ns of ph'sical trauma to corro&orate that sexual contact occurred$ Swa&s will also &e collected to identif' seminal fluid from orifices in which the victim indicates there was penile penetration B or saliva from sites where the victim indicates that the suspect>s mouth came into contact$ =n addition to a written description* a colposcope can &e used to ma8nif' and photo8raph 8enital microtrauma that serves as an indicator for recent sexual contact and penetration$ As for the third purpose* evidence to esta&lish the presence of force or threat will include: 9he victim>s ver&al account of the incident durin8 the medical interview %ritten documentation of 8enital and non28enital in@uries +ictures of in@uries 9orn or soiled clothin8 +ositive toxicolo8' tests for dru8s present in the &lood or urine (in cases of dru82facilitated sexual assault)
3inall'* all of the evidence collected in a forensic examination can used to either corro&orate or clarif' the victimDs account of the assault$ .ltimatel'* the forensic examiner will conclude whether the forensic evidence is consistent with the victimDs description of events$ The importance of the victim interview in interpreting forensic evidence 9hese purposes can &e met with forensic evidence* &ut onl' if it is interpreted within the context of the victim>s account of the assault$ =t is therefore critical that this module on the forensic examination &e considered alon8 with the previousl' provided information on victim interviews$ 3or example* if the victim indicates to medical personnel where the suspect lic?ed or ?issed her &od'* these sites &ecome crucial to swa& for the presence of saliva$ =f the suspectDs saliva is indeed found at these locations* moreover* this provides powerful evidence that the assault too? place as descri&ed &' the victim$
9he interview can thus su88est locations on the victimDs &od' where valua&le evidence mi8ht &e recovered$ =n addition* evidence collected in the forensic exam mi8ht su88est additional areas of inCuir' to explore with the victim$ 3or example* victims occasionall' disclose penile2va8inal penetration in their initial interview with police or medical personnel* while withholdin8 information on other t'pes of penetration that are seen as especiall' em&arrassin8 or humiliatin8 (e$8$* sodom' or oral copulation)$
9he interviewer should thus alwa's as? whether the offender committed sexual acts other than those alread' descri&ed &' the victim$
-learl'* a forensic examination must &e conducted in strict accordance with the 8uidelines provided in materials such as the Sexual Assault Nurse Examiner manual developed &' (inda (edra'$7 ;owever* it is not enou8h to simpl' conduct a thorou8h forensic exam$ 9hese procedures must &e performed alon8 with a comprehensive victim interview in order to 8uide the interpretation and meanin8 of an' forensic evidence o&tained$ Traditional problems with the forensic examination Despite the o&vious importance of a forensic examination in the investi8ation of sexual assault* there have &een a num&er of historic pro&lems limitin8 &oth their value for law enforcement and their sensitivit' toward victims$ 3or example* sexual assault victims rarel' reCuire emer8enc' medical attention$ =n a traditional medical settin8 that utiliAes a tria8e s'stem* sexual assault victims are thus 8iven relativel' low priorit' in receivin8 care$ +atients comin8 into the emer8enc' room with cardiac arrest* 8unshot wounds* and other emer8encies ta?e priorit' over victims of sexual assault* which can leave them lan8uishin8 for hours in the waitin8 room$ 3or victims* this can &e a terri&l' upsettin8 experience* particularl' if the' have &een advised not to eat* drin?* or urinate until after the examination is complete$ 9he situation also compromises their ri8ht to privac' and confidentialit'* and ma' deter some victims from receivin8 the care the' need$ =t ma' even erode the victim>s confidence and trust in the communit' response s'stem* which can ne8ativel' affect their cooperation with police and prosecutors$ 3or law enforcement* this wait is frustratin8 &ecause it contri&utes to the loss or deterioration of evidence$ =t also means that the officer is spendin8 unnecessar' time waitin8* rather than investi8atin8 the case or clearin8 to 8o &ac? into service$ ther pro&lems traditionall' associated with the forensic examination include: Examiners who are insensitive or improperl' trained Examiners with insufficient experience to maintain their proficienc' 3ailure of examiners to reco8niAe* properl' collect* or preserve evidence 3ailure of examiners to reco8niAe and document su&tle ph'sical findin8s (ac? of appropriate eCuipment to conduct a thorou8h examination (e$8$* colposcope)
(edra' ("###)
=n addition* man' examiners are reluctant to perform a forensic examination* out of concern that the' will &e called to testif' re8ardin8 the evidence o&tained$ Coordinated community response =n response to this situation* cooperative communit' models have arisen for providin8 &etter and more coordinated services to victims$ 3or example* some communities have implemented an interdisciplinar' response s'stem commonl' referred to as the SA)9 (Sexual Assault )esponseF)esource 9eam) model$ thers (who ma' or ma' not use the SA)9 model) also emplo' nurses with specialiAed forensic trainin8 to conduct the examination and provide testimon' in court$ 9hese nurses are usuall' termed Sexual Assault Nurse Examiners (SANE)$
<oth of these models are discussed at 8reater len8th in the module on coordinated response$ The Forensic Examination When to obtain a forensic examination !enerall'* law enforcement should o&tain a forensic examination of the victim if the sexual assault occurred within the previous G7 hours$ fficers should also reCuest a forensic examination &e'ond G7 hours if the victim is still experiencin8 pain* &leedin8* descri&es an unusual amount of force* or reports e@aculation without cleanup$ 9raditionall'* law enforcement officers were trained to determine whether the assault involved penileFva8inal penetration and e@aculation to evaluate the need for a forensic examination$ fficers must understand* however* that this standard no lon8er applies$ A forensic sexual examination should alwa's &e o&tained if the sexual assault occurred within the last G7 hours$ 9his is true re8ardless of the t'pe of penetration* even when the contact is minimal (e$8$* oral contact* di8ital penetration)$ Dependin8 on the circumstances of the assault* this could even include attempted assaults$ 3or example* the suspect ma' have ?issed or suc?ed the victim>s &reasts &ut not completed penetration or e@aculation$ 9he saliva evidence will still &e critical to o&tain* in order to identif' a suspect andFor corro&orate the victimDs account of what happened$
How the forensic examination process is initiated %hen law enforcement is called to the scene of a sexual assault* the' will protect the victim from further harm* secure the crime scene* and ta?e a limited statement from the victim to determine if a sex crime was committed$ At this point* either the respondin8 officer or communications personnel should call emer8enc' room staff who will then contact the forensic examiner (nurse* ph'sician* or SANE) and rape crisis advocate who is on call$ <' notif'in8 the hospital or clinic that the' are on their wa'* the facilit' can &e prepared to receive the victim and officer$ 9he forensic examiner can also prepare for the process of interviewin8 and examinin8 the victim$ Similarl'* the rape crisis advocate can &e dispatched to arrive as soon as possi&le and assist the victim throu8hout the medical and police procedures$ %hen the police and victim arrive at the hospital* medical staff will determine if the victim should receive emer8enc' room evaluation &' a ph'sician or &e8in the forensic examination$
=f a victim ori8inall' presents to the emer8enc' room* law enforcement should &e called immediatel' to determine if a crime has &een committed$ =f the elements of a crime have &een esta&lished and the criteria for a forensic examination have &een met* the rape crisis advocate and forensic examiner should &e contacted$ =n a limited num&er of communities* a prosecutin8 attorne' also responds to the hospital or clinic as a mem&er of the response team$ =n man' areas* the police are called initiall' to certif' that a crime has &een committed$ =n these locales* the hospital is compensated for the medical evidentiar' exam onl' if there is an accompan'in8 police statement certif'in8 that there was a crime$ <efore the examination is conducted* law enforcement personnel should consult with the forensic examiner to share information a&out the case$ 9his allows &oth professionals to maximiAe their ?nowled8e of the case and promotes comprehensive evidence collection &ased on the victim>s account of events$ Explaining the examination to victims <efore the forensic examination is conducted* it is important that the victim understands all of the followin8 aspects of this process$ Althou8h these issues will t'picall' &e discussed &' the forensic
examiner andFor rape crisis advocate* law enforcement personnel must also &e prepared to address them with the victim$ 9hese issues include: 9he importance of forensic evidence and the need to collect it as soon as possi&le 9he fact that the cost of the exam will &e covered if the victim meets certain criteria (or in those states where law enforcement is reCuired to pa' for all evidentiar' examinations) !eneral information re8ardin8 the process of forensic evidence collection 9he role of each professional involved in the forensic examination process* includin8 law enforcement* medical personnel* and the rape crisis advocate %hat to expect after the crime is reported to the police 9hat the victim>s clothin8 ma' need to &e collected if it was worn durin8 or immediatel' after the assault 9hat the victim>s name will not &e a matter of pu&lic record and will not &e included in an' media reports unless she wants it to &e 9he extent of confidentialit' in communications with each of the professionals involved (e$8$* forensic examiner* law enforcement* rape crisis advocate) 9he ri8ht of the victim to refuse to cooperate with an' aspect of the evidence collection or medical procedures
(aw enforcement must also &e aware of the state laws 8overnin8 informed consent* especiall' with respect to complicatin8 factors such as victim a8e* disa&ilit'* or ps'chosis$ ddressing the victim!s reluctance to report =f the victim is unsure or unwillin8 to ma?e a formal statement to police a&out the assault* professionals involved in the team response should reiterate the importance of immediatel' collectin8 evidence$ 9his is true even if the decision re8ardin8 police involvement is made at a later date$ 9he medical facilit' or law enforcement a8enc' ma' even &e a&le to store the evidentiar' ?it for a specified period of time (usuall' " month) while the victim ma?es a decision re8ardin8 whether or not to participate in the criminal @ustice process$ 9he victim will also &e informed of her ri8ht to report at a later date and the procedures for doin8 so$
=f an evidentiar' examination is not completed for whatever reason* the forensic examiner can still treat an' in@uries* provide medications to prevent S9D>s* evaluate her ris? for pre8nanc'* and administer emer8enc' pre8nanc' interception (within G7 hours of the assault)$ =n some cases* the forensic examiner ma' refer the victim elsewhere to receive these services$ 9he forensic examiner
andFor rape crisis advocate will also provide referrals for follow2up medical care and counselin8* as well as providin8 the victim with written information re8ardin8 follow2up care$ Components of a forensic examination nce the victim has provided informed consent* the forensic examination will &e8in$ %hether conducted &' a SANE* ph'sician* or other nurse* this examination will &e completed accordin8 to esta&lished protocol$ 9he forensic examination includes these 8eneral components: -omprehensive medical interview -ollection of forensic evidence Evaluation of ris? and proph'lactic treatment of S9D>s Evaluation of ris? and emer8enc' pre8nanc' interception -risis intervention and referralsH
An uncomplicated exam* without in@uries* will 8enerall' ta?e 7 to I hours to complete$ I "edical care for in#uries After o&tainin8 informed consent* the emer8enc' department or clinic staff will first assess the sexual assault victim for serious in@ur'$ =f the in@uries are life threatenin8 or reCuire immediate medical treatment* these will o&viousl' receive attention &efore forensic evidence collection$ ;owever* this occurs with less than IJ of sexual assault victims$K Comprehensive medical interview nce an' immediate medical needs are addressed* the forensic examination will &e8in$ %hen the officer arrives at the facilit'* heFshe must &rief the examiner a&out the facts of the assault as the' are ?nown$ 9he examiner will then need to o&tain a complete histor' from the victim$ 9his will include determinin8 whether the victim is postmenopausal* and whether she has had children or 8'necolo8ical sur8er'$ =t will also include Cuestions a&out the assault* such as: %hen and where the assault too? place +rior sexual experience
(edra'* "### ;ollowa' & Swan* "##HL (enehan* "##"L Sandric?* "##1 K 9uc?er* (edra' & %erner* "##6
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9he t'pe of sexual acts perpetrated &' the suspect(s) 1 %hether e@aculation occurred and where %hether a condom or lu&ricant was used 9he position of the victim and suspect at the time of the assault =n8estion of an' dru8s or alcohol within the previous "7 hours A description of the t'pe of force used
9he forensic examiner must also as? the victim whether she had consensual sex with a partner within the previous G7 hours$ =f so* man' of the same Cuestions will need to &e as?ed a&out the prior consensual activit'$ Althou8h the histor' o&tained &' the examiner is comprehensive* its focus should &e on the sexual assault incident and not the surroundin8 events (e$8$* pre2 or post2assault &ehavior)$ =t is critical that the examiner not attempt to conduct the t'pe of interview reCuired &' a police investi8ator$ 9his will su&@ect the victim to more Cuestionin8 than is necessar'$ =n addition* @oint interviews should &e conducted whenever possi&le in order to reduce the Cuestionin8 and potential for discrepancies in the reports of police and medical professionals$
Types of Forensic Evidence Althou8h some states have standardiAed their protocol* there remains si8nificant variation in the evidence collection procedures in the forensic examination$ ;owever* the followin8 are provided as 8uidelines$ 3or each t'pe of evidence* the specific purpose is noted &oth in the title and descri&ed in the textL these include identif'in8 the assailant* confirmin8 recent sexual contact* esta&lishin8 force or threat* and corro&oratin8 the victim>s stor'$ $N evidence %identification& 9he use of DNA evidence is a recent technolo8' used primaril' in the criminal @ustice s'stem to identif' an assailant$ +referred DNA collection procedures ma' var' as a result of la&orator' processin8$ ;owever* all reCuire a comparison sample to &e collected from the victim$ Most @urisdictions reCuire that &lood must &e drawn from the victim to distin8uish her DNA from an' forei8n DNA recovered from her &od' or other crime scene evidence from clothin8* &eddin8* etc$
=f multiple suspects are involved in the sexual assault* the' should &e identified &' num&er in the documentation$ 3or example* the acts perpetrated &' suspect 0" should &e distin8uished from those of suspect 07* etc$
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Alternativel'* cell scrapin8s can &e collected from the side of the victim>s mouth (usin8 a &uccal swa&) to distin8uish her DNA from that of her assailant$G
9hese DNA standards from the victim are t'picall' collected at the time of the initial forensic examination* however* some @urisdictions do not collect them unlessFuntil the' &ecome necessar' durin8 the process of investi8ation and su&seCuent prosecution$ 9he' are then compared with an' DNA evidence collected from the victim* suspect* and crime scene$ DNA evidence can &e o&tained &' collectin8 an' availa&le &iolo8ical evidence that could have come from the assailant and remained on the s?in or clothin8 of the victim$ =f the victim reports that she scratched the assailant* fin8ernail scrapin8s (or swa&&in8s if the nails are too short for scrapin8s) should &e collected for potential DNA or trace evidence$ Althou8h man' @urisdictions collect fin8ernail clippin8s* there is some concern that this is invasive and adds no evidentiar' value to the scrapin8s or swa&&in8s$E DNA from semen can also &e o&tained &' swa&&in8 the orifices involved in the sexual assault with a standard siAe cotton swa&$ A swa& should also &e used on an' part of the &od' that the suspect mi8ht have lic?ed* suc?ed* ?issed* or &itten$
3inall'* an' dried or liCuid forei8n matter on the &od' or clothin8 should &e collected for DNA evidence$# Hair evidence %identification& 9he primar' use of hair evidence is to identif' the assailant$ %hile o&tainin8 forei8n hair samples is relativel' common* the' are often not anal'Aed &ecause the' are less relia&le for identification purposes than DNA evidence$ ;air samples can onl' &e used to ma?e the most 8eneral of distinctions &etween peopleL the' cannot identif' a suspect with an' de8ree of certaint' as with DNA evidence$ %hen forei8n hair is collected and anal'Aed* samples must also &e availa&le from the victim for comparison purposes$ 9here is some controvers'* however* re8ardin8 how and when to collect these samples$
3ran?* "##1 -lippin8s are also difficult to o&tain amon8 women with acr'lic fin8ernails$ # (edra' & NetAel* "##G
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3or example* some examiners alwa's pluc? (or as? the victim to pluc?) "K to 76 head hairs and pu&ic hairs as a part of the evidentiar' exam$ thers cut hairs rather than pluc?$"6 <ecause the victim>s hair ma' chan8e due to permin8* d'ein8* or other treatment* man' crime la&s reCuire that a sample of the victim>s hair &e collected at the time of the initial forensic examination$ Still other examiners do not collect samples of the victim>s hair as a routine part of the evidentiar' exam &ecause collection is uncomforta&le and &ecause hair is retrieva&le from the victim at a later date if it is needed$"" =f the hair evidence is not availa&le later* either &ecause the victim cannot &e located or will not cooperate with law enforcement* it is unli?el' that the case will move forward B with or without the hair evidence$
%ith the suspect* hair evidence should alwa's &e collected &' pluc?in8 (either &' the examiner or suspect)* as law enforcement ma' have difficult' locatin8 him later if he flees 'eminal fluid evidence %identification( sexual contact( corroboration& Seminal fluid evidence is used for two primar' purposes: to identif' the assailant and to confirm that recent sexual intercourse occurred$ =t can also &e thou8ht of as corro&orative evidence if the presence of seminal fluid is consistent with the victimDs account of events$ ;owever* a percenta8e of rapists are sexuall' d'sfunctional and others wear condoms or withdraw &efore e@aculation* so it is important to remem&er that the a&sence of seminal fluid does not disprove recent sexual intercourse$"7 Seminal fluid evidence is anal'Aed &' crime la&orator' personnel for spermatoAoa and for acid phosphatase (A-+)$ A-+ is actuall' an arra' of related isoenA'mes which is found in much 8reater concentration in semen than in an' other &od' fluid$"H A hi8h level of A-+ in va8inal secretions would therefore indicate that there has &een recent sexual contact with seminal fluid left in the va8ina$"I -ases ne8ative for sperm and positive for A-+ t'picall' indicate an assailant who has had a vasectom'* &ut this result is also possi&le in cases involvin8 an assailant who is a chronic alcoholic or due to other reasons$"K
s&orn & Neff* "#E# (edra'* "##7& "7 9uc?er* (edra'* & %erner* "##6 "H Davies* "#GE "I !reen* "#EE "K Enos & <e'er* "#E6
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Motile sperm can t'picall' &e recovered from the victimDs va8ina if specimens are collected within E hours of the sexual assault$ =t is also common to recover intact* nonmotile cells from the va8ina up to "1 hours followin8 intercourseL and less commonl' as lon8 as "II hours afterward$ "1 Sperm has even &een found in the postmortem va8ina up to "1 da's after death$ =n this case (investi8ated &' San Die8o +olice Department) it is &elieved that sperm was still present &ecause ph'sical draina8e of semen from the va8ina was impossi&le due to the victim>s posture at the time of death$ =n addition* sperm cells do not de8rade as activel' in the postmortem va8ina due to an a&sence of cells normall' found in a live victim>s va8inal and cervical fluids$
Sperm found in the mouth followin8 oral copulation are more transitor' than in the va8ina$ ;owever* intact sperm cells have &een recovered from the mouth up to 1 hours after e@aculation B even despite mouth rinsin8 or tooth &rushin8$"G Sperm have &een found in rectal swa&s up to 76 hours after an assault* however researchers caution that conclusions re8ardin8 sodom' should &e &ased on other factors in addition to sperm since semen drainin8 from the va8ina freCuentl' contaminates the analFrectal re8ion$"E
=n conclusion* the va8inal site is the most li?el' location to o&tain specimens positive for sperm$ =t also indicates that deterioration of evidence first occurs in mouth samples and then in va8inal or rectal samples$ Clothing evidence %force( corroboration& -lothin8 is useful as evidence to prove that force was used* if it is torn or soiled$ =t can also &e helpful to corro&orate the victim>s stor'$ 3or instance* if the victim claims she stru88led on the 8rass* stains on her clothin8 will corro&orate this and the a&sence of 8rass stains can &e used a8ainst her* as happened in the widel' pu&liciAed trial of %illiam 5enned' Smith$ f course* evidence such as forei8n de&ris* &lood* seminal fluids and other stains can also &e collected from clothin8 (these are discussed in the correspondin8 sections)$ %hile some pro8rams recommend collectin8 all of the victim>s clothin8*"# others specif' that clothin8 should onl' &e collected if it has clear evidentiar' value 22 for example* if the clothin8 has visi&le tears* stains* de&ris* or if it was worn closest to the 8enital structures$
=nformation provided &' San Die8o -ount' Sheriff>s Department =nformation provided &' San Die8o -ount' Sheriff>s Department "E =nformation provided &' San Die8o -ount' Sheriff>s Department "# 3ran?* "##1
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3or man' victims* a winter coat or pair of shoes ma' &e valua&le propert' that cannot easil' &e replaced$ =t is thus sometimes appropriate to allow the victim to ?eep these items$ n the other hand* crime la&oratories have sophisticated eCuipment for detectin8 evidence* and clothin8 often has evidentiar' value that cannot &e detected &' a forensic examiner$ 3or this reason* it is 8enerall' advisa&le for forensic examiners to collect as much clothin8 evidence as possi&le$ %hen examinin8 clothin8 for stains* man' forensic examiners utiliAe a %ood>s lamp$ 9his t'pe of lamp emits a lon8 wave ultraviolet li8ht that ma?e it easier to see stains caused &' semen and other su&stances$ 3or example* dried semen will usuall' fluoresce &ri8ht 8reen or 'ellow under illumination with a %ood>s lamp$ ther su&stances will t'picall' fluoresce easil' usin8 %oodDs lamp illumination$ Moist semen will fluoresce poorl' or not at all* however* so the %ood>s lamp should &e used to supplement visual examination$
%hen clothin8 is collected as evidence* it should &e allowed to air dr' prior to placin8 each article into a separate paper &a8* avoidin8 transfer from one item to another$ <a8s should then &e la&eled with the victim>s name* identif'in8 num&er* date* time* forensic examiner>s name* and the t'pe of article$76 'aliva evidence %identification( corroboration& fficers and examiners have &een trained to note* photo8raph* and possi&l' even cast &ite mar?s on the sexual assault victim in order to identif' the offender$ ;owever* it is much more common for the suspect to ?iss or lic? the victim>s &od' durin8 an assault$ 9he examiner should thus determine whether the suspect>s mouth touched an' part of the victim>s &od'$ Saliva swa&s should then &e o&tained from these areas &' the examiner for potential DNA anal'sis to assist in cases where identification is the issue$ 9his is especiall' critical if the victim does not &elieve that the suspect e@aculated or if he used a condomL in these instances seminal fluid is unli?el' to &e o&tained$
9he collection of saliva evidence from the victim>s &od' is also useful for corro&oratin8 the victimDs account of what happened durin8 the assault$ =f saliva evidence is recovered from areas
76
(edra'* "##7&
of the victimDs &od' that she indicated were lic?ed or ?issed &' the suspect* this provides persuasive evidence that the assault too? place as descri&ed &' the victim$ )lood evidence %identification( force( corroboration& 9he forensic examiner should alwa's draw the victim>s &lood for t'pe and DNA evidence (whether this is done at the time of the initial examination or later will depend on departmental polic')$7" 9his evidence will then &e used to assist in identification &' distin8uishin8 the victimDs DNA from the suspectDs$ <lood evidence is also used to corro&orate the victimDs stor' and esta&lish the use of force$ Evidence of the suspectDs &lood can &e used to corro&orate the victimDs account and esta&lish force if it resulted from a stru88le with the victim$ =n addition to the &lood provided &' the victim for identification purposes* it is also recommended that an additional tu&e of &lood &e routinel' drawn from the victim for toxicolo8ical screenin8* should this &ecome an issue durin8 the investi8ation and su&seCuent prosecution$77 9estin8 for the presence of dru8s or alcohol ma' assist law enforcement &' corro&oratin8 aspects of the victim>s stor' or demonstratin8 that the victim>s level of intoxication contri&uted to her vulnera&ilit'$ =t can also provide evidence that the victimDs level of intoxication or even unconsciousness ne8ated the possi&ilit' of consent$ As discussed in the module on law and investi8ative strate8'* extreme levels of victim intoxication or unconsciousness create a situation in which no force is necessar' for sexual penetration to constitute criminal &ehavior$
Anal'Ain8 the victimDs &lood for the presence of dru8s or alcohol reCuires separate consent in some @urisdictions* creatin8 a controvers' that is discussed in detail in the module on dru82 facilitated sexual assault$ %hatever the polic' re8ardin8 toxicolo8ical screenin8* the issues must &e discussed with the victim$ *rine analysis %force( corroboration& As with &lood evidence* a sample of the victim>s urine should &e collected in order to test for the presence of dru8s$ A8ain* this evidence ma' &e used to corro&orate the victim>s account of dru8 use or to provide evidence for her intoxication or unconscious state$ )ecentl' a 8reat deal of attention has focused on the specific dru8s that are &ein8 used to facilitate sexual assault$
7" 77
3ran?* "##1 (edra'* "##7a
As discussed in the module on dru8 facilitated assault* these date rape dru8s: include the lon82actin8 &enAodiadepine flunitraAepam (e$8$* )oh'pnol)* the powerful sedative 8amma h'drox' &ut'rate (!;<)* the veterinar' anesthesia ?nown as ?etamine (5)* and man' more$ Althou8h these cases often involve little memor' on the part of the victim and uncertaint' re8ardin8 whether or not a sexual assault too? place* the forensic examination should nonetheless &e conducted$ =f law enforcement has contact with the victim prior to comin8 to the hospital or clinic* she should &e told to collect her first voided urine in a clean @ar and &rin8 it with her$ 7H
%henever the victim>s stor' is consistent with a dru8 facilitated sexual assault* and if she is seen within G7 hours of the assault* a urine specimen should &e collected for a complete dru8 anal'sis$ =t is important to do a complete dru8 screen with sexual assault victims* unless there is specific evidence that a particular dru8 was used$ Non+biological evidence %identification( corroboration& f course* an' non2&iolo8ical trace evidence should &e collected which lin?s the victim to the suspect andFor crime scene$ 9his could include such items as lu&ricants* contraceptives* de&ris* fi&ers* soil* sand* paint* or other forei8n &odies$ 9his evidence can &e used &oth to assist in the identification of the suspect and to corro&orate the victimDs account of the assault$ on!"enital #n$%ry Evidence &force, corroboration' +h'sical in@uries are the &est proof of force and should alwa's &e photo8raphed* descri&ed on drawin8s* and documented in writin8 on the report$ 7I Evidence of in@ur' can also corro&orate the victimDs account of events$ =t is imperative to note* however* that the a&sence of in@uries does not mean that force or coercion was not used$ !iven that the ma@orit' of sexual assault victims do not sustain in@uries* an a&sence of in@uries does not prove consent$7K ,ates of non+genital in#ury 9he literature indicates that in@uries resultin8 from sexual assault are relativel' rare$
An8lin* Spears* & ;utson* "##GL (edra'* "##7& (edra'* "##7& 7K 9uc?er* (edra'* & %erner* "##6
7H 7I
=n a review of HG7 cases of sexual assault examinations conducted &' the hospital emer8enc' department* 1EJ of the victims seen had no in@ur'* 71J had mild in@uries* KJ had moderate in@uries* and onl' 6$7J were severel' in@ured$71 ther studies indicate that onl' H2KJ of all sexual assault victims have ma@or non28enital in@uries or in@uries reCuirin8 treatment and that onl' "J t'picall' reCuire hospitaliAation$7G
-onsistent with our previous discussion in the d'namics module* non28enital in@uries are not t'pical amon8 sexual assault victims$ Althou8h evidence of non28enital in@ur' is thus powerful in demonstratin8 force* the a&sence of in@ur' should not &e interpreted as consent$ Photographic evidence %henever photo8raphs are ta?en of non28enital in@uries* the first picture should alwa's &e of the victim>s face* and others should follow in a s'stematic order* such as head to toe* or front to &ac?$ +hoto8raphs should &e ta?en first without a scale to show that nothin8 is &ein8 concealed* and then with a scale to document siAe$ %hile a coin such as a Cuarter is sufficient for documentin8 siAe* a 8ra' photo8raphic scale will also assist with color determination$ Man' forensic examiners utiliAe the (2shaped scale recommended &' the American <oard of 3orensic dontolo8'$ 9he forensic examiner should print hisFher name and title* alon8 with the date* the time* and the victim>s name andFor record num&er on the &ac? of ever' picture$ Althou8h some a8encies routinel' photo8raph the victim>s name on a la&el with HK mm film or print it on the front with +olaroid pictures* there is some concern that practice this violates the victim>s privac' andFor confidentialit'$ =t is therefore recommended that the photo8raphs &e la&eled on the &ac? andFor use a medical record num&er rather than the victim name$ +hoto8raphic documentation of in@uries should &e completed usin8 a HK mm (or di8ital) camera with a standard K6 mm lens* or a HK2""6 Aoom lens* and "662766 speed (ASA) color film$
9intinalli & ;oelAer* "#EK -artwri8ht* Moore* Anderson* & <rown* "#E1L March&an?s* (ui* & Merc'* "##6L 9uc?er* (edra'* & %erner* "##6
71 7G
A disadvanta8e of HK mm (or di8ital) pictures is that the' must &e sent out for developin8 and are often not availa&le to the police when the' investi8ate or to prosecutors when the' are decidin8 if the' will char8e the case$ +olaroid film has the advanta8e of &ein8 availa&le to the police durin8 their initial investi8ation$ =t has the disadvanta8e* however* of poorer Cualit'L especiall' for close2ups$ +olaroid film is also ver' expensive$7E 3or all of these reasons it is 8enerall' not recommended for use in sexual assault investi8ations$ Some have su88ested* however* that the newer and more expensive +olaroid cameras desi8ned for close2up photo8raph' overcome man' of these disadvanta8es$
=t is sometimes recommended that +olaroid pictures &e ta?en in addition to the HKmm (or di8ital) photo8raphs when non28enital in@uries are present$ 9his approach com&ines the advanta8es of each t'pe of film$ =t also means that the photo8raphs can &e availa&le to the prosecutor and @ud8e when a suspect is in custod' and decisions are &ein8 made to file a char8e* enhance &ail* issue a warrant* etc$ Some a8encies have implemented a polic' that photo8raphs ta?en durin8 a forensic examination will not &e released to law enforcement$ 9his practice has two primar' advanta8es$ 3irst* it provides 8reater protection to the victim>s privac' andFor confidentialit'$ Second* it encoura8es (in fact it necessitates) consultation &etween law enforcement and medical personnel$ Pattern of non+genital in#ury 9he forensic examiner must &e ?nowled8ea&le a&out the pattern of in@uries resultin8 from violence* in order to as? the appropriate Cuestions and locate in@uries on the &asis of the histor'$ 7# 9he most common in@uries amon8 sexual assault victims include: .pper le8 and thi8h &ruisin8 Nec? &ruisin8 from cho?in8 +unch &ruisin8 to the upper arm Defensive posturin8 in@uries to the outer side of the arms
7E 7#
Sheridan* "##H Sheridan* "##H
=n a stud' of H6I adult victims of sexual assault* for example* the head* nec?* and facial re8ions were the most commonl' recorded site of non28enital in@ur'$ f the cases involvin8 non28enital in@ur'* KHJ were recorded as occurrin8 at one or more of these three sites$H6 Also common are: %hip or cord li?e in@uries to the &ac? +unch or &ite in@uries to the &reasts and nipples +unch in@uries to the a&domen +unch and ?ic? in@uries to the thi8hs 3acial &ruisin8* a&rasions* and lacerationsH"
Patterned non+genital in#ury +atterned in@ur': is different from the similar term* pattern of in@ur': discussed a&ove$ <oth are important forensic terms* however* +atterned in@uries: are those where the o&@ect used to inflict the in@ur' can &e easil' identified &' the pattern left on the victim$ Examples include a coat han8er* iron* extension cord* &elt* or the imprint of a rin8 worn &' the assailant$ <ite mar?s are important patterned in@uries that can &e lin?ed to a suspect>s dental pattern$ Stran8ulation also constitutes a patterned in@ur'$ Since most assailants who stran8le their victim use their dominant hand* the fin8ertip pattern can &e used to identif' the assailant>s handedness$ A ri8ht2handed assailant will usuall' 8ra& the victim>s anterior nec? so as to leave a sin8le thum& &ruise at the ri8ht of the nec? and several fin8ertip &ruises to the left of the nec?$H7
f course* &ruisin8 is also common amon8 sexual assault victims* &ut the literature cautions a8ainst tr'in8 to closel' date the a8e of a &ruise &' its color$ %hile we ?now that recent &ruisin8 is red or dar? &lue in color* and older &ruisin8 ma' &e 8reen2&lue or 'ellow2&lue* and older still &ruisin8 ma' &e &arel' visi&le 22 people var' 8reatl' in their rates of healin8$ Medications* s?in tone* a8e* and other factors affect &leedin8 and healin8 response as well$ Sheridan ("##H) su88ests that deep &lue2purple &ruisin8 is &est documented as a relativel' recent &ruise: or as consistent with Mar' /ane>s report of &ein8 punched &' /im Smith 7I hours prior$:
(indsa'* "##E Sheridan* "##H H7 Sheridan* "##H

H6 H"
3ollow2up examination is especiall' important for documentin8 such non28enital in@uries* &ecause &ruises often don>t develop until after the initial documentation$ =t is therefore important to have a seCuence of photo8raphs ta?en over a series of da's$
"enital Tra%ma Evidence &sex%al contact, force' !enital trauma is useful to show &oth recent sexual contact and force$ Studies have consistentl' shown that althou8h 8enital trauma can occur as a result of consentin8 sexual intercourse* it is much more li?el' to &e seen after sexual assault$ 3or example* research has found 8enital trauma in IK2E#J of sexual assault victims* in comparison with G2""J of adult women examined after consentin8 intercourse$ HH 9hese findin8s have led researchers to conclude that the incidence of 8enital microtrauma is stron8l' su88estive: of non2consentin8 sexual intercourse$HI
;owever* even in cases of sexual assault there is often no evidence of 8enital trauma$ 9hus* the a&sence of 8enital trauma should not &e interpreted as evidence of consent$ =n other words* the forensic examiner will often not find 8enital in@uries* and the reasons for this must &e explained to the @ur'$HK Pattern of genital in#ury 9he pattern of 8enital in@ur' in female sexual assault victims has &een a more recent area of stud'$ 3or example* of the H"" sexual assault victims studied &' Slau8hter and collea8ues* 7"H (1EJ) exhi&ited ano8enital trauma of some ?ind$ f these 7"H victims with some form of 8enital trauma* the percenta8e with in@ur' at each specific site was as follows: posterior fourchette (G6J) la&ia minora (KHJ) h'men (7#J) fossa navicularis (7KJ) anus ("KJ) cervix ("HJ va8ina (""J) perineum (""J) periurethral area (#J) la&ia ma@ora (GJ) rectum (IJ)
3or a definition of these and other medical terms* please see Appendix "$ Since the posterior fourchette is the point of 8reatest stress when forceful stretchin8 occurs and the point of first contact of the penis with the va8ina* it is not surprisin8 that this is the most
(au&er & Souma* "#E7L Mc-aule'* !uAins?i* %elch* !orman* & smersL Slau8hter et al$* "##G Mc-aule' et al$* "#EG* p$"6G HK -artwri8ht et al$* "#E1L <o'er & Dalton* "##G
HH HI
common site of in@ur' (often descri&ed as acute mountin8 in@ur':)$H1 =n@uries most often seen can &e descri&ed as 9EA)S 22 9ears* Ecch'mosis (&ruisin8)* A&rasions* )edness* and Swellin8$HG ssociation between non+genital and genital trauma Studies also demonstrate that there is a stron8 association &etween non28enital in@uries and in@uries to the 8enitals* anus* or rectum$ 3or example* Slau8hter and collea8ues found that KGJ of the victims with non28enital trauma in their stud' also had some form of 8enital in@ur'$HE =n another stud' of H6I adult sexual assault victims* G#J of those with non28enital in@ur' also showed evidence of 8enital trauma$H#
Despite the fact that sexual assault victims do not alwa's exhi&it 8enital or non28enital in@ur'* positive findin8s certainl' increase the li?elihood of prosecution$ 3or example* in a H2'ear prospective stud' of evidentiar' findin8s and disposition outcomes* suspects were more than twice as li?el' to &e prosecuted if the victim>s examination revealed evidence of 8enital or non2 8enital in@ur'$I6 Characteristics associated with genital in#ury 9here are a num&er of characteristics that have found to &e associated with 8enital in@ur'$ 3or example* in the stud' conducted &' Slau8hter and her collea8ues* the timing of the exam was found to &e crucial$ f 7"H victims with ano8enital in@ur'* GHJ were examined within 7I hours of the assault* EJ were examined &etween 7I and IE hours followin8 the assault* and "#J were seen at or &e'ond G7 hours$I" -learl'* the li?elihood of identif'in8 8enital in@ur' was si8nificantl' reduced if the examination occurred more than 7I hours after the assault$
(au&er & Souma* "#E7L Slau8hter et al$* "##G )edness and swellin8 are not necessaril' indicative of trauma unless accompanied &' tears* ecch'mosis* or a&rasions$
H1
HG
Slau8hter et al$* "##G (indsa'* "##E I6 (indsa'* "##E I" Slau8hter et al$* "##G
HE H#
%ith respect to victim age* these researchers found that with the exception of tears of the h'men (which were nearl' four times more common amon8 adolescent victims)* 8enital in@ur' was not seen at different rates with older versus 'oun8er victims$I7 Another stud' found that prior sexual experience was associated with differential rates of 8enital in@ur'$ Specificall'* when "H7 women were examined within "6 da's of their sexual assault* 1KJ of those without sexual experience exhi&ited 8enital in@ur' whereas onl' 7KJ of those with prior sexual experience showed similar trauma$IH )ates of in@ur' appear to &e somewhat hi8her amon8 male victims in comparison with female victims$ 3or example* studies have found that K621GJ of male victims exhi&it anal trauma$II
Colposcopic evidence 9he literature also su88ests that colposcopic examination to ma8nif' 8enital tissue is an important asset to the identification of 8enital trauma$IK +hoto8raphic eCuipment* &oth still and video* can also &e easil' attached to a colposcope for forensic documentation$I1 9o demonstrate the importance of the colposcope* positive 8enital findin8s are t'picall' reported in onl' "62H6J of cases usin8 8ross visualiAation$IG %ith colposcopic examination* however* the 8eneral ran8e for identified trauma is 162E6J$ IE ne stud' even identified 8enital trauma in EGJ of sexual assault cases usin8 colposcopic examination$I#
%hen a colposcope is used* the ma8nification must alwa's &e well documented* the pictures or video must &e well focused and clear* standard positions for examination should &e used and documented* and a method of measurement should &e used$K6 =n addition* it is critical to explore with the forensic examiner an' alternative explanations for positive findin8s$
(indsa'* "##EL Slau8hter et al$* "##G <ri88s* "##E II ;illman et al$* "##6L ;illman et al* "##"L 5aufman et al$* "#E6 IK 3ran?* "##1L +eele & Matran8a* "##GL Slau8hter & <rown* "##7L Slau8hter et al$* "##G I1 As with photo8raphs of non28enital in@uries* it is recommended that colposcopic photo8raphs remain with the medical facilit' and not &e released to law enforcement$ IG <o'er & Dalton* "##GL -artwri8ht et al$* "#E1L Norvell* <enru&i & 9hompson* "#EIL Satin* ;ansell* Stone* 9heriot & %endel* "##"L Solola et al$* "#EHL 9intinalli & ;oelAer* "#EK IE ><rien* personal communication I# Slau8hter & <rown* "##7 K6 Soderstrom* "##I
I7 IH
3or example* 8enital microtrauma can &e caused &' events other than nonconsensual intercourse* such as tampon use* vi8orous consensual sex* etc$ =t is critical for police to understand that the colposcope cannot differentiate trauma caused &' consensual intercourse* nonconsensual intercourse* or an' other event$
3indin8s must therefore &e interpreted in the context of a comprehensive victim interview and consultation with the forensic examiner$ Toluidine blue 9oluidine &lue is a nuclear stain commonl' used in sexual assault examinations to detect 8enital microtrauma$K" Some research su88ests that toluidine &lue can si8nificantl' enhance the detection of 8enital in@uries compared with 8ross visualiAation alone$ 3or example* one stud' found that the use of toluidine &lue increased the detection of perineal lacerations amon8 adult women from 7IJ with 8ross visualiAation to I6J$ K7 =n a second stud'* the d'e increased the incidence of positive findin8s from IJ to KEJ$ KH
Since toluidine &lue is spermicidal in nature* the literature consistentl' su88ests that it should onl' &e used after all specimens are collected$ 9here is no evidence* however* that it interferes with A-+ levels$KI -enital in#ury and human sexual response %hen documentin8 8enital in@uries* the forensic examiner will 8enerall' use a cloc? to descri&e their location (e$8$* H o>cloc?* G o>cloc?)$ =n@uries commonl' found in forci&le sexual assaults are caused &' an a&sence of human sexual response &' &oth parties* resultin8 in the followin8 factors: (ac? of pelvic tilt to prepare for penetration (ac? of partner assistance with the insertion of a penis or forei8n o&@ect (ac? of lu&rication (ac? of relaxation =ncreased force of penetration
9here is some discussion of other d'es used for the same purpose* includin8 !entian ,iolet and (u8ol>s solutionL however* 9oluidine <lue is currentl' the most commonl' used of these in the detection of perineal lacerations$ K7 (au&er & Souma* "#E7 KH Mc-aule' et al$* "#EG KI <a's & (ewman* "##7L Mc-aule' et al$* "#EG
K"
Male sexual d'sfunction (ac? of communication
9he forensic sexual assault examination has traditionall' focused on the collection of evidence used to identif' an assailant$ ;owever* 8iven that the ma@orit' of suspects raise a defense of consent it is imperative that forensic examiners and law enforcement carefull' document these 8enital and non28enital in@uries to corro&orate the use of force$ .ollow+up examination =n those cases where 8enital trauma is identified* a follow2up examination of the victim ma' stren8then the documentation of evidence$ 9he American -olle8e of Emer8enc' +h'sicians recommends that sexual assault victims &e referred for follow2up examinations 7 wee?s* H months* and 1 months after the assault to evaluate for pre8nanc' and sexuall' transmitted diseases$KK Man' prosecutors also li?e to have evidence from the follow2up examination to document that a particular findin8 was in fact an in@ur' that healed within the expected time frame$ +hoto8raphs should &e ta?en at the time of the follow2up exam to document the healin8 of the 8enital in@uries for comparison purposes in court$ 9here are also situations where the forensic examiner is unsure whether the suspected in@ur': is due to the victim>s medical histor' or other 8'necolo8ical condition$ =n these cases* a follow2up examination can &e used to evaluate whether the findin8 is the same or healed as an in@ur' naturall' would$
.nfortunatel'* most forensic examiners do not routinel' perform follow2up examinations* and the' ma' not &e reim&ursa&le in ever' state$ 9his is somethin8 that investi8ators can therefore discuss with the forensic examiner and victim in a particular case$ =n some cases* a forensic examination mi8ht &e postponed for a few da's followin8 the assault if the victim is in@ured to the extent that a 8enital examination is intolera&le$ 9he examiner and investi8ator will need to discuss schedulin8 a postponed examination with consideration of &oth medical and forensic issues$
KK
Amercian -olle8e of Emer8enc' +h'sicians* "###
(edical )omponents of the *ex%al Assa%lt Examination 'T$ evaluation and preventive care/0 9he sexual assault exam alwa's involves other components in addition to the collection of forensic evidence$ 9hese t'picall' include S9D evaluation and preventive care$ Actuall'* the ris? for contractin8 an S9D durin8 sexual assault is relativel' low$ 9he -enters for Disease -ontrol and +revention estimate that the ris? of sexual assault victims 8ettin8 8onorrhea is I$7J* chlam'dia is "$KJ* trichomonas is "7$HJ* and &acterial va8inosis is "#$KJ$KG -ontractin8 an S9D from the assailant is of si8nificant concern to victims* however* and so it should &e addressed as part of the initial examination$ 3or example* one stud' found that H1J of sexual assault victims presentin8 to the emer8enc' department stated that their primar' reason for comin8 was concern a&out havin8 contracted an S9D$KE
3or this reason* most clinicians recommend preventive treatment followin8 -D- 8uidelines* @ust in case$ 9hus* althou8h preventive treatment is 8enerall' recommended as a routine part of the sexual assault examination* the issue of assessment is controversial$ Some a8encies ar8ue that a &aseline evaluation should &e conducted* so that an' future S9D can &e attri&uted to the assault rather than an' previous sexual encounter$ ;owever* 8iven that preventive treatment is routinel' provided* it is actuall' rare for victims to contract an S9D as a result of the sexual assault$ )outine preventive treatment is also more cost2effective than conductin8 &aseline evaluations$ Some a8encies do perform &aseline evaluation for S9DDs to 8ive a more thorou8h medical assessment of the victim$ Especiall' in cases where the sexual assault report is dela'ed* it is sometimes advisa&le to test the victim for definitive dia8nosis$
9he preferred term amon8 forensic examiners is now S9= for Sexuall' 9ransmitted =nfections$ ;owever* for ease of communication with law enforcement audiences we have retained the term S9D (Sexuall' 9ransmitted Disease)$ KG /enn'* ;ooton* <owers* et al$ ("##6) KE (edra'* "##"
K1
At present* there is no research to evaluate how useful the information provided in a &aseline evaluation mi8ht &e in court* althou8h there is anecdotal evidence that the presence of a pre2 existin8 S9D can &e used a8ainst victims &' su88estin8 that the' are sexuall' promiscuous$ K#
3or more information* call the National S9D ;otline at "2E66277G2E#77$ H12 testing Since the earl' "#E6>s* ;=, infection has &een a 8rave concern for sexual assault victims even thou8h the actual ris? still appears to &e ver' low$ 9he more 8eneral ris? of ;=, transmission is thou8ht to &e the same as a sin8le consensual sexual encounter: 6$"26$7J for va8inal intercourse and "27J for anal penetration$ 16
n this &asis* routine ;=, testin8 is not 8enerall' recommended with sexual assault victims$ ;owever* victims should &e provided information &' the forensic examiner a&out their ris?* testin8* and safe sex options$ 9his will allow them to ma?e decisions &ased on facts rather than fear* and it can help reduce the ps'cholo8ical trauma associated with the fear of ;=, infection$1" =n cases where the assailant is ?nown to &e ;=,2positive* it is possi&le to consider antiretroviral treatment$ =nitial post2exposure treatment must &e started within G7 hours* however* or it is not recommended$17 As a result of various state and federal laws* involuntar' ;=, testin8 of the offender is now reCuired$ =n most states* testin8 cannot &e done until after the assailant is char8ed or convicted of sexual assault and a court order is o&tained$ 3or more information* contact the National A=DS =nformation ;otline at "2E662HI72A=DS$ 3or Spanish spea?ers call "2E662HII2S=DA* and for hearin8 impaired persons call 99MF9DD ;otline "2E662A=DS299M$
(edra'* "##7a American -olle8e of Emer8enc' +h'sicians* "### 1" -enters for Disease -ontrol and +revention* "##EL (edra'* "##H 17 -enters for Disease -ontrol and +revention* "##E
K# 16
Pregnancy ris3 evaluation and prevention Sexual assault victims of reproductive a8e also fear &ecomin8 pre8nant as a result of the attac?$ 9his is another cause of concern and additional trauma for man' victims$ Most medical facilities and clinics providin8 forensic examinations will offer pre8nanc' prevention or interception for the woman at ris? of &ecomin8 pre8nant* if she is seen within G7 hours of the rape and has a ne8ative pre8nanc' test in the hospital emer8enc' department$ Sometimes referred to as the mornin8 after pill*: oral contraceptives such as vral are used for emer8enc' contraception$ 9his will reduce the ris? of pre8nanc' &' 162#6J$ 1H -atholic facilities ma' not routinel' provide emer8enc' contraception to sexual assault victims* and the rape crisis advocate will usuall' assist the victim in ma?in8 alternative arran8ements$ Man' rape crisis centers also have networ?in8 a8reements with medical personnel who will provide emer8enc' contraception for victims examined at a -atholic hospital or clinic$ =n addition* a few -atholic facilities have o&tained special permission to provide the mornin8 after pill*1I and others ma' assist with alternative arran8ements$
=n 8eneral* the ris? of pre8nanc' from a sexual assault is the same as the ris? of pre8nanc' from a one2time sexual encounter$ 9his is estimated to &e a 72KJ ris?$1K %ith emer8enc' care provided after the sexual assault* however* it is possi&le that more of these pre8nancies (or later a&ortions) can &e prevented$ Crisis intervention and referrals Another &asic component of the evidentiar' exam is crisis intervention and referrals for follow2up counselin8$ Some SANE pro8rams even provide their own crisis intervention and follow2up counselin8$11 )eferrals are also provided &' forensic examiners* rape crisis advocates* and hospital or social service personnel$1G Concluding the examination %hile man' sexual assault victims want to 8o home and for8et: a&out the experience* the information in the victim impact module su88ests that this is unli?el'$ 9he information and referrals provided durin8 the forensic examination are therefore crucial to assist the victim in her recover' from sexual assault$
American -olle8e of !'necolo8ists* "##1 3ran?* "##1L ><rien* "##G 1K ;olmes* )esnic?* 5ilpatric?* & <est* "##1L MuApe* Smith* & )adema?er* "#E7 11 (edra'* "##7&L Spec? & Ai?en* "##K 1G Anto8noli29oland* "#EK
1H 1I
Some hospitals and clinics will provide the victim with a place to shower* &rush her teeth* and chan8e clothes after the exam$ 9his is recommended where possi&le* as it 8ives the victim a chance to re8ain her composure and ph'sical appearance &efore leavin8 the facilit'$ Either the medical facilit' or rape crisis advocate should provide the victim with a chan8e of clothes if needed$1E 9he Assistance (ea8ue* a national charita&le or8aniAation* also provides clothin8 for sexual assault victims throu8hout the countr'$ =f a chapter exists in an area that does not currentl' provide this service* it ma' &e willin8 to do so after &ein8 made aware of the need$ Alternativel'* the rape crisis center ma' address this need$
3inall'* the victim will &e provided with written dischar8e information to ta?e home with her$ 1# 3ollow2up phone calls are also t'picall' made within 7I to G7 hours B either &' medical personnel or the rape crisis advocate 22 to chec? on the victim>s emotional and ph'sical status* medical concerns* and compliance with medications provided$ Medical personnel or rape crisis advocates can also assist with additional referrals if needed$G6 *%spect Examinations Man' law enforcement a8encies reco8niAe the value of the victim>s forensic examination 'et local protocol does not alwa's dictate that a medical2le8al examination &e conducted with the suspect$ Suspect examinations should &e o&tained as soon as possi&le if the suspect is arrested shortl' after the assault or if the officer &elieves that he has not &athed since the assault$ Types of evidence collected 9he procedures involved in the suspect examination are &asicall' the same as those for the victim$ 9he suspect examination will include ta?in8 a medical histor'* conductin8 a 8eneral and 8enital examination* and collectin8 an' ph'sical evidence such as clothin8* forei8n de&ris* and swa&s$ =n addition to considerin8 evidence transferred to the victim &' the suspect* officers must also consider an' evidence transferred from the victim to the suspect$ 3or example* va8inal fluids* saliva* and epithelial cells from the victim are often recovered from the &od' of the suspect$ =n cases of di8ital penetration* cells from the victim have &een found under the suspect>s fin8ernails even after he has washed his hands andFor &athed$
3ran?* "##1L ;ollowa' & Swan* "##HL Sandric?* "##1L 9homas & NachritA* "##H s&orn & Neff* "#E#L Spec? & Ai?en* "##K G6 (edra'* "##1L s&orn & Neff* "#E#L 9intinalli & ;oelAer* "#EK
1E 1#
A forensic examination can &e used to identif' and document an' in@uries to the suspect that mi8ht have &een caused &' the victim$ 9he victim mi8ht also descri&e some t'pe of a&normalit' (e$8$* 8enital warts* or tattoos) that the examiner can photo8raph$
=f the suspect is not arrested for several da's followin8 the assault* a full forensic examination is not recommended* &ut an a&&reviated exam should still &e o&tained to collect a DNA reference sample$ Dependin8 on state and local protocol* this mi8ht include &lood andFor saliva samples* and it ma' reCuire law enforcement to o&tain a warrant or court order (see sample warrant included in Appendix 7)$ Policies and procedures 9hrou8hout the process of conductin8 a forensic examination with the suspect* it is crucial that law enforcement personnel are present at all times$ =n addition* if the suspect and victim are &ein8 examined at the same time* contact &etween the two (and their evidence) must &e prevented at all costs$ =n some cases this ma' mean that the victim and suspect are transported to different medical facilities$ =n others* it ma' simpl' reCuire lo8istic arran8ements to preclude the possi&ilit' of contact (e$8$* the suspect can &e &rou8ht in after the victim and &e examined in a different room andFor &' a different examiner)$
=n addition to the examination conducted &' a forensic specialist* officers should also &e encoura8ed to carr' mouth (&uccal) swa& ?its in the field$ Suspects often consent to providin8 mouth swa&s &ecause the' do not have to &e transported and it is much less intrusive than drawin8 &lood$ (aw enforcement a8encies also prefer mouth swa&s &ecause medical personnel are not needed* ma?in8 the procedure less costl' and time consumin8$ 9he procedures for collectin8 mouth (&uccal) swa& ?its are descri&ed in the module on DNA$ Evidentiary )onsiderations Clarify any discrepancies in documentation After the forensic examination is complete* there are a num&er of evidentiar' issues to consider with the 8oal of successful prosecution$ 3irst and foremost* police and medical professionals involved in the case should confer after the examination to compare notes and clarif' an' factual
discrepancies$ 9his is perhaps &est done immediatel' followin8 the examination* &ut if this is impossi&le the conference should ta?e place as soon as possi&le$ As previousl' discussed* this comparison mi8ht reveal sexual acts that were onl' reported to one of the two professionals$ 9hese discrepancies should therefore &e explored with the victim* to ensure that documentation is clear and consistent$
*pdate crime scene personnel fficers should also Cuestion the forensic examiner a&out an' forei8n fi&ers or de&ris that mi8ht have &een found durin8 the sexual assault examination$ 9hese findin8s should &e rela'ed &ac? to the police or la& personnel who are processin8 the crime scene to ensure proper identification and collection$ =t is also common for victims to disclose information a&out condoms durin8 the medical interview* or items that the victim or suspect used to clean 8enitalia after the assault$ A8ain* this information needs to &e provided to police or la& personnel who are processin8 the crime scene$
"aintain chain of custody Maintainin8 proper chain of custod' (or chain of evidence) is as important as collectin8 the proper evidence$ -ompleted documentation is also essential and must include the si8nature of ever'one who had possession of the evidence from the person who collected it to the individual &rin8in8 the evidence into the courtroom$ =f this proper chain of custod' is not maintained* the evidence ma' &e inadmissi&le$G" =n addition* maintainin8 chain of custod' is critical to prevent an' possi&ilit' of evidence tamperin8 and to deter defense counsel from raisin8 the issue of reasona&le dou&t on the &asis of evidence inte8rit'$ <oth si8natures on the chain of evidence document are necessar' for an' transfer B one from the person releasin8 the evidence and a second from the person receivin8 it$
=f the police are unavaila&le to pic? up the evidence* the forensic examiner should place it in a loc?ed refri8erator* prefera&l' with si8ned access$ %hen the police do return* the forensic
G"
(edra'* "##H
examiner can then si8n for the evidence that has &een removed from the refri8erator and handed to law enforcement personnel$G7 Alternativel'* some facilities release all evidence in their custod' at some specified interval (e$8$* twice a wee?) to an emplo'ee of the police propert' room$ 9his eliminates one person from the chain of custod' and releases officers and victims from havin8 to wait for swa&s to dr' and evidence to &e pac?a8ed* transported* and impounded "aintain evidence integrity %hile it is su88ested that the specimens collected from a forensic examination &e refri8erated for lon82term stora8e to prevent deterioration* it is essential that the evidence &e ?ept in an area of less than GK de8rees 3ahrenheit$ f course* clothin8 and other non2&iolo8ical evidence can &e stored in an unrefri8erated area$ !eneral rules for forensic evidence stora8e are these: =f the sample was once livin8 (such as &lood and &od' fluids)* it should &e refri8erated or froAen* dependin8 on local protocol$ =f the evidence needs dr'in8* this should &e done with air and N 9 with heat (heat de8rades)$ +lastic should not &e used* onl' paper and 8lass$ +lastic does not &reathe and causes mold$ =tems must &e stored separatel' to avoid transfer of trace evidence$ Envelopes should not &e lic?ed to moisten* &ut taped and initialed$ =tems that mi8ht contain fin8erprints should not &e touched without 8loves* and pac?a8ed to preserve them$GH
=t is of course important to avoid contamination of an' ?ind* &ut it is a&solutel' paramount that there &e no possi&ilit' for contact &etween evidence collected from the victim and that collected from the suspect$ 3or example* the suspect examination should N 9 &e conducted in the same location as the victim examination$ Althou8h &lood evidence has traditionall' &een stored in vials* some departments are storin8 &lood evidence dried on rice paper swatches$ 9here are three si8nificant advanta8es to this stora8e method$ 9hese dried paper swatches reCuire less space for stora8e* and the' do not reCuire refri8eration$ =n addition* dried swatches present less of a &iohaAard ris? than traditional vials$
G7 GH
(edra'* "##H !uidelines are adapted from the American -olle8e of Emer8enc' +h'sicians ("###)
Assessment of Forensic Evidence =n their report* forensic examiners will offer an assessment of the ph'sical findin8s$ 9his will 8enerall' refer to whether the examination was normal (i$e$* no ph'sical findin8s) or whether ph'sical findin8s were documented as related to the assault$ At the time of the forensic examination* conclusions should primaril' focus on visi&le findin8s$ ther conclusions are left until after crime la& personnel have anal'Aed the evidence collected in the forensic examination$ +ositive ph'sical findin8s at the initial forensic exam could thus include: An' in@ur' sustained durin8 the assault Su&@ective tenderness descri&ed &' the victim Stains or su&stances detected with a %ood>s lamp 9race evidence collected Detection of sperm or A-+ indicatin8 seminal fluid
=f the exam findin8s match the histor' 8iven &' the victim* it is also important for the forensic examiner to note this$ 9his can &e done in the report &' statin8 that there is con8ruence &etween the victim>s stor' and her in@uries: or the in@uries are consistent with the victim>s account of the assault$:GI What can and cannot be concluded %hen considerin8 the assessment of medical personnel* it is critical that law enforcement understand what can and cannot &e concluded on the &asis of the forensic examination$ 3or example* it is inappropriate for the forensic examiner to ma?e a conclusion re8ardin8 the validit' of the claim$ =n other words* medical personnel cannot ma?e a conclusive dia8nosis: of sexual assault$ =t is also pro&lematic for a forensic examiner to ma?e a definitive conclusion a&out the de8ree of force used &' the assailant* whether the victim consented to an' sexual activit'* and whether there was traumatic vs$ non2consensual penetration$
%hat the forensic examiner can appropriatel' conclude is whether there is evidence of sexual contact andFor recent trauma$ 9he forensic examiner can also ma?e a conclusion re8ardin8 consistenc' &etween the ph'sical findin8s and the victim>s account of what happened$
GI
-onsistenc' &etween the victimDs account of events and the ph'sical findin8s are not confirmation or proof that the assault occurred as descri&ed &' the victim$ )ather* consistenc' means that the findin8s or lac? of findin8s could have resulted from the events descri&ed$
Sheridan* "##H
Preparing for court <ecause of their trainin8 and experience* a forensic examiner will li?el' &e Cualified to testif' as an expert* rather than @ust a factual witness in a sexual assault case$GK <oth police investi8ators and forensic examiners should &e familiar with the research cited in this manual and elsewhere* to counter the li?el' defense claim that the o&served findin8s could have resulted from consensual sexual intercourse$ .suall' the courts do not allow hearsa' evidence* &ut there are two exceptions to this rule$ An individual can provide hearsa' evidence if the statement was made as an excited utterance: (i$e$* immediatel' followin8 a trauma) or if it was made as part of a medical examination$ (9he courts reco8niAe that people are li?el' to &e truthful when their health is at sta?e$) Since forensic examiners conduct a medical2le8al examination* the' are a&le to testif' in court a&out the thin8s the victim sa's durin8 the procedure$ Man' times important statements a&out the use of force or coercion are admissi&le into court in this manner (e$8$* = thou8ht he was 8oin8 to ?ill me:)$ Althou8h there is a &od' of research that compares the ph'sical findin8s of sexual assault victims with women who have recentl' en8a8ed in consensual sexual intercourse* there will alwa's &e aspects of a particular case that can &e raised &' the defense as possi&le explanations for the ph'sical findin8s$ =t is therefore important for law enforcement* forensic examiners* and prosecutors to understand that the findin8s in a forensic examination can onl' &e interpreted in relation to the victim>s histor' of the assault$
9he ma@orit' of @urors will have some sort of sexual experience and will realiAe that their consensual activities did not result in the t'pe of in@uries documented in the forensic examination$
GK
(edra' & <arr'* "##E
References American -olle8e of Emer8enc' +h'sicians ("###)$ Evaluation and management of the sexually assaulted or sexually abused patient4 Manual prepared under contract #E26HIG (p) with the .S Department of ;ealth & ;uman Services$ American -olle8e of !'necolo8ists$ ("##1)$ Evidence2&ased 8uidelines for clinical issues in o&stetrics and 8'necolo8'$ Practice Patterns4 An8lin* D$* Spears* 5$* & ;utson* ;$ )$ ("##G* April)$ 3lunitraAepam and its involvement in date or acCuaintance rape$ cademy of Emergency "edicine I:I$ Anto8noli29oland* +$ ("#EK* Ma'F/une)$ -omprehensive pro8ram for examination of sexual assault victims &' nurses: A hospital2&ased pro@ect in 9exas4 5ournal of Emergency Nursing "":H$ <a's* /$ & (ewman* ($,$ ("##7)$ 9oluidine &lue in the detention at autops' of perineal and anal lacerations in victims of sexual a&use$ rchives of Pathological 6aboratory "edicine ""1(1): 176$ <o'er* ($ & Dalton* M$E$ ("##G)$ 3emale victims of rape and their 8enital in@uries4 )ritish 5ournal of 7bstetrics and -ynecology "6I: 1"G$ <ri88s* M$* Stermac* ($E$ & Divins?'* M$ ("##E)$ !enital in@uries followin8 sexual assault of women with and without prior sexual intercourse experience$ Canadian "edical ssociation 5ournal* "K#("): HH$ -artwri8ht* +$S$* Moore* )$A$* Anderson* /$)$* & <rown* D$;$ ("#E1)$ !enital in@ur' and implied consent to alle8ed rape$ The 5ournal of ,eproductive "edicine4 -enters for Disease -ontrol and +revention ("##E)$ -uidelines for treatment of sexually transmitted diseases4 -D-: Atlanta$ Davies* A$ ("#GE)$ A preliminar' investi8ation usin8 p2Nitrophen'l +hosphate to Ouantitate Acid +hosphatase on swa&s examined in cases of sexual assault$ "edicine 'cience 6aw "E:H$ Enos* %$3$ & <e'er* /$-$ ("#E6* April)$ +rostatic acid phosphatase* aspermia* and alcoholism in rape cases$ The 5ournal of .orensic 'ciences 7K:7$ 3ran?* -$ ("##1* Decem&er)$ 9he new wa' to catch rapist$ ,edboo3
!reen* %$ ("#EE)4 ,ape8 The Evidential Examination and "anagement of the dult .emale 2ictim4 Massachusetts: (exin8ton <oo?s4 !roth* A$N$ & <ur8ess* A$%$ ("#GG* cto&er 1)$ Sexual d'sfunction durin8 rape$ The New England 5ournal of "edicine4 ;illman* )$/$* >Mara* N$* 9omlinson* D$* & ;arris* /$)$%$ ("##")$ Adult male victims of sexual assault: An underdia8nosed condition$ 1nternational 5ournal of 'T$ & 1$' 7:77$ ;illman* )$/$* 9omlinson* D$* McMillan* A$* 3rench* +$D$* & ;arris* /$)$%$ ("##6)$ Sexual assault of men: A series$ -enitourinary "edicine 11: 7IG$ ;ollowa'* M$ & Swan* A$ ("##H* /ul' 7E)$ A & E mana8ement of sexual assault4 Nursing 'tandard G:IK$ ;olmes* M$M$* )esnic?* ;$S$* 5ilpatric?* D$!$* & <est* -$($ ("##1)$ )ape2related pre8nanc': Estimates and descriptive characteristics from a national sample of women$ /enn'* -$* ;ooton* 9$* <owers* A$* et al$ ("##6)$ Sexuall' transmitted diseases in victims of rape$ New England 5ournal of "edicine* H77 (""): G"H2G"1$ 5aufman* A$* Divasto* +$* /ac?son* )$* ,oorhees* D$* & -hrist'* /$ ("#E6)$ Male rape victims: NoninstitutionaliAed assault$ merican 5ournal of Psychiatry "HG(7): 77"$ (au&er* A$A$ & Souma* M$($ ("#E7* Novem&er)$ .se of toluidine &lue for documentation of traumatic intercourse$ 7bstetrics and -ynecology 16:K$ (edra'* ($E$ ("##")$ Sexual assault and sexuall' transmitted disease: 9he issues and concerns$ ,ape and 'exual ssault 1118 ,esearch Handboo34 New Mor? & (ondon: !arland +u&lishin8$ (edra'* ($E$ ("##7a)$ 9he sexual assault nurse clinician: A fifteen2'ear experience in Minneapolis$ 5ournal of Emergency Nursing "E:H$ (edra'* ($E$ ("##7&)$ 9he sexual assault exam: verview and lessons learned in one pro8ram$ 5ournal of Emergency Nursing "E:H$ (edra'* ($E$ ("##H)$ Evidence collection: An update$ 5ournal of Child 'exual buse 7:"$
(edra'* ($E$ ("###)$ 'exual ssault Nurse Examiner %' NE&8 $evelopment & 7peration -uide4 Manual prepared under 8rant num&er #12,32!4256"7* awarded &' the ffice for ,ictims of -rime* ffice of /ustice +ro8rams* .$S$ Department of /ustice$ (edra'* ($E$ & <arr'* ($ ("##E* /une)$ SANE expert and factual testimon'$ 5ournal of Emergency Nursing 7I:H$ (edra'* ($E$ & NetAel* ($ ("##G* April)$ 3orensic Nursin8: DNA evidence collection$ 5ournal of Emergency Nursing 7H:7$ (enehan* !$+$ ("##"* 3e&ruar')$ Sexual assault nurse examiners: A SANE wa' to care for rape victims$ 5ournal of Emergency Nursing "G:"$ (indsa'* S$ ("##E)$ n epidemiological study of the influence of victim age and relationship to the suspect on the results of evidentiary examinations and law enforcement outcomes in cases of reported sexual assault4 .npu&lished dissertation* San Die8o State .niversit'$ March&an?s* +$A$* (ui* 5$/$ & Merc'* /$A$ ("##6)$ )is? of in@ur' from resistin8 rape$ 5ournal of Epidemiology "H7:H$ merican
Mc-aule'* /$* !uAins?i* !$* %elch* )$* !orman* )$* & smers* 3$ ("#EG)$ 9oluidine &lue in the corro&oration of rape in the adult victim$ merican 5ournal of Emergency "edicine K(7): "6K$ Norvell* M$5$* <enru&i* !$=$* & 9homson* )$/$ ("#EI* April)$ =nvesti8ation of microtrauma after sexual intercourse$ The 5ournal of ,eproductive "edicine 7#:I$ ><rien* -$ ("##G) =mproved forensic documentation of 8enital in@uries with colposcop'$ 5ournal of Emergency Nursing 7H(K): I16$ s&orn* M$ & Neff* /$ ("#E#* Ma'F/une)$ +atient care 8uidelines: Evidentiar' examination in sexual assault$ 5ournal of Emergency Nursing "K:H$ +asCualone* !$A$ ("##1)$ 3orensic )Ns as photo8raphers: Documentation in the ED$ 5ournal of Psychosocial Nursing HI:"6$ +eele* 5$ & Matran8a* M$ ("##G* April)$ .se of microscope and video colposcope in sexual assault investi8ations$ The Nurse Practitioner 77:I$ Sandric?* 5$M$ ("##1* /une K)$ 9i8htenin8 the chain of evidence$ Hospitals and Heath Networ3s4
Satin* A$/$* ;emsell* D$($* Stone* =$-$* 9heriot* S$* & %endel* !$D$ ("##")$ Sexual assault in pre8nanc'$ 7bstetric -ynecology GG* G"62I$ Slau8hter* ($ & <rown* -$)$,$ ("##7* /anuar')$ -olposcop' to esta&lish ph'sical findin8s in rape victims$ merican 5ournal of 7bstetrics and -ynecology "11:"$ Slau8hter* ($* <rown* -$)$,$* -rowle'* S$ & +ec?* )$ ("##G* March)$ +atterns of 8enital in@ur' in female sexual assault victims$ merican 5ournal of 7bstetrics and -ynecology "G1:H$ Soderstorm* )$M$ ("##I* /anuar')$ -olposcopic Documentation: an o&@ective approach to assessin8 sexual a&use of 8irls$ 5ournal of ,eproductive "edicine H#:"$ Solola* A$* Scott* -$* Severs* ;$* & ;owell* /$ ("#EH)$ )ape: Mana8ement in a noninstitutional settin8$ 7bstetrics & -ynecology 1"(H): HGH$ Spec?* +$M$ & Ai?en* M$M$ ("##K* April)$ 76 'ears of communit' nursin8 service: Memphis sexual assault resource center$ Tennessee Nurse4 9homas* M$ & NachritA* ;$ ("##H* /une)$ 9ulsa sexual assault nurse examiners (SANE) pro8ram$ 5ournal of 73lahoma 'tate "edical ssociation E1$ 9intinalli* /$E$ & ;oelAer* M$ ("#EK* Ma')$ -linical findin8s and le8al resolution in sexual assault$ nnals of Emergency "edicine "I:K$ 9uc?er* S$* (edra'* ($E$* & %erner* /$S$ ("##6* /ul')$ Sexual assault evidence collection$ Wisconsin "edical 5ournal4 MuApe* A$A$* Smith* )$+$ & )adema?er* A$%$ ("#E7* April)$ A multicenter clinical investi8ation emplo'in8 ethin'l estradiol com&ined with dl2nor8estrel as a postcoital contraceptive a8ent$ .ertility and 'terility HG:I$
Appendix +, (edical and Anatomic Terms Abrasion: An area of the &od' surface denuded of s?in and mucous mem&rane &' some unusual or a&normal mechanical process$ Adenexae: +elvic appenda8es ad@acent to the uterus* usuall' includin8 the fallopian tu&es and ovaries$ Anal -er.e, 9he tissue overl'in8 the su&cutaneous external anal sphincter at the most distal portion of the anal canal (anoderm) and extends exteriorl' to the mar8in of the anal s?in$ Anterior )ommiss%re: 9he union of the two la&ia minora anteriorl' (toward the clitoris)$ An%s, 9he anal orifice* which is the lower openin8 of the di8estive trac?* l'in8 in the fold &etween the &uttoc?s$ /artholin0s "lands: ECuivalent to -owper>s 8lands in male$ h'men in the vesti&ule$ (ies in &ase of &ul&$ pen at K & G o>cloc? outside the
/%lb of the -estib%le or /%lbi -estib%li, val masses of erectile tissue in &ul&ocavernosus muscle in the floor of the vesti&ule$ ECuivalent to &ul&us penis in the male )ervical Ectropion, Eversion of the cervical canal exposin8 its linin8$ )ervical 1s, 9he openin8 in the cervix which leads to the endometrail cavit' of the uterus$ )ervical 2ortio, 9he va8inal portion of cervix that protects into the cavit' of the va8ina$ )ervicitis, =nflammation of the cervix$ )ervix, 9he portion of the uterus &etween the isthmus and the va8ina$ )litoral 3ood, 9he s?in covin8 the clitoris$ ;omolo8ous with the prepuce (fores?in) in the male$ )litoris, A small c'lindric erectile &od' situated at the anterior (superior) portion of the vulva (covered &' sheath of s?in called the clitoral hood)* which is homolo8ous with the penis in the male$ )ont%sion4/r%ise, A superficial in@ur' produced from impact without laceration$
)orona of "lans 2enis, 9he rounded proximal &order of the 8lans penis* separated from the corpora cavernosa penis &' the nec? of the 8lans$ Ecchymosis, An extravasion of &lood under the s?inPthese can &e dated$ Epididymis, 9u&e which passes from the testes to vas deferensL the ducts within this tu&e store sperm$ Epididymitis: =nflammation of the epidid'mis$ Erythema, A flush upon the s?inPA redness of the s?in produced &' con8estion of capillaries which ma' result from a variet' of causes$ Fossa avic%laris, -oncavit' of the lower part of the vesti&ule situated (inferior) to the va8inal orifice and extendin8 to the posterior fourchette (posterior commissure)$ Fren%l%m, A small fold of mucus mem&rane that attaches the prepuce to the ventral surface of the penis$ "lans 2enis, 9he cap2shaped expansion of the corpus spon8iosum at the end (head) of the penis* also called &alanus$ =t is covered &' a mucus mem&rane and sheathed &' the prepuce (fores?in) in the uncircumcised male$ 3ymen 1rifice: 9he openin8 to the va8ina throu8h the h'menal mem&rane$ 3ymen: A mem&rane which partiall'* or rarel' completel' covers the external va8inal orifice$ =t is located at the @unction to the vesti&ular floor and the va8inal canal$ #nd%ration: An a&normall' hard spot or place$ Labia (a$ora: )ounded folds of s?in formin8 the lateral &oundaries of the vulva$ Labia (inora: (on8itudinal* thin folds of tissue within the la&ia ma@ora$ =n the prepu&ertal child* these folds extend from the clitoral hood to approximatel' the midpoint on the lateral wall of the vesti&ule$ =n the adult* the' enclose the vesti&ule and contain the openin8 to the va8ina$ Laceration, 9he act of tearin8PA wound made &' tearin8$ (edian &perineal' Raphe, A rid8e or furrow that mar?s the line of union of the two halves of the perineum$
(ons 2%bis, 9he rounded flesh' prominence created &' the underl'in8 fat pad* which lies over the s'mph'sis pu&is (pu&ic &one) in the female$ (yrtiformes )ar%nc%lae, ;'menal remnants usuall' rounded moundsL ma'&e seen after child &irth$ 1rchitis, =nflammation of the testes$ 2ectinate Line &dentate line', 9he saw toothed line of demarcation &etween the distal (lower) portion of the anal valves and the pecten* a smooth Aone of simple stratified epithelium which extends to the anal ver8e$ 2elvic #nflammatory, =nfection of the fallopian tu&es or ovaries disease commonl' called +=D$ 2enis, Male sex or8an composed of erectile tissue throu8h which the urethra passes$ ;omolo8ous with the clitoris in the female$ 2erianal *5in Folds, %rin?les or folds of perianal s?in radiatin8 from the anus* which are created &' the contraction of the external anal sphincter$ 2eri%rethral: +ertainin8 to tissue surroundin8 the urethra meatus$ 2osterior )ommiss%re: 9he union of the two la&ia minora posteriorl' (toward the anus)$ 2osterior Fornix, A cavit' within the va8ina and located posteriorl' (inferior) to the cervix$ 2osterior Fo%rchette: 9he @unction of the two la&ia minora posteriorl' (inferiorl')$ 9his area is referred to as a posterior commissure in the prepu&ertal child$ =n children* the la&ia minora are not completel' developed and do not connect inferiorl' until pu&ert'$ =n the postpu&ertal female* it is referred to as the posterior fourchette$ 2rep%ce,(fores?in): A coverin8 fold of s?in over the 8lans of the penis$ 2roctitis, =nflammation of the rectum$ 2rostate, !land in the male which surrounds the nec? of the &ladder and urethra and contri&utes to the seminal fluid$ 2rostatitis, =nflammation of the prostate$
Rect%m, 9he distal portion of the lar8e intestine &e8innin8 anterior to the third sacral verte&ra as a continuation of the si8mold and endin8 at the anal canal$ *crot%m, 9he pouch which contains the testicles and their accessor' or8ans$ Testes, Male sex or8ans (8onads) which produce spermatoAoa and testosterone$ 6rethra (eat%s: 9he external openin8 of the canal leadin8 from the &ladder$ 6rethra, 9he mem&ranous canal which conve's urine from the &ladder to the exterior of the &od'$ 6rethrits, =nfection of the urethra$ 6ter%s, ;ollow muscular reproductive or8an of the female composed of &od'* fundus (a&ove the openin8 of the fallopian tu&es)* isthmus* and cervix$ -a.ina, 9he uterova8inal (8enital) canal in the female$ 9his internal structure extends from the uterine cervix to the inner aspect of the h'men$ -a.inal #ntroit%s: 9he muscular &and of tissue which forms the entrance to the va8ina$ 9he muscular &ul&ospon8iosus in the female$ -a.inal #ntroit%s, 9he muscular &and of tissue which forms the entrance to the va8ina (&ul&ospon8iosis muscle)$ -a.inal R%.ae, 3olds of epithelium (ru8ae) runnin8 circumferentiall' from the va8inal columns$ -a.inal -estib%le, An anatomical cavit' containin8 the openin8 of the va8ina* the urethra* and the ducts of <artholin>s 8lands$ <ordered &' the clitoris anteriorl'* the la&ia on the sides* and posterior commissure (fourchette) posteriorl' (inferiorl')$ 9he vesti&ule encompasses the fossa navicularis immediatel' posterior (inferior) to the va8inal introitos$ -a.initis, =nflammation of the la&ia$ -as Defferens, 9he tu&e which connects the epidid'mis to the urethra$ -%lva, 9he external 8enitalia or pudendum of the female$ =t includes the mons pu&is* clitoris* la&ia ma@ora* la&ia minora* va8inal vesti&ule* urethral orifice* va8inal orifice* h'men* and the posterior fourchette (or commissure)$ -%lvitis, =nflammation of the la&ia$
Appendix 7, *ample *earch 8arrant for /iolo.ical Reference *amples from a *%spect =* /oseph -ristinAiani* do on oath ma?e complaint* sa' and depose the followin8 on this 2 da' of 2* "###: that = have su&stantial pro&a&le cause to &elieve and = do &elieve that = have cause to search: the person ?nown as +aul ,asCueA* an ;ispanic male adult havin8 a date of &irth of 6"2612G6* &ein8 a&out KDEQ in hei8ht and "IK l&s$ in wei8ht* and is &elieved to &e currentl' residin8 and in custod' of the State of hio under hio Department of -orrections num&er E67I#I* located at the hio State +risonL at 7GHG %est -ecil Avenue* Midtown* hioL for the followin8 propert'* to wit: to seiAe the person and ta?e hair* &lood and saliva samples sufficient for comparison purposes usin8 the least amount of force necessar' to ta?e said samples$ = am a peace officer emplo'ed &' the Midtown +olice Department (hereafter M+D) and have &een so emplo'ed for a&out 76 'ears$ = am currentl' assi8ned to the ;omicide Division and have &een so assi8ned for a&out I 'ears$ +rior to this assi8nment* = was assi8ned to the Sex -rimes .nit$ = was so assi8ned for approximatel' "I months$ Durin8 m' career* = have
investi8ated at least "66 ;omicide cases as well as approximatel' "66 sexual assault cases$ Durin8 the course of m' duties* = have learned the followin8 information &ased upon m' discussions with the named witnesses or &' havin8 read the reports of or tal?ed with other M+D officers who have spo?en directl' with the named witness$ All references to dates refer to the current calendar 'ear unless otherwise stated$ = have prepared the attached "G pa8e report in the course of m' duties$ = was assi8ned the case after the victim initiall' reported the crime to M+D patrol officers$ = here&' reCuest incorporation &' reference herein of said report as if full' set forth and identified &' M+D case num&er #K26#"IKI located in the upper left portion of the front pa8e$ 9his crime was a forci&le rape* committed in violation of section 71"(7) of the hio +enal -ode$ 9he victim in this case was identified as Ms$ /ac?ie (indsa'$
Durin8 the course of the investi8ation* the victim* /ac?ie (indsa'* was examined &' medical personnel followin8 the rape and &iolo8ical samples were ta?en from her va8inal vault$ 9he evidence was anal'Aed &' the Midtown +olice Department and &iolo8ical samples sufficient for DNA testin8 were identified$ 9he Midtown +olice Department used a +ol'merase -hain )eaction (+-)) DNA test to identif' the 8enetic mar?ers of the assailant in (indsa'Ds assault$ 9he evidence was then sent to -ellmar? for )3(+ testin8 with the intent to attempt to identif' the suspect usin8 the -om&ined DNA index s'stem computer data&ase (- D=S) maintained &' the 3<=$ )3(+ was o&tained* however* there was no match in - D=S$ =n /une of "###* Mr$ <rian <urritt was hired &' the Midtown +olice Department -rime (a&orator' as a -riminalist$ ;is specific field of expertise is that of a DNA Anal'st$ +rior to his emplo'ment with the Midtown +olice Department* Mr$ <urritt was emplo'ed as a -riminalist with the hio Department of /ustice* DNA (a&orator'* -inncinati* hio$ Mr$ <urritt has &een Cualified as an expert witness* in the area of DNA in the Superior -ourts of "" different counties within the State of hio$ 9he Midtown Superior -ourt is included in that list$ .pon his emplo'ment with the Midtown +olice DepartmentDs -rime (a&orator'* part of Mr$ <urrittDs @o& description was to examine an' and all unsolved cases containin8 DNA evidence and* to create a M+D data &ase for unsolved cases with +-) evidence$ n /une 76* "###* Mr$ <urritt &e8an an anal'sis of the +-) profile collected from (indsa'Ds case$ nce the +-) profile from this case was entered into the data&ase* the data&ase
compares the profile a8ainst at least 766 other +-) profiles collected from ?nown sex andFor violent offenders from within Midtown -ount'$ 9he data&ase compares a8ainst other +-) profiles searchin8 for matches$ 9he search revealed a +-) profile match to +aul ,asCueA$ Mr$ <urritt examined ,asCueAD +-) profile and found that in the -aucasian population the freCuenc'
is " in 7166L in the ;ispanic population the freCuenc' is " in KI66 and in the <lac? population the freCuenc' is " in ""6*666$ .tiliAin8 official police computers* = conducted a &ac?8round investi8ation on ,asCueA$ = learned ,asCueA was not in custod' at the time (indsa' was forci&l' raped$ = learned ,asCueA was livin8 within the -it' of Midtown at the time the rape occurred$ ,asCueAD residence was located at G"61 Arillo Street* in the -it' and -ount' of Midtown$ Arillo Street is well within a three (H) miles radius of the location where (indsa' was raped$ 9hrou8h m' &ac?8round investi8ation* = learned ,asCueAD ph'sical description matched the suspect description 8iven to me &' (indsa'$ Additionall'* = learned ,asCueA has prior convictions for sexuall' related t'pe crimes$ A &iolo8ical reference sample is now needed from ,asCueA for )3(+ testin8 which will provide additional 8enetic information to more conclusivel' include or exclude ,asCueA as the person who sexuall' assaulted /ac?ie (indsa'$ <' o&tainin8 saliva swa&s from ,asCueA* forensic la&orator' personnel will &e a&le to ma?e further comparisons to the )3(+ identified in (indsa'Ds case$ = ?now that comparisons can &e made &etween fluids found on or in the victim and that of the suspect$ <' removin8 &lood and saliva* la&orator' personnel will &e a&le to ma?e comparisons with those samples ta?en from the suspect to those ta?en from the victim usin8 DNA andFor more conventional la&orator' comparisons$ = have &een advised that DNA is short for deox'ri&onucleic acid$ DNA molecules are contained within human cells and hold the 8enetic Dcodin8D that ma?es each of us individuall' distinctive (except identical twins)$ %hile forensic DNA technolo8' cannot 'et discriminate amon8 human &ein8s to the same extent as fin8erprint evidence can* it is capa&le of identification within a ver' small percent of ma@or populations dependin8 on the t'pe of anal'sis emplo'ed$ 3orensic DNA evidence has &een routinel' admitted in courts of hio since "#E#$ Samples ta?en
from the suspect as descri&ed more full' a&ove will &e compared a8ainst that found on the victim$ =n removin8 the &lood and other samples from the suspect* = will use medicall' accepted practices* utiliAe the services of a trained person in drawin8 the &lood* and use the least amount of force necessar' to collect the descri&ed evidence$ 9he suspect was &oo?ed into State +rison on an unrelated char8e and was &oo?ed under the a&ove descri&ed hio Department of -orrections num&er$ = reCuest that this declaration* the affidavit* search warrant and supportin8 attachments &e sealed pendin8 further order of the court$ = ma?e the reCuest for the followin8 reason$ %ithout sealin8* the affidavit and supportin8 documentation and warrant &ecome a matter of pu&lic record within ten da's$ +enal -ode section "KHI(a)$ Also* +enal -ode section 7#H provides that a victim of a sex offense &e advised that his or her name will &ecome a matter of pu&lic record unless he or she reCuests that it not &ecome a matter of pu&lic record$ 9he victim in this matter has not 'et determined whether or not she wishes her name to &ecome a part of the pu&lic record$ =f the information in these documents is not sealed the victimDs name can &e revealed to an'one who wishes to examine the court files* and the victim will &e denied her ri8hts under +enal -ode section 7#H$ 3or this reason* = &elieve all information identif'in8 the victim should remain sealed pendin8 further order of the court$ 9herefore* &ased on m' trainin8* experience* and the a&ove facts* = &elieve that = have su&stantial cause to &elieve the a&ove descri&ed propert' or a portion thereof will &e on said person when the warrant is served$ <ased on the aforementioned information and investi8ation* = &elieve that 8rounds for the issuance of a search warrant exist as set forth in +enal -ode section "K7I$ =* the affiant* here&' pra' that a search warrant &e issued for the seiAure of said propert'*
or an' part thereof* from said person at an' time of the da'* 8ood cause &ein8 shown therefor* and that the same &e &rou8ht &efore this ma8istrate or retained su&@ect to the order of this -ourt$ 9his affidavit has &een reviewed for le8al sufficienc' Deput' District Attorne' David /$ (attuca$ !iven under m' hand and dated this 2 da' of 2* "###$
/oseph -ristinAiani =D 07#"H Midtown +olice Department ;omicide Section Su&scri&ed and sworn to &efore me this 2 da' of * "### at a$m$Fp$m$
RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR /ud8e of the Superior -ourt -entral Division 9he +eople of the State of hio* to an' sheriff* consta&le* marshal* police officer* or an' other peace officer in the -ount' of Midtown: +roof* &' affidavit* havin8 &een this da' made &efore me &' /oseph -ristinAiani* a peace officer emplo'ed &' the Midtown +olice Department* that there is su&stantial pro&a&le cause for the issuance of the search warrant pursuant to +enal -ode section "K7I* 'ou are therefore* commanded to ma?e search at an' time of the da'* 8ood cause &ein8 shown therefor* the: person ?nown as +aul ,asCueA* an ;ispanic male adult havin8 a date of &irth of 6"2612G6* &ein8 a&out KDEQ in hei8ht and "IK l&s$ in wei8ht* and is &elieved to &e currentl' residin8 and in custod' of the State of hio under hio Department of -orrections num&er E67I#I* located at the hio State +risonL at 7GHG %est -ecil Avenue* Midtown* hioL for the followin8 propert'* to wit: to seiAe the person and ta?e hair* &lood and saliva samples sufficient for comparison purposes usin8 the least amount of force
necessar' to ta?e said samples* and* if 'ou find the same* or an' part thereof* to &rin8 it forthwith &efore me at the Superior -ourt of the -entral Division* -ount' of Midtown* State of hio* or to an' other court in which the offense in respect to which the propert' or thin8s is tria&le* or retain such propert' in 'our custod'* su&@ect to the order of this -ourt* pursuant to section "KH1 of the +enal -ode$ !iven under m' hand and dated this 2 da' of 2* "###$
/ud8e of the Superior -ourt
RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR -entral Division

Forensic Exam

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"Successfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement" Develo e!

3ran?* "##1 (edra'* "##7a

Sheridan* "##H Sheridan* "##H

(indsa'* "##E Sheridan* "##H H7 Sheridan* "##H

Male sexual d'sfunction (ac? of communication

Amercian -olle8e of Emer8enc' +h'sicians* "###

(edra' & <arr'* "##E

/ud8e of the Superior -ourt

RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR -entral Division

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