Sexual Assault

One of the jobs of emergency doctors is to deal with sexual assault.

For cases to be investigated, must need police report.
Requirements to be a criminal medico-legal case:
Police report number, police form, police officer present (for arrest offences grievous hurt,
unnatural offence, rape), consent, police photographer (if need to take photos as evidence
forensics physician may take photos for documentation)
Consent from patient - >18 years old, if <18 years old need to get consent from
guardian/parents/police/protector from the welfare office
Patient history given to the police, there may be discrepancies -> will cause problems during
cross-examination by the lawyers -> dont give out specific time/place/date/names/things that
happened too long ago etc, but do report what happened
Victim reactions
Patients demeanor was patient crying etc at the time of presentation
Rape sexual intercourse between a man and a woman without her consent -> false
presence, force/threats, fraud (spiking drinks) will make the consent void even if the victim
has consented
Sexual intercourse with a girl under 16 is an offence -> statutory rape
Sexual intercourse with a mentally incapable/mentally subnormal/retarded -> unable to judge
and give informed consent, or mentally ill/psychiatrc person -> rape
Sharp weapon injuries -> incised etc
Lacerations injuries due to blunt trauma
Chopped wound subset of incised wound
Defense injury extensor, forearm
Stab wound sometimes with hilt-guard abrasion, fish tail edge = sharp edge of the weapon
(2 fish tails = double sharp edge), depth indicates length of weapon
Refer victims of rape for genital exam by O&G specialists
Type of specimen depends on cold and fresh case
Fresh acute - <120 hours in Penang -> must be seen by a doctor within 1 hour -> take
swabs
Cold non-acute - >120 hours -> arrange for doctor appointment the next day -> no swabs
taken
3 elements of offence
Must prove penetration proof of anal/vaginal penetration to show injuries of the genitals
and surrounding area of the genitals
Must prove lack of consent when the patient is 16 years old, if consented can it be false
consent?
The intention of the accused person in sexually penetrating without consent -> not so
important
Physical, consent and mental elements!

Hymen can be torn in non-sexual acts

Penetration
Anus in sodomy penetration of the anus through the anal verge
Penis tip of penis no need erected penis to penetrate -> even someone with impotence
can be charged for rape
Vagina introduce the penis beyond the labia majora
Eg -> if tip of penis enters labia majora = penetration due to blunt object penetration
abrasions, bruises, lacerations, redness, swelling
If in young children, infant no need penetration -> signs of injury eg bruises are enough
Cribiform hymen in adolescence
Tulip hymen pre-puberty children to adolescents
In victims who never delivered, can use Foley Catheter insert catheter with balloon not
expanded, inflate the balloon -> stretch hymen from behind to look for any tear -> look for
partial tears etc
Continually reinsert to the floor, suck fluids through the catheter -> swab = vaginal swab
Vaginal speculum only if hymen is torn, not used even if partially torn as it can cause
further tear
Sodomy is more difficult to be proven
Acute type, non-acute, habitual anoreceptive (regularly sodomised), combination acute in
habitual anoreceptive victim
Acute findings differ from habitual findings!
>120 hours cold usually no findings
No hymen, pooping can also cause anal mucosa injuries, harder to penetrate anus if victim
does not consent unless the person use lubricants because external sphincter is voluntary
Toluidine blue not for young children as can cause irritation
Normally used to show anal injuries