Friday, July 22, 2022

FORENSIC MEDICINE:Examination of sexual assault / rape victim in the living

Topic:  Examination of sexual assault / rape victim in the living.

Sub-topics:

1) Definition

2) Medicolegal Examination

3) Forensic Evidence /Sample collection

4) Documentation 

1) Definition: Legal definition of rape

A man is said to commit “rape” if he has sexual intercourse with a woman under circumstances falling under any of the six following descriptions:

• First– Against her will.

• Second – Without her consent.

• Third – With her consent, when her consent has been obtained by putting her or any person in whom she is interested in fear of death or of hurt.

• Fourth – With her consent, when the man knows that he is not her husband, and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married.

• Fifth – With her consent, when, at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration by him personally or through another of any stupefying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent.

• Sixth – With or without her consent, when she is under sixteen years of age.

Explanation: Penetration is Surface sufficient to constitute the sexual intercourse necessary to the offence of rape.

Exception: Sexual intercourse by a man with his own wife, the wife not being under fifteen years of age, is not rape.

Dangers of Rape:

The victim may develop shock due to fear which may turn fatal and when the victim survives, may make her mentally deranged temporarily or permanently. She may suffer from haemorrhage due to genital injuries, may be fatal when severe. She may suffer from accidental death like suffocation ,the rapist may cover his hand over her mouth and nostrils preventing the victim from shouting or screaming for help. There maybe the case of  homicidal death for example from strangulation in order to conceal the event, the rapist may kill his victim after rape. The victim may even end her life.

 

Provisions and the laws regarding rape case in Nepal

No. 1 : Having sexual intercourse with an unmarried girl, a widow or someone's wife under sixteen years of age with or without her consent and with one above sixteen years of age without her consent by using force or showing threat or even under inappropriate influence is proved to be a rape case.

No. 2 : For raping a woman within family relationship, the one who rapes will get punishment mentioned in the chapter regarding sexual intercourse within kinship in addition to the punishment in accord with this chapter. As for the case of life imprisonment, the punishment for rape will not be added.

No. 3 : One who commits rape should be imprisoned for six upto ten years if the woman raped is under fourteen years of age, and for three upto five years if the woman is fourteen or above fourteen years of age.

No. 4 : One who knowingly accompanies the one who intends to commit rape, and who grabs the woman or helps in the act should be punished upto one year each. As for the case of a girl under fourteen years of age, he will be punished doubly.

No. 5 : The one who has made an attempt to rape but has not committed rape will get punished equal to half of the one's who has committed it.

No. 6 : If someone has instigated someone else to commit rape, the one who has instigated to perform the act will, in the case of rape having committed, get punishment equal to half of the rapist's, and in the case of attempted but not actually committed rape, he will get equal to half of the attempt maker's punishment.

No. 7: If someone has a sexual intercourse with a prostitution without her consent, the one who commits it will either be fined an amount of Rs. five hundred or imprisoned upto one year.

 

2) Medicolegal Examination of rape victim

Examination of the scene: The forensic pathologist should himself visit the crime scene.

General examination: a) Examination of the clothing

Examination of clothing: The victim should ideally undress herself whenever possible or otherwise assisted by the third party. The person is made to stand over

a wide white paper/cloth to collect any trace evidence that may dislodge while undressing. Followings finding can found out from the clothing.

 

Ø There may be tears in the clothing and loss of buttons can be noticed.

Ø Various stains can be noticed. Those stains may be of blood,semen, saliva, urine, faecal matter, mud ,etc

Ø Other traces evidences like hairs, fibers, grass ,etc can be found.

Ø Stains and any other trace evidences  should be collected.

.

 Vital signs of the victim should be recorded and noted. We should look for the sign of struggle to overcome the violence which may present in any form such as

Abrasions, nail scratches, bruises, bite marks,  lacerations, incised and stab wounds, etc. Any injuries present should be properly documented, incorporating  sketches or photographs whenever possible,  giving exact location, detailed description: size,  shape,type of injury, age of injury, etc

 

Genital/Local Examination: Following requirement should be arranged for genital examination.

Ø Position:  Proper examination is possible only by making

          the patient adopt the lithotomy position .

Ø Proper illumination:  This can help in  good observation.

Ø Local anaesthesia: Use of local anasthesia may be beneficial when the victim is complaining of severe pain.

Ø Examination proper: Findings differ depending on the  victim who could be a virgin, deflorated woman, or a child. Now we shall discuss those findings.

 

Findings in a Virgin Victim

All findings are described as typical findings of rape and become

corroborative evidence in law and these are as followings.

• On the vulva – redness, bruises, swellings, tears, scratches, bleeding, etc. can be noticed and maybe suggestive of rape.

• With the hymen – Recent rupture is of maximum corroborative value. The site and degree of tears should be noted. Hymen examination kit should be used.

• In the vagina – bruises, tears, bleeding, discharges (venereal origin), foreign particles, etc. Menstrual flow may be there if the victim is in her menstruating period.

Findings in Deflorated Woman Victim

Typical findings described in the virgin victim may not be elicited in a deflorated woman victim. However, presence of the following is important in such cases:

• Semen in the vagina (in fornices or vulva or garments worn).  And that can be confirmed by vaginal smear.

• Evidence of struggle is more important these victims because of the lack of typical genital findings in these patients. Perineal tears can be anticipated in such patients suggested by uncontrolled bleeding or clotted blood.

• Discharges of lesions of sexually transmitted infections such as gonorrhea, syphilis, etc. if present noted.

 

 

Hymen Examination :Hymen examination is an essential step in the examination of a rape victim if the victim is unmarried. It is done with a special kit called ‘hymen examination kit’ that comprises of a set of glass rods of varying sizes with a spherical bulbous expansion at one end.

Collection of Evidence: Rape is an excellent example for Locard’s Principle of Exchange which states that every contact leaves a trace. Physical and biological evidence play a pivotal role in the objective and scientific reconstruction

of the events in question. The evidence should be collected from the victim, from the crime scene and from the suspect employing standard techniques. Each sample should be packed using appropriate packaging materials, labelled, sealed and stored as per specification before transporting it to the laboratories. Documented chain of custody of the evidence should be maintained strictly at every level to ensure the authenticity of the evidence.

1. Stains and foreign materials present on the clothing or body.

2. Fingernail scrapings.

3. Brushing/combing of the person’s hairy region: head, body and pubic.

4. Samples of the person’s hair: head, body and pubic.

5. Urethral, perianal, vulvar swabs, vaginal content aspiration and swab, and cervical swab to be collected under direct visualisation. Ideally it should be collected prior to the examination to avoid contamination.

6. Sample of blood

Detection of semen

The type of physical evidence most frequently associated with

sexual assault cases is semen. The presence of semen is indicative of the occurrence of sexual activity.

Process of Collecting Biological Samples

a. Dried Stains: Application of absorbent swabs moistened in distilled water or normal saline.

b. Wet Stains: Under direct visualisation any liquid secretions in the body cavities can be collected by aspiration or insertion of dry absorbent swabs.

Various screening test are done for the indentification of occult seminal stains like ultraviolet light scanning and chemical tests like Barberios test and fluorescent test.

Other chemical markers can be used as well for seminal content in the stain like alkaline phosphatase,  creatinine phosphokinase, lactate

dehydrogenase isoenzymes, etc.

Confirmatory Tests for detection of semen from stains extract

The seminal stain is processed for extraction, which yields a supernatant and a cell pellet. The cell pellet is used for detection of spermatozoa and for DNA analysis while the supernatant portion is used for detection of noncellular markers in semen and to develop genetic profiling or grouping. Depending on the time elapsed since the crime, spermatozoa may be alive and motile or dead. Identification of one or more spermatozoa is conclusive proof of the presence of semen and affirms sexual

contact.

 

 

Examination of the Accused

The accused of a rape case can be made to present for medicolegal examination. Except some differences, the procedure is almost the same as with examination of rape victim.

Ø Genital Examination: Following things can be noted and should be looked for.

Ø Injuries suggestive of forcible sexual intercourse such as bruises, nail scratch marks, etc. by the victim in resisting the act of rape

Ø Tearing of prepuce, frenulum, etc. due to forcible penetration can be noted.

Ø Swabs from the urethra, shaft and glans are collected in addition to the above-mentioned physical evidence.

Lugol’s iodine test: During sexual intercourse, vaginal epithelial cells,

which are transferred to glans penis are confirmed by this test in the accused individuals. In this test glans penis is mopped with a filter paper and the paper is then exposed to Lugol’s iodine vapor. A brownish discoloration on the paper is suggestive of presence of vaginal epithelium, which is rich in glycogen

content, responsible for color change on the paper.

 

SIGNIFICANCE OF MEDICAL EXAMINATION OF SEXUAL ASSAULT

Medical evidence of rape can be derived from:

• Presence of stains of body fluid and foreign materials in the clothing and body including genitalia of the victim or vice

versa.

• Presence of marks of struggle or violence in the body and clothing inflicted by the accused or vice versa.

• Evidence of injuries in and around genitalia of the victim.

• Presence of semen in the vagina of the victim.

• Evidence of implanted venereal disease on the body of the

victim.

In the legal context, to constitute the offence of rape there need not be full penetration of the vagina by the penis with emission of semen and rupture of hymen. Even the slightest penetration or even touching the vulva without

producing any injury to the genitals including hymen or leaving any evidence of seminal emission will be sufficient to conclude that was a rape case.

As per that view the proof of seminal emission in a victim who is below 16 years of age or injuries in the genitals provides the proof of rape.

Documentation

Documentation should contain following details of rape victim:

 

1. Name and address:

2. Age as stated by:

3. Occupation:

4. Married or not:

5. Number of children if married:

6. Persons accompanying and their relationship:

7. Consent—Obtained from parents in the case of minor girls. Always get signature.

8. Nurse or other female present

9. Marks of identification

10. History as given by the police

11. History as given by parents/relatives

12. Statement of the female with regard to the following:

• Date, time and place of occurrence

• Exact position of the parties

• Did she struggle or cry for help?

• Was she menstruating or not?

• Was she conscious the whole time?

• Did she urinate or not? Pain?

• Did she change her clothes?

13. Date and time of lodging a complaint, explain delay

14. Date and time of physical examination

15. Mental disposition. Excited or calm

16. Gait. Does she walk as if in pain?

17. Clothes—look for blood, semen, hair, tears, loss of buttons, mud, grass, etc. Describe location and extent of each.

18. Physical development—height, weight, build.

19. Marks of general violence—look for abrasions or contusions of face, back of the shoulder, arms, and thighs.

20. Breasts—look for contusion, abrasion, and bitten nipples.

21. Pubis, perineum, thighs—look for stains, matting of hair, scratches.

22. Vulva—look for bruises, abrasions

23. Hymen—present or replaced by carunculae, if present—type, position of natural opening, whether torn/intact, if torn—

position, extent and age of tear.

24. Fourchette—intact/torn.

25. Vagina—look for bruises, tear, nature of discharge

26. Veneral disease—gonorrhea/syphilis—get specialist’s opinion if it is necessary and possible.

27. Vaginal smear—for spermatozoa, blood.

28. Preserve following material for chemical examination

29. Clothes are dried to prevent decomposition of stains. Put in a cardboard box, seal, and label.

30. Take vaginal fluid with a swab

.

 

 

 

 

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