1.3B MEDICO-LEGAL ASPECT OF SEX CRIMES.pdf

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LEGAL MEDICINE 1.3B MEDICO-LEGAL ASPECT OF SEX CRIMES

RAPE Three elements are necessary for rape of a female:  Carnal knowledge (need not to be penetrate, touch around genital area is enough)  Force  Commission without consent REPUBLIC ACT NO. 8353 - ANTI RAPE LAW RA 8353 - Act known as "The Anti-Rape Law of 1997.“ Article 266-A. Rape: When And How Committed. - Rape is committed: 1) By a man who shall have carnal knowledge of a woman under any of the following circumstances: a) Through force, threat, or intimidation; b) When the offended party is deprived of reason or otherwise unconscious; c) By means of fraudulent machination or grave abuse of authority; d) When the offended party is under twelve (12) years of age or is demented, even though none of the circumstances mentioned above be present. 2) By any person who, under any of the circumstances mentioned in paragraph 1 hereof, shall commit an act of sexual assault by inserting his penis into another person's mouth or anal orifice, or any instrument or object, into the genital or anal orifice of another person.

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MEDICO-LEGAL EXAMINATION Written Request (without this investigation can not be proceed) Consent (incase of Father or mother are the victim. Investigator can sign) Data of the Subject/Complainant General Physical Examination: – General Survey – Mental Status – Physical Findings Ano-Genital Examination – External Genitalia, Hymen, Discharge, Internal Examination GENITAL EXAMINATION ANATOMY

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ANO-GENITAL INJURY TYPES Abrasion Contusion or Bruise Hematoma Laceration HYMEN INJURY

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Contusion Hematoma Laceration  Fresh  Healing  Healed

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LEGAL MED

1.3B MEDICO-LEGAL ASPECT OF SEX CRIMES NORMAL EXAMS IN CHILD SEXUAL ABUSE 1. Nothing happened 2. Something happened which did not cause injury 3. Something happened which may have caused injury, which has healed

Figure 1.A 14-year-old 12 hours after assault. Marked submucosal hemorrhages are present on the lower half of the hymenal membrane. Note the fresh-cut edge of a hymenal laceration at the 3 o'clock position. Figure2. Four days after assault. The major portion of the submucosal hemorrhage has resolved, exposing evidence of hymenal lacerations at the 3 o'clock and 8 o'clock positions. Figure3. Sixteen days after assault. Evidence of the acute injuries has disappeared, leaving only a cleft at the 8 o'clock position. Healing starts the moment the injury was inflicted --- but for the purpose of standardization, NHQ crime lab 24hrs – fresh/acute. 24hrs to 7days to 21 days – healing. 3days to 7 days to 30days – healed, cannot be dated accurately. Whereas most signs of an acute injury were gone within 7 to 10 days, the changes in the depth and the configuration of a laceration continued for up to 3 weeks in the prepubertal girl and 4 weeks in the adolescent girl. McCann et.al, American Academy of Pediatrics,2007

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LABORATORY EXAMINATIONS Swab for presence of semen for cases within 24 hours DNA for acute case Acid Phosphatase or Prostate Specific Antigen Pregnancy test / ultrasound

Microscopic examination of vaginal swabs/TMG • Trichomonas (exam is wet mount) • Monilia (exam is KOH prep) Gram stain Culture for gonorrhea and chlamydia when resources are available Serology for STD (VDRL, Hep B, HIV) INTERPRETATION Definite evidence of sexual contact • Positive presence of spermatozoa • Pregnancy • STD

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REASONS FOR THE ABSENCE OF PHYSICAL FINDINGS Touching, fondling, oral contact Insertion of finger or an object into vulva or anus Masturbation Other genital contact; intercrural Deliberate avoidance to inflict injury- skillful perpetrator, incest Difference in the interpretation of the word “Penetration” Elasticity of the hymen and anus – “Redundant hymen” Delay in disclosure : 36% had genital trauma when examined within 24 hours to 13% after 24 hours • •

Genital Trauma when assaulted by stranger (25%) vs. known assailant (12%) Prepubertal age – heal fast, heal back to normal

DISCOURAGED TERMS IN SA EVALUATION 1. Virgin State 2. Intact Hymen 3. Size of hymenal opening --- “ the emotional value of collecting evidence should always be weighed against the emotional cost of the procedure and examination of the child” MYTHS 1. Sexually transmitted infections through sharing the same bed, toilet seat or towel. 2. Biking, horseback riding, dancing (split) can cause hymenal laceration 3. Masturbation can cause hymenal laceration • Normal masturbation in girls involves clitorral or labial stimuation • Self injurous behaviors in 97 mentally retarted individuals resulted in NO genital or anal injuries

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MEDICAL GENITAL EXAM + INVESTIGATION Most important  Statement of child  Police investigation to corroborate story - Collateral interviews - Gather evidence at the site

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Clear evidence of recent blunt penetrating/force trauma • Laceration of hymen, acute • Contusion of hymen • Laceration of Posterior Fourchette • Perianal lacerations •

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No evident ano-genital injury at the time of examination. Further investigation, such as careful questioning of the child, is required. Does not exclude sexual abuse/ rape.

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