Quality Education for a Healthier Scotland

SEXUAL OFFENCES EXAMINATION

Quality Education for a Healthier Scotland

A YEAR IN THE LIFE OF AN URBAN FORENSIC PHYSICIAN 2011

Fitness to be detained 671

Fitness to be interviewed 7

Sudden Death 3

Mental Health 130

CSA 9

Examination of injuries 52

S4 RTA 11

S5 RTA 13

Rape 59

NAI 5

Quality Education for a Healthier Scotland

A YEAR IN THE LIFE OF AN URBAN FORENSIC PHYSICIAN

Quality Education for a Healthier Scotland

RAPE

Previously a crime at Common Law (Scotland).Now Sexual Offences (Scotland) Act 2009 defines rape - being implemented autumn 2010.Carnal knowledge of a female by a male, against her will.A serious physical assault by a male against a female.It is a deliberate and vindictive attack upon another human being who is made powerless in order to humiliate, degrade and subjugate her.

Quality Education for a Healthier Scotland

Definition of Rape

Male perpetratorFemale victimBy force i.e. also against her willPenetration slightEjaculation not necessaryInsensible VictimS v HMA 1989 SLT 469

Quality Education for a Healthier Scotland

Penetration

Absence of consent

RAPE

Quality Education for a Healthier Scotland

SEXUAL OFFENCES

Consent

History

Specific history relating to offence

General examination

Examination of genitalia

Anal examination (including RAD)

Colposcopy (video & 35 mm)

Forensic samples

FORENSIC SAMPLES

Suspector

Clothing

Victimor

Clothing

Items Scene

e.g.knife, bottle

Quality Education for a Healthier Scotland

ClothingSheet of paperHead hair (cut/combed)Pubic hair (cut/combed)SalivaMouth swabVenous blood (EDTA/preserved)Penile swabAnal swabsVaginal swabsFingernail scrapingsSkin samples (UV light)

FORENSIC SAMPLES

Quality Education for a Healthier Scotland

Hair (other than pubic)From a nail or under a nail

Swab from any part of a body except a body orifice

Footprint or similar impression

Dental impressionBlood

SemenPubic Hair

Swabs from body orificesSalivaUrine

FORENSIC SAMPLES

Quality Education for a Healthier Scotland

EVIDENCE OF PRESENCE OF SEMEN

‘Usually, a low vaginal swab is obtained by passing the swab into the vagina under direct vision avoiding contact with the external genitalia. “However, even when taken very carefully it is difficult to refute the accusation that in taking the swab contamination had been introduced; its value is therefore questionable.’[1]

[1] McLay WDS Clinical Forensic Medicine 2nd Ed, 1996, Greenwich Medical Media, London, 11.203.

 

Quality Education for a Healthier Scotland

DNA PROFILING

Discovered by Professor Alec Jeffreys in 1984.Most powerful tool ever to discriminate between

individuals (except identical twins).Any fluid or stain material containing nucleated

cells.Particularly effective with semen.Single locus probes - improved sensitivity.Short Tandem Repeats 1994 - one in several

million chance of random match.

Quality Education for a Healthier Scotland

EMERGENCY CONTRACEPTION

HORMONALSchering PC4 - two tablets, followed 12 hours later by a further two tablets.Levonelle 1500 mcg – one tablet stat.First dose must be taken within 72 hours (3 days) of unprotected intercourse.Prevents implantation in 98% of cases.Ulipristal – 5 days

IUCDCan be inserted up to 120 hours (5 days) after unprotected intercourse and is more effective.

Prevents implantation in almost 100% of women.

Quality Education for a Healthier Scotland

SEXUAL VIOLENCE

‘Injury is a feature of sexual assault in perhaps three-quarters of adult cases, but the damage inflicted to the genitalia or extragenital sites is commonly minor.’

Manser T I (1991). The Police Surgeon, 38, 4.

Quality Education for a Healthier Scotland

‘However, more recent work with use of a colposcope has discovered that injury was present in 11% of consenting volunteers examined after consensual sexual intercourse[1]’

[1] Slaughter L et al The pattern of genital injury in female sexual assault victims, Am J Ob Gyn 176:609, 1997.

SEXUAL VIOLENCE

Quality Education for a Healthier Scotland

‘Clinical aging of bruising is known to be one of the most contentious areas of Clinical Forensic Medicine[1] and although one can say that the bruises shown are likely to be have been caused in the week preceding the photograph, it is not possible to be more accurate than this’.

[1] McLay W D S . Clinical Forensic Medicine 2nd Ed 1996; 144.

SEXUAL VIOLENCE

Quality Education for a Healthier Scotland

‘Langlois and Gresham[1] suggested that a bruise which incorporates yellow colouration is more than 18 hours old and although I do not feel one should be entirely dogmatic, this view is one that is generally quoted’.

[1] Langlois NEI and Gresham GA (1991) The ageing of bruises: a review and study of the colour changes with time. Forensic Science International 50, 227-238.

SEXUAL VIOLENCE

Quality Education for a Healthier Scotland

INJURIES IN RAPE VICTIMS

Of 103 rape victims the proportions injured are shown below:No body or genital injury 27 26%No body injury (excl genital) 31 30%No body injury + genital injury 4 4%

Manser T I (1991). The Police Surgeon, 38,4.

SEXUAL VIOLENCE

Quality Education for a Healthier Scotland

EVIDENCE OF PRESENCE OF SEMEN

Spermatozoa - motile sperm found in endocervix up to seven days after intercourse.Semen not likely to be found in the mouth after few hours.Sperm not recovered if the assailant azospermic or vasectomised.Acid phosphatase found up to 12 hours after intercourse in 50% vaginal swabs. Also found after a vasectomy.Anal intercourse - semen may be found up to 3 days later.

Quality Education for a Healthier Scotland

INTERPRETATION OF MEDICAL FINDINGS

Has an assault taken place and, if so, when?

Was its nature sexual?

Is there evidence of restraint/resistance?

Did intercourse (vaginal/oral/anal) occur?

Was there ejaculation, and, if so, where?

What trace evidence is available?

Quality Education for a Healthier Scotland

REFLEX ANAL DILATATION

Examination in left lateral positionButtocks separatedIn +ve test sphincter relaxes within 30 secsDilatation should last for 2-3 secondsDilatation should be > 15 mmShould raise level of suspicionNo physical sign is diagnostic of CSADigital examination may give more information