FORENSICS
EXTRACT FROM FORENSIC PATHOLOGY -BY DE MAIO, CHAPTER 18, RAPE-THE LIVING RAPE VICTIM

For the correct handling of rape cases, both medically and legally, there has to be coordination between the physicians examining the survivors and the crime laboratory. It is preferable that survivors of rape be examined at one central hospital by experienced physicians trained in the handling and treatment of such patients and in the collection of evidence. Written, witnessed consent should be obtained before the examination, collection of specimens, release of information to the authorities, and taking of photographs. The name of the survivor is recorded, along with the date and the time of the alleged assault, the date and the time of the examination, and the attending law officer's name and badge, if the police have been notified.

The law officer is not present at the examination, only the doctor and a nurse. Examination of the survivor should preferably be by a senior staff obstetrician/gynaecologist and not by a resident. Senior staff are more experienced and his  or her testimony will carry greater weight in court. Rape is not a diagnosis, it is a matter of jurisprudence. All that the physicians can do is document evidence of trauma, state whether there has been recent sexual intercourse, and report trace evidence.  

The first step is to obtain a history from the patient. This includes the medical history and a brief account of the alleged assault. Some questions to be asked:
1.did the penis penetrate the vulva?
2.did the assailant experience orgasm?
3.did the assailant wear a condom?
4.did anal or oral intercourse take place?

the survivor should be asked whether she bathed, showered, urinated, or defecated prior to the examination.
Vertical drainage from the vagina is the worst enemy to the collection of evidence. Because of this, it is recommended that the examinig physician retain the panties (the survivor was wearing). After taking a history, the patient is examined. The physician will conduct the examination in such manner that objectively acquired evidence can be used to prosecute the assailant in an actual case of rape, or disprove a false charge of sexual assault.  

The patient's general appearance and emotional state are noted. If she is under the influence of alcohol or drugs , this should be indicated. The patient's emotional state does not necessarily reflect on the validity of her charges. Some rape survivors will appear cold and detached, while others will be hysterical.  

All clothing should be examined for stains, tears, missing buttons, dirt, gravel, leaves, and so on. The patient herself is then examined. The examiner will look for bruises, bites, lacerations.

He or she will examine the hands, to see if fingernails are broken. Is the pubic hair matted? Are there foreign hairs mixed with the patient's pubic hair?  

The external genitalia are examied for abrasions , lacerations, and haematomas.

The vagina and cervix are then examined internally by the use of an unlubricated speculum. All injuries noted are then described.  

During the physical examination, evidence will be collected to document the rape. The only difference in the collecting of evidence between the living rape victim and the dead is that, in the living individual , a culture will be made from the cervix for detecting the presence of venereal disease. A blood test will be taken to detect HIV and hepatitis.

Absence of trauma to a rape survivor, does not negate the validity of her claim or rape.  

Following the examination, the patient is treated for her injuries, she is given drugs for the prevention of pregnancy, and medication for the prevention of venereal disease and HIV (if she is not already HIV+). The patient should be seen 2 weeks following the assault in a follow-up examination. If she says she was pushed she should be seen three days afte the first examination to detect and note on the J88 bruising. + compiled by Mihaela Sola, forensic lawyer  - <tutusol@yahoo.com>

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