Sexual Offences

1. Sexual Offences Dr Srikumar

2. Sexual Offences Offences committed as a result of sexual acts

3. Natural : Rape Incest Unnatural : Sodomy Tribadism Bestiality Buccal coitus. Classification

4. Sadism, Masochism, Necrophilia, Fetichism, Transvestism, Exhibitionism, Masturbation, Voyeurism, Frotteurism, Undinism. Sexual perversions

5. A charge of rape is easy to make, hard to prove, harder still to disprove

6. Rape • Sexual intercourse with woman • Against her will • Without her consent • With consent, when consent obtained by putting her in fear of death or hurt • Consent under unsound mind , intoxication • Under 16 yrs, with/ out consent

7. Consent • Woman of 16 yrs or above • Free and voluntary • Sound mind, not intoxicated • Prior to the act

8. What constitutes rape ? • Male private parts inserted into female, no rule extent of depth • Need not be completed act of intercourse • Slightest penetration of penis within vulva, with or without emission of semen or rupture of hymen. • Committed even when inability to produce penile erection. • No age limit for accused – potency decided by court based on evidence.

9. Examination of victim • Objective : • Search for physical signs, • Collect & preserve evidence for lab exam, • Treat victim for injury, STD, psych damage.

10. Procedure • Police advise victim not to change clothes, bathe before ME. • Should not be examined without authority of investigating PO/ magistrate. • Consent of victim/ guardian, date/ time, identified by escorting female PO. Examine in POs presence. • Examine without delay – vulva tenderness, detection of spermatozoa.

11. Statement of victim • Date & time of alleged offence • Exact positions of parties • Details of struggle, resistance • Pain, haemorrhage, penetration • Assault, LOC.

12. Preliminary steps in Exam, contd. • The doctor must record the following: • Person who brought the survivor, • A short factual account of the incident • survivor's history for habits, intercourse, vaginal discharge, infections, pregnancies. • Menstrual history. • Survivor's general behavior, mental state, signs of alcohol or drug influence are noted. • To know if she has had a bath/ change of clothes.

13. Clothes • Clothes are examined for the presence of blood and seminal stains, tears and mud. • Any marks or suspicious stains are preserved for examination by the chemical examiner. • Stands on clean sheet of paper, and anything that falls is preserved – earth, buttons, hair. • Foreign hair preserved and compared with accused.

14. General examination • Marks of violence identified - scratches, bites and bruises on the forearms, wrists, face, mouth & throat, chest and lower abdomen, inner thighs & back. • All marks recorded and carefully described with regards to their appearance, extent, situation and probable duration. • Petechiae on face – partial asphyxia due to forcible restraint. • Swabs are taken of teeth marks on the survivor's body for the presence of the accused's saliva. • Broken nails are noted and debris under the nails removed for examination.

15. Genital examination • Examined by an O&G specialist. • Genital organs examined for signs of bleeding, bruises and lacerations. • Matted pubic hair due to the presence of semen is cut off for examination. • Comb pubic hair for non-matching hair, root study. • Dried seminal stains on the external genitals and thighs are scraped off by means of a clean blunt knife for subsequent examination.

16. Hymen examined for rupture signs if survivor was a virgin before the attack. • Vaginal secretion obtained by introducing a sterile cotton wool swab for presence or spermatozoa within 24 hrs (Slide test). • Any muco-purulent/ purulent discharge is examined for signs of STD.

17. In case of pregnancy • When victim is pregnant and would like to seek abortion, a stringent procedure is adhered to. • According to Abortion Act 1967, Termination of Pregnancy (TOP) is illegal in Malaysia. • However, it can be allowed if foetus endangers the mother's health or if pregnancy causes great psychological stress to the mother, • Under the Medical Act, the recommendations of these specialists make TOP legal.

18. Rape on a virgin • Laceration & rupture of hymen. • Tearing posteriorly at sides, or in middle. • Margins sharp and bleed on touch. • Labia minora swollen and tender. • Scratches and bruises by fingers of assailant – dark red, purple in 24 hrs, vagina, cx. • 3-4 days – edges of laceration congested and swollen, heal in 1 week, never unite.

19. Rape on a deflorate woman • Even without childbirth, hymen destroyed, vaginal orifice dilated, mucous membrane thickened and wrinkled. • Only evidence is semen/ spermatozoa. • Resistance – local injury, tearing of vagina. • Older women – senile atrophy and friability – extensive vaginal lacerations and perineal trauma. • Injuries obscure in 3-4 days.

20. Rape on children • No signs of general violence, as child has no idea, incapable of resisting. • Hymen is deep, vagina small, difficult penetration. • During penetration, penis compresses labia, causing bruises. • Tears - Hymen posterior, Ant & post vaginal wall, perineum, anterior anorectal canal, vaginal herniation of abdominal viscera.

21. Corroborative signs of rape • Presence of seminal fluid • Vaginal discharge • Struggle & findings related to time of assault • Wounds • Seminal material - motility • STD

22. Specimens to be collected from victim • Avulsed head hairs • Pubic hair combings • Avulsed pubic hair • Blood group • Urine drug screening • Nail scrapings for blood or tissue • Saliva for secretor group • Swabs from bite marks for saliva

23. Sequelae of rape • Death due to • Shock due to emotion/ blunt force • Haemorrhage from genital/ peritoneum • Suffocation/ strangulation • Psychological trauma - Mental derangements, convulsions, epilepsy • Rape trauma syndrome – disrupt patients physical, social and sexual life.

24. Examination of accused • If the survivor is able to identify the accused, he will be taken to the police station to make a cautioned statement (his version) • He is then taken to hospital for examination. • Before the examination, the accompanying PO has to identify the accused. • The name and the number of the officer is noted. • Before written consent of the accused is obtained, it is explained to him that the result of the examination may go against him.

25. Examination • Examined after victim without delay, to look for injuries inflicted by her. • Age, physical power, genital development noted. • Mental history, alcohol, drugs. • Clothes – hair, fibres, foreign matter, cosmetic contact – powder, lipstick; mud; grass; semen. • Nail scrapings – blood, epithelial cells. • Struggle – bruise, scratches, teeth marks. • Pubic area – matting, female hair, abrasions, tears of prepuce, glans. • Saline wash of penis – pap stain for vaginal cells. • Absence of smegma on corona glandis, seen in 24 hrs.

26. Specimens to be collected from accused • Pubic hair combings • Avulsed pubic hair • Head hair • Blood group • Nail scrapings for blood or tissue • Swabs from coronal sulcus, prepuce, urethra

27. Report • Rape is not a medical diagnosis. • MO gives opinion of signs of recent vaginal penetration, intercourse, physical injury. • Comprehensive negative and positive findings. • Medical proof of rape is not legal proof. • False charges – injured by blunt instrument, thumb, chillis, garments stained with starch, egg white; for blackmail (inconsistent statements).

28. Incest • Sexual intercourse by a man with woman who is closely related to him by blood. • daughter, grand daughter, sister, aunt, mother. • Occurs between defectives unable to understand prohibitions against it. • Alcohol removes sense of prohibition. • Cerebral disease, senile degeneration. • Relatives separated in childhood. • Close relations living in intimacy.

29. Unnatural offences

30. Sodomy • Anal intercourse between 2 males, or male & female. • Gerontophilia – passive agent adult • Paederasty – passive agent child – catamite. • Frequent among sailors, prisoners, hostels, military barracks. • Hermaphrodites may act as passive agents.

31. Examination of passive agent • Consent, history, degree of penetration. • PE with presence of 3rd person, knee elbow position. • Perianal and rectal swab. • Rectal bruising , fissure, inflammation. • Anal muscle dilated, tender, sphincter torn, prolapse. • Digital examn – loss of elasticity, admitting finger. • Anal blood stains, lubricants, faecal matter, pain on walking. • Abrasions – 1-2 days; perianal haematoma – 10 days, fissure – weeks.

32. Habitual passive agent • Shaving anal hair • Anal skin thickened, extends deeper. • Funnel shaped depression of buttock, loss of fat. • Compete relaxation of sphincter – 5 cm. • Muscle loses tone. • Anal fissures, piles, STDs.

33. Specimens to be collected • Head hairs • Pubic hair • Blood group • Urine drug screening • Nail scrapings for blood or tissue • Swabs - soiled areas of skin, anal, rectum • Swab - penis of accused.

34. Active agent • Smell of anal glands on penis. • Traces of faeces and lubricant. • Abrasion of prepuce, glans. • Penis elongated and constricted, twisted urethra. • STD, HIV.

35. Buccal coitus, Sin of Gomorrah • Male organ introduced into mouth of child. • Teeth marks and abrasions on penis. • Death – aspiration of semen, impaction of penis in oropharynx. • Dx – semen in respiratory tract, stomach.

36. Tribadism • Greek isle of Lesbos • Female homosexualism • Genitals – scratch marks, abrasions. • Masculine due to endocrine disturbances, indifferent to opposite sex. • Mental degenerates, psychological, social and developmental factors. • Morbid jealousy – resort to homicide/ suicide.

37. Beastiality • Sexual intercourse with lower animal. • Domesticated farm animals or pets – calves, sheep, ducks, geese, donkeys, dogs. • Vaginal/ anal. • Villagers while grazing, mental derangements. • False belief, cure for gonorrhoea.

38. Signs in accused : • Penis contaminated with animal faeces, vaginal secretion, hair, tearing of glans. • Injury marks – teeth, kicks, claws. • Signs in animal ( by vet) • Human semen in vagina/ anus. • Abrasions, discharges

39. Sexual perversions

40. Sadism • Marquis de Sade – French nobleman & writer • Gratification obtained from acts of physical cruelty, infliction of pain. • Bite, beat, whip, inflict cuts. • Lust murder – extreme cases, outbreaks of paroxysmal sexual desire. • Cutting breasts, genitalia, eat flesh, intercourse with dying/ injured victim (necrophagia). • Mental disease, anger, jealousy, revenge.

41. Masochism • Leopold von Sacher Masoch, Austrian novelist, stimulant for literary work, whip • Sexual gratification enhanced by suffering of pain. • Beaten, abused, tormented, humiliated, enslaved, bound, dominated by partner. • Bondage – sadism & masochism.

42. Necrophilia • Sadomasochistic foundation – desire for intercourse with cadavers. • Offence committed on newly buried corpse, body awaiting burial. • Corpse may be mutilated following intercourse. • Decomposition, stench and coldness play a part.

43. Fetichism • Fetish – Use of fascinating objects for sexual gratification. • Part of woman’s body, article – underclothes, shoes, flower. • Mere act of stealing fetish affords satisfaction. • Common in Males

44. Transvestism/ eonism • Opposite clothing – Chevalier d’Eon Beamont, Frenchman. • Transvestite – desire to be identified with opposite sex, males wear female dress. • Psychologically, individual’s attraction to opposite sex, violent against own sex. • Associated with homosexuality, sadomasochism. • No hormonal disturbance/ genital abnormality.

45. Masturbation • Deliberate self stimulation which effects sexual arousal. • Offence only when practised openly – telephone booths, public toilets.

46. Exhibitionism • Intentional exposure of private parts in public, in presence of others, to obtain sexual pleasure. • Males to children, or opposite sex. • Women in public. Psycopath/ neurosis. • Punishable obscene act.

47. Voyeurism/ scoptophilia • Counterpart of exhibitionism. • Voyeur – see people undress to be sexually gratified. More in males. • Sociopathic personality disorder. • Sometimes assault victim or commit murder.

48. Wife battery • Woman who has received deliberate severe repeated physical injuries from marital partner. • Personality or neurotic disorders – suspicious, violent, dominating. • Normally stable and affectionate.

49. Others • Frotteurism – contact with other person, rubbing in crowds. Usually impotent. • Undinism – witnessing act of urination. • Pyromania – Seeing flames, destruction of buildings. Psychosexual disorders. • Indecent assault – Offence committed on female with intention of outraging her modesty. Against Children, adolescents.

50. Semen analysis - Parameters • Volume. • Liquefaction time. • Sperm count. • Sperm morphology. • Sperm motility. • pH. • White blood cell count