SEXUAL OFFENCES EXAMINATION

1. SEXUAL OFFENCES EXAMINATION

2. 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

3. A YEAR IN THE LIFE OF AN URBAN FORENSIC PHYSICIAN

4. 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.

5. Definition of Rape • Male perpetrator • Female victim • By force i.e. also against her will • Penetration slight • Ejaculation not necessary • Insensible Victim • S v HMA 1989 SLT 469

6. RAPE • Penetration • Absence of consent

7. SEXUAL OFFENCES • Consent • History • Specific history relating to offence • General examination • Examination of genitalia • Anal examination (including RAD) • Colposcopy (video & 35 mm) • Forensic samples

8. FORENSIC SAMPLES Suspect or Clothing Victim or Clothing Items Scene e.g.knife, bottle

9. FORENSIC SAMPLES • Clothing • Sheet of paper • Head hair (cut/combed) • Pubic hair (cut/combed) • Saliva • Mouth swab • Venous blood (EDTA/preserved) • Penile swab • Anal swabs • Vaginal swabs • Fingernail scrapings • Skin samples (UV light)

10. FORENSIC SAMPLES 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 impression Blood Semen Pubic Hair Swabs from body orifices Saliva Urine

11. 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.

12. 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.

13. EMERGENCY CONTRACEPTION HORMONAL Schering 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 IUCD Can be inserted up to 120 hours (5 days) after unprotected intercourse and is more effective. Prevents implantation in almost 100% of women.

14. 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.

15. SEXUAL VIOLENCE ‘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.

16. SEXUAL VIOLENCE ‘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.

17. SEXUAL VIOLENCE ‘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 International50, 227-238.

18. SEXUAL VIOLENCE 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.

19. 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.

20. 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?

21. REFLEX ANAL DILATATION • Examination in left lateral position • Buttocks separated • In +ve test sphincter relaxes within 30 secs • Dilatation should last for 2-3 seconds • Dilatation should be > 15 mm • Should raise level of suspicion • No physical sign is diagnostic of CSA • Digital examination may give more information