Presentation of victims of sexual offences

Group 4

MFC/AL 2000/858-877

What are sexual offences

Rape

Incest
Un-natural offences

(eg Anal,Oral,Intercrural intercourse) Acts of gross indecency Grave sexual abuse Sexual harassment (words/actions)

The laws relating to sexual offences in Sri Lanka are embodied in section 363 to 365 of the Penal Code.
Amentdment Acts, No 22 of 1995 and No. 29 of 1998 have been introduced.

To whom will they commonly present

To the police -children with their parents/guardian

-adults (mainly women) To a doctor-children (GP,Pediatric physician/surgeon/psychiatrist, JMOs) -adults (GP,VOG,Physician,Surgeon,Venerologist,Derma tologist, Psychiatrist,JMOs) To school teachers/principals. To parents/guardians.

How will they present

With a complaint of being sexually

victimised.
Without a complaint of being sexully

victimised.

With a complaint of being sexually victimised

1.Injuries General Parasexual Genital 2.UTI +/-Vaginal discharge 3.Ulcers-(genital,oral,anal) & Warts(genital) 4.Painful defecation eg due to anal fissures 5.Loss of menstrual periods. 6.Without any detectable physical signs. 7.With behavioural abnormalities and emotional distress

Without a complaint of being sexually victimised

1.Injuries General Parasexual Genital 2.UTI +/-Vaginal discharge 3.Ulcers-(genital,oral,anal) & Warts(genital) 4.Painful defecation eg due to anal fussures 5.Loss of menstrual periods. 6.Behaviour abnormalities and emotional distress 7.A dead body with injuries. Thus a detailed Hx & thorough Ex is more crucial.

Injuries
General

Due to threatening behaviour by assailant and struggling and restraining the woman -Gripping marks on the arms at the wrists -Injuries at the back of shoulders, elbows,thighs,calves and buttocks from being forcibly held down on a rough surface. -Grazed abrasion at the back by a struggle or being dragged on the ground

General injuries cont

-injuries around the mouth due to forcibly closing her mouth to prevent victim shouting -Imprint of muzzle when threatened by a gun. -imprint abrasions & contusions of nails including thumb marks due to holding woman by neck. -punch marks /slaps -Torn clothes

Para-sexual injuries
These areas includes the lips, breasts and the

thighs. -swelling of the lips from passionate kissing -love bites and hostile bites on the face, neck and the breast or any area. -finger tip contusions on the breasts from squeezing -nail marks, thumb impressions and other injuries on the thighs following forcible separation

Genital injuries
Perineum-injuries include abrasions and

contusions in an adult, caused by the assailant trying to forcibly insert the penis into the introitus. In children, in addition, there will be lacerations.They are extensions of the hymenal tears and may extend into vaginal canal or the anus.

 Introitus-labia majora and minora

In inter labial penetration there may be reddening or an abrasion or a contusion. At times a vaginal discharge my indicate inter labial penetration. Pressure exerted on the labia majora and minora by the male organ will cause abrasions and contusions and lacerations.

 Hymen

The position of the tear is indicated as on the face of a clock. In fresh tears there is swelling ,tenderness and bleeding. In not so fresh tears there will be tenderness and contact bleeding. Vagina The tip of the penis may also cause abrasions, contusions and even lacerations when excessive force is used for penetration.

Thus it is important to be aware about how these victims may present and take relevant actions as medical officers.

References
Forensic Medicine and Medical Law by Dr.

Hemamal jayawardena Reading material provided by the department of Forensic Medicine. The Essentials of Forensic Medicine and Toxicology 23rd Edition-Dr.Narayan Reddy

THANK YOU