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Health Care Providers > Sexual Assault > Examination

In the case of Sexual Assault

A detailed systematic examination is important because it provides evidence that could be used in the court of law. It provides information about the extent of damage caused to the survivor both physically and mentally. It also provides information on the amount of force that the perpetrator would have exercised and the resistance that the survivor might have used to avoid the situation.

- Examination should be carried out with the survivor's consent.

- Examination can be carried out by any registered medical practitioner. It is not necessary that examination be carried out by a woman doctor or a gynaecologist. ny practitioner in whom the survivor reposes trust may do the examination. The choice of the patients regarding sex of the examining clinician should be respected.

- It is important that the examination takes place in a separate examination room so that the privacy and identity of the survivor are protected. Unauthorized persons should not be able to view or hear any aspects of the consultation. Preferably, examination rooms should have walls and a door, not merely curtains.

- Examination should include a detailed and systematic general, systemic and local examination.

A general examination begins with the inspection of the body surface for bruises, scratches, bites and other injuries. Specifically look for marks on the face, neck, shoulders, breast, upper arms, buttocks and thighs. All injuries are to be noted on body charts. Describe the type of injury, abrasion, laceration etc. Mention possible weapon of infliction in the form of words such as - hard, blunt, rough, sharp etc. Number the injuries and also mark them in body charts. Actual measurements, site, shape, with time since injury must be described.

Along with physical examination mental state examination should also be carried out to assess the mental and emotional state of the patients. Please note that the patient is indifferent, detached or controlled may be used against her by the defence hence such reference may be avoided.

Genital Examination: Please note these important points to remember when conducting a genital examination in the case of sexual assault.

- A careful observation of the perineum is made for evidence of injury, seminal stains and stray pubic hair. The vulva and labia are inspected likewise.

- A note is made of any swelling, bleeding and tearing, these being signs of recent injury. Examination of the vagina of an adult is done with the help of a sterilised speculum.

- Gentle retraction allows for inspection of the vaginal canal. Look for bruises, redness, bleeding and tears, which may even extend into the perineum, especially in the case of girl children. In case injuries are not visible but suspected; 1% toluidine blue is sprayed and excess is wiped out .

- Micro injuries will stand out blue and then marked on the pictures or body charts.  Micro injuries are better appreciated under colposcope. Per vaginal and per speculum examination is not a must in case of a child, when there is no history of penetration and no visible injuries.

- Please note that the size of the vaginal introitus has no bearing on a case of sexual assault, and therefore the two-finger test of admissibility must not be conducted. It is often used against survivors in court to prove that they are 'habituated to sexual intercourse', even though such information about past sexual conduct has been considered irrelevant to the case. (Section 146 of the Indian Evidence Act).

- Routinely, there is a lot of attention given to the status of hymen. However it is largely irrelevant because the hymen can be torn due to several reasons such as cycling, riding or masturbation among other things. Research shows that an intact hymen does not rule out sexual assault, and a torn hymen does not prove previous sexual intercourse. Hymen should therefore be treated like any other part of the genitals while documenting examination findings in cases of sexual assault. Only those that are relevant to the episode of assault (findings such as fresh tears, bleeding, edema etc.) are to be documented.

- Examination must be guided by the kind of history that the survivor reveals. For example, if the history reveals that the perpetrator held the the survivor's wrists during the assault to restrain her, then the doctor must look for such marks on the survivor.

***In case of minors, examination for estimation of age has to be carried out.

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