Sexual Offences

Reporting

Documentation

medical records are used in courts as evidence Help the courts in decision making and provide information about past and present sexual activities Appropriate and sympathetic follow up care Estimate the incidence of sexual violance and guide policy making

What should be documented ?

what was said (by the patient, in her own words) What was seen and done ( by the health worker) Documentation should include the following
-

Demogarphic info (i.e. name, age, sex) Consents obtained History ( general medical and gynaecological) An account of the assault Results of physical examination ( injuries and their description) Tests and their results Treatment plan Medications given Pt. education and referrals

The Law

A man is said to commit rape when he has sexual intercourse

without the consent even where such women is his wife and she is judicially separated from the man with her consent when the consent has been obtained, by use of force, or threats or intimidation, or by putting her in fear of death or of hurt or while she was in unlawful detention with her consent when her consent has been obtained at a time when she was of unsound mind or was in a state of intoxication induced by alcohol or drugs, administered to her by the man or by some other person with her consent when the man knows he is not her husband, and that her consent is given because she believes that he is another man to whom she is, or believed to be, lawfully married with or without her consent when she is under sixteen years of age, unless the women is his wife who is over twelve years of age and is not judicially separated from the man

a)

b)

c)

d)

e)

Rape

The conclusion rape strictly a legal matter Solely decided by the courts The doctor does not see a rape victim. He sees a victim of alleged sexual assault

Questons to be answered!

Has sexual penetration taken place? *supporting evidence injuries

*absence of injuries ? does not rule out

If sexual penetration has taken place is it of recent origin?

If sexual penetration has taken place, by whom and by what (penile or other) has the penetration been done?
*presence of sperms in genital tract

identification *absence of sperm cannot rule out penile penetration

consent / was force used or not? *supporting injuries offering resistance force used on the victim *no injuries! Cannot say consent was given

Whether the victim was of unsound mind or evidence of loss or diminished level of consciousness?

*alcohol, drugs, head injury etc.

Writing reports a few points

Explain what you were told and observed Use precise terminology Maintain objectivity Stay within your field of expertise Distinguish findings and opinions Detail all specimens collected Only say what you would be prepared to repeat under oath in court

References

Guidelines for medico-legal caer for victims of sexual violance - WHO 2003 Medico-legal aspects of injuries C.J Babapulle 2000

Special thanks to

Dr. Buddika Weerasundera for the valuable advice given

THANK YOU