1. Sexual Offences
DR: Asmaa Fady. Assistant professor of forensic medicine and Clinical Toxicology
اسم ورقم المقرر – Course Name and No.
6/7/2019

2. Learning Objectives By the end of the lecture, the student should:
Diagnose cases of sexual offences.
Diagnose virginity
Diagnose differentially between ruptured & non ruptured hymen
Diagnose differentially between recent & old tears in the hymen
Investigate cases of sexual offences including both victim & assailant.
Define unnatural forms of sexual relationships.
اسم ورقم المقرر – Course Name and No.
6/7/2019

3. RAPE
Definition: Rape is unlawful sexual intercourse by a male with a female by force and against her will.
اسم ورقم المقرر – Course Name and No.
6/7/2019

4. RAPE Unlawful: means outside the bond of marriage.
Sexual intercourse: complete or incomplete penetration with or without emission of semen.
By a male with a female: the male age should be above puberty (14) with no upper age limit. While, for female there is no age limit but punishment depends on her age.
Against her will: means no consent.
By force: means either physical force or even fear or threats.
اسم ورقم المقرر – Course Name and No.
6/7/2019

5. Consent is considered free and legal when the following conditions are fulfilled
1- She must not be under the age of 18 years (age of consent for rape) 2- She must not be mentally deficient. 3- She must not be under fear or threats. 4- She must not be under fraud, as when a man impersonates her husband. 5-She must be fully conscious (i.e. not under the effects of alcohol, narcotics or anesthesia.
اسم ورقم المقرر – Course Name and No.
6/7/2019

6. MEDICAL EXAMINATION OF A CASE OF RAPE 1-Examination of the victim
1- Her written consent. 2- Her full story is taken. 3- Her age is estimated. 4- Her mental condition is evaluated. 5- Her body built is compared with that of the accused. 6- Signs of disturbed consciousness: chemical analysis of her blood and urine is done to detect the drugs.
اسم ورقم المقرر – Course Name and No.
6/7/2019

7. MEDICAL EXAMINATION OF A CASE OF RAPE 1-Examination of the victim
7- Signs of general violence.
a-The victim’s clothes may show tears and loss of buttons.
b-The victim’s body may show signs of general resistance in the form of
nail abrasions and bruises:
- Around her mouth (to prevent her from shouting),
- On her wrists (to prevent her resistance),
- On the inner aspect of her thighs (to force them apart)
Bite marks may be present which are of two types:
i- Suction bites: Circular or oval area of bruises consists of intradermal petechial hemorrhages (love bites)
ii- Actual bites: abrasions and bruises matching the dental arches of the assailant.
اسم ورقم المقرر – Course Name and No.
6/7/2019

8. MEDICAL EXAMINATION OF A CASE OF RAPE 1-Examination of the victim
8- Signs of local violence:
a- Abrasions, bruises or may be lacerations of the vulva.
b- Recent tear of the hymen (in virgin).
c- Assailant’s hair, seminal stains may be found on the victim’s genitalia forming good evidence against him.
9- Delayed repeated
examination for tests for
pregnancy & STDs.
Lithotomy position
اسم ورقم المقرر – Course Name and No.
6/7/2019

9. MEDICAL EXAMINATION OF A CASE OF RAPE 2-Examination of the accused
1- His consent for examination is essential. 2- Detailed history to compare it with that of the victim and with any previous story given by him. 3- His age is estimated to see if he is below 14 years. 4- His mental condition is noticed for any deficiency. 5- His body built is compared with that of the victim for the possibility of overpowering her.
اسم ورقم المقرر – Course Name and No.
6/7/2019

10. MEDICAL EXAMINATION OF A CASE OF RAPE 2-Examination of the accused
6- General examination: for signs of struggle as abrasions or bruises about his face, hands or private parts. Sometimes he may show actual bite marks His clothes are also examined for signs of struggle.
7- Local examination, his genitalia are examined for:
Injuries (as abrasions caused by the victim’s fingers) coinciding with the date of crime.
Foreign matter (pubic hair or epithelial cells related to the victim).
8- Blood stains & Finger nail scrapings
9- Examination for erectile dysfunction (inability to perform the sexual act). It may be alleged by the assailant as a defense for the charge of rape.
اسم ورقم المقرر – Course Name and No.
6/7/2019

11. Virginity
Anatomy of female genital organs
Medico-legal conditions in which a female is examined for signs of virginity: 1- Alleged rape. 2- Alleged erectile dysfunction of the husband. 3- Alleged non-virginity of the wife.
اسم ورقم المقرر – Course Name and No.
6/7/2019

12. Signs of virginity are:
1- Hymen is intact. 2- Labia majora are firm and rounded, completely closing the vaginal orifice in the lithotomy position. 3- Labia minora are pink and covered by labia majora. 4- The vestibule is narrow, the fourchette is intact. 5-The mucosa of the vagina is rugose, reddish in color, its walls are approximated and its orifice remains closed in lithotomy position
اسم ورقم المقرر – Course Name and No.
6/7/2019

13. Types of hymen
The hymen is a thin membrane, which partially closes the vaginal orifice in the virgin. Its commonest types are:
1- Semilunar or crescentic hymen: is a thin crescentic membrane with anterior opening.
2- Annular dilatable hymen: is a membrane with a central opening which may be wide and dilatable to allow intercourse without being ruptured.
3- Dentate hymen: the opening has a serrated edge.
4- Fimbriated hymen: It has a number of fimbria around its opening.
اسم ورقم المقرر – Course Name and No.
6/7/2019

14. Types of hymen
5- Septate hymen: It shows a longitudinal septum dividing the opening into two.
6- Cribriform hymen: It has a number of small openings giving the membrane a sieve-like appearance.
7- Imperforate hymen: the membrane completely closes the vaginal orifice, resulting in collection of the menstrual blood and distension of the uterus, which simulate pregnancy.
اسم ورقم المقرر – Course Name and No.
6/7/2019

15. Hymens of medico-legal importance
1- Imperforate hymen: This may simulate pregnancy 2- annular (dilatable) hymen: which is fleshy dilatable hymen that dose not bleeds with the first intercourse. 3- Dentate and Fimbriated hymen: This may simulate torn hymen.
اسم ورقم المقرر – Course Name and No.
6/7/2019

16. Dentate or fimbriated hymen
Differences between recent tears, old tears &Dentate or fimbriated hymen
Recent tears hymen
Old tears hymen
Dentate or fimbriated hymen
1- Painful swollen edges
- Painless edges.
-Painless edges.
2- Hyperemic, they bleed on touch.
-Do not bleed on touch
3- Irregular asymmetrical indentations not disappear on stretching the hymen.
-Irregular asymmetrical indentations not disappear on stretching the hymen.
-Bilateral symmetrical indentations that disappear on stretching the hymen.
4- May not reach the vaginal wall.
- Reach the vaginal wall.
Never reach the vaginal wall.
5-Transillumination shows translucency.
-Transillumination shows opaque scar following healing of the tear.
Translucent tissue with no scar or fibrosis.
6/7/2019

17. Male Homosexuality (Sodomy): anal intercourse between two males.
Examination of a case of sodomy I- Examination of victim (passive sodomist): 1- Consent should be taken before examination. 2- History is taken as regards sites of injuries and behavioral characteristics of assailant. 3- The victim is examined in knee elbow position with proper lighting.
اسم ورقم المقرر – Course Name and No.
6/7/2019

18. Examination of a case of sodomy I- Examination of victim (passive sodomist):
4- Local signs:
(A) Signs in habitual sodomist:
1- If the victim is a habitual sodomist, he may have (feminine gait and manner of speaking); he lies easily in knee elbow position.
2- Weak anal reflex (i.e. on pinching the skin around anal sphincter, it can not contract).
3- Anus dilated with keratinization of the mucosa.
4- Mucous membrane may be prolapsed with loss of its usual mucosal folds i.e. smooth mucous membrane.
5- Piles or fissures may be present.
6- Evidence of any venereal diseases.
اسم ورقم المقرر – Course Name and No.
6/7/2019

19. Examination of a case of sodomy I- Examination of victim (passive sodomist):
(B) Signs in unwilling partner: 1- Tenderness around the anus with bruising of the anal margins and splitting of the skin that may extend internally. 2-Perineal tear may be found. 3- Strong anal reflex. 4- Examination of the passive partner should include swabs for seminal fluid, lubricants and tests for venereal diseases, foreign hair should be collected. 5- Signs of general resistance in unwilling partner. 6- Signs of venereal diseases.
اسم ورقم المقرر – Course Name and No.
6/7/2019

20. Examination of a case of sodomy I- Examination of assailant (Active sodomy):
1- Consent for medical examination is obtained. 2- He is examined for: a) Age, mental condition and signs of resistance. b) Presence of bloodstains or hair related to the victim either on his private parts or clothes. Also, search for fecal matter on his clothes. c) Contamination of the penis by fecal matter or lubricant. d) Presence of signs of venereal diseases.
اسم ورقم المقرر – Course Name and No.
6/7/2019

21. Role of physician in case of Rape
Do:
Obtain a brief history from patients with the nurse as a silent witness. The details should be left for the police.
Examine the patient and collect evidence as soon as possible.
Collect each piece of clothing in a separate paper bag.
Write a primary medicolegal report for all wounds.
اسم ورقم المقرر – Course Name and No.
6/7/2019

22. Role of physician in case of Rape
Don't
Allow any other person to obtain the history of the assault – take it yourself.
Allow any other person to collect any part of evidence.
Permit any shower to be taken in both victim and assault except after collection of any evidence.
Permit any break in the chain of evidence.
Let the evidence in the refrigerator for any length of time this can raise procedural issues by the defense about the proper handling of the evidence.
اسم ورقم المقرر – Course Name and No.
6/7/2019

23. UNNATURAL (ABNORMAL) SEXUAL OFFENCES
Bestiality: sexual connection between human beings and animals.
Sadism: The male inflicts pain on the female partner as a source of sexual arousal.
Masochism: It is opposite to sadism; a man obtains sexual arousal on receiving a painful stimulus from women.
Necrophilia: sexual intercourse with a dead female.
Pedophilia: sexual activity with children either males (homosexual pedophilia) or females (heterosexual pedophilia).
Incest: carnal connection between persons of the forbidden degrees of relationship.
Female Homosexuality (lesbianism): abnormal sexual connection between females.
Male Homosexuality (Sodomy): anal intercourse between two males.
Buggery: anal intercourse between male and female.
اسم ورقم المقرر – Course Name and No.
6/7/2019

24. اسم ورقم المقرر – Course Name and No.
6/7/2019