Guidelines examination of victims of sexual assault harmonization of forensic and medico-legal examination of persons

International Journal of Legal Medicine - Sexual assault is a complex situation with medical, psychological, and legal aspects. Forensic experts play a major role in terms of forensic and...     

Overweight and the sexual assault forensic medical examination: A pressing problem

This paper examines the problems faced by forensic physicians assessing overweight victim/survivors of sexual assault, using sample cases and reviewing the literature. This under-researched area is a minefield of practical difficulties and unanswered questions, with the need for solutions becoming more pressing as overweight becomes more common.Overweight has the potential to alter injury patterns; the way forensic medical examinations are conducted; and injury and specimen interpretation. Pertinent questions include whether the “cushion effect” noted in motor vehicle accidents is relevant to sexual assault and how obesity-related comorbidities affect our ability to age injuries. Practical problems include positioning the client safely, obtaining clear views of areas of interest, and taking high-quality specimens.Although overweight victims appear to be uncommon in sexual assault services, as the obesity epidemic progresses clinicians will need to address these issues.     

Scientific examination in sexual assault

Details are given of the sexual assaults dealt with by this laboratory, with particular mention of the increasing number of rape cases submitted each year. The contribution of a forensic biologist to the investigation of alleged rapes is summarized. The laboratory's sexual assault index is explained using examples of three series of linked rapes recognized by this method. The uses and limitations of the ABO grouping of semen are briefly mentioned and an example given showing how the male's ABO group may be ascertained even in the absence of semen.     

A postgraduate sexual assault forensic medicine program: sexual assault medicine from scratch

A government-funded service to provide forensic and medical care to survivors of sexual assault was established in the Australian Capital Territory (ACT) in 2001. Doctors employed by the service lacked the specific skills required to care comprehensively for survivors. Our aim was to develop, implement and evaluate a sexual assault medical education program. It consisted of an 'in-house' education program, and external university course and incorporated team-building, networking activities and protocol development. Core elements were: forensic evidence collection, assessment and management of injuries, prevention of sexually transmissible infections and pregnancy, counselling and emotional support. Participant satisfaction and knowledge acquisition were evaluated using a semi-structured interview and a questionnaire. Seven doctors participated in a 16-session program conducted by the director and nurse coordinator with help from local forensic, legal and medical experts. All doctors successfully completed the Certificate in Forensic Medicine, and reported satisfaction with the program and their increased knowledge, particularly associated with collection of forensic evidence and court procedures. A compete set of protocols was developed and cohesive networks established. We have designed an effective education program for doctors working in the field of sexual assault and offer it as a template to other health professionals working in this area.     

The role of a forensic clinical nurse specialist in a sexual assault treatment program

The role of a Forensic Clinical Nurse Specialist has been developed within our Regional Sexual Assault Treatment Centre in London, Ontario, to assist in meeting the short-term and long-term physical and psychological needs of victims of acute sexual assault. We report on the development and application of this most valuable role within our medical and nursing health care team.     

Ability to consent to a sexual assault medical forensic examination in adult patients with serious mental illness

When a patient reporting a sexual assault (SA) presents with signs and symptoms of serious mental illness (MI), medical providers or forensic examiners may have concerns regarding the ability to legally consent to a sexual assault medical forensic examination (SAMFE). Numerous encounters have occurred where a SAMFE was not offered to a cooperative adult patient because the patient exhibited signs and symptoms of MI. Medical providers and examiners may be motivated by beneficence (believing that treating the patient's MI must take priority over the SAMFE) and/or non-maleficence (a concern that the in-depth SAMFE may worsen the patient's psychological state). Situations where a patient has received psychiatric medications or is under involuntary psychiatric detention also raise capacity to consent to SAMFE concerns. This review explored these concerns and provides recommendations for conducting SAMFEs in adult patients with MI. In instances where a patient has the capacity and is cooperative, the decision to undergo, postpone, or decline a SAMFE ought to be ultimately made by the patient, rather than on their behalf by the provider, SANE or forensic examiner.     

Analysis of aborted fetal material using autosomal STR markers in forensic cases of sexual assault

Sexual violence represents a widespread social problem associated with serious lifelong consequences. In many cases, an outcome of sexual violence is the victim's unwanted pregnancy, usually ended in an abortion. The objective of this paper is to report five rape cases, including rapes of a minor and young woman, two incest cases and a case of human trafficking for sexual exploitation, where every case resulted in the victim's pregnancy. In each case, pregnancy was terminated in the first trimester or at the beginning of the second trimester in the relevant medical center or clinic. Fresh fetal blood or aborted tissue samples were delivered to our laboratory in order to perform paternity testing for the purpose of proving the crime. DNA extraction using Qiagen Dneasy™ Tissue Kit was optimized according to the sample type. Amplification of autosomal STR (Short Tandem Repeat) markers was performed using the PowerPlex®16 System. In two cases, mixtures of maternal and fetal DNA in the aborted fetal material were found. Using the LRmix Studio v.2.1.5 Software for interpreting DNA mixtures based on a probabilistic model, the likelihoods of maternal contribution and presence of fetal allelic variants inherited from the alleged father/suspect were calculated. Based on these results, we confirmed the presence of assumed fetal fractions (determined before software analysis) in the mixtures. In all cases, positive paternity proved the crime (probabilities of paternity >99.9999%). This cases report once again pointed out the importance of DNA analysis in the process of clarifying and solving forensic cases and demonstrated that the LRmix Studio v.2.1.5 Software can deal with complex cases such as sexual assaults.     

The optimal timing of forensic evidence collection following paediatric sexual assault

BackgroundForensic evidence collection following sexual assault has an important medico-legal role. Despite the advent of DNA profiling, research into the optimisation of forensic biological specimen collection is limited. This has led to inconsistent and variable guidelines for forensic evidence collection. The guidelines in this jurisdiction (Victoria, Australia) recommends that specimens be collected up to 7 days following sexual assault in some circumstances. The aims of this study were to determine the optimal times post sexual assault for the collection of forensic biological evidence in paediatric cases (aged 0–17 years).MethodsA retrospective review of paediatric sexual assault cases seen by the Victorian Forensic Paediatric Medical Service (VFPMS) between 1 January 2009, and 1 May 2016, was undertaken. Specimen site and collection times post assault were collated from VFPMS medico-legal reports and compared with the forensic evidence analysis results reported by the Victoria Police, Forensic Services Department. In addition, a survey of recommended forensic specimen collection times post assault in the different Australian jurisdictions was undertaken for comparison.ResultsWithin the 6 year 5 month period studied there were 122 cases consisting of 562 different forensic specimens that were collected and analysed. 62 (51%) of cases produced one or more positive forensic result and, of the 562 specimens collected, 153 (27%) were positive for one or more of foreign DNA, spermatozoa, semen or saliva. Foreign DNA was more likely to be found if forensic specimens were collected during the first 24 h after the assault as compared with those collected at 25–48 h, (p < 0.005). Similarly, spermatozoa were identified more frequently on swabs collected at 0–24 h compared to 25–48 h (p < 0.002). Foreign DNA was not identified beyond 48 h post assault and spermatozoa were not identified beyond 36 h. Saliva and semen were not identified beyond 24 h. The youngest victims with positive forensic evidence were 2–3 years old. The survey of current forensic specimen collection practice in Australia shows that the guidelines for timing of forensic evidence collection in child sexual assault cases is highly variable between jurisdictions.ConclusionsOur results highlight the importance of collecting forensic specimens as a matter of urgency, regardless of age, within the first 48 h post assault. Although there is need for further research, the findings indicate a need for the re-evaluation of current guidelines for specimen collection in paediatric sexual assault cases.     

Drug-mediated sexual assault

Psychoactive substances may be given to a potential victim to alter their behaviour or conscious state. This problem is not new; alcohol has been used alone or in combination with other substances to the same effect. Doctors involved in the examination of complainants of sexual assault need to be aware of the effects of the drugs that may be used and ensure that a detailed history, examination and the appropriate specimens are taken. This report describes a series of incidents involving drug-mediated sexual assault and outlines the dilemmas that accompany such incidents.     

Swipe right: the emergence of dating-app facilitated sexual assault. A descriptive retrospective audit of forensic examination caseload in an Australian metropolitan service

The use of dating ‘apps’ to facilitate real-word social encounters between strangers is culturally mainstream. Sexual assaults facilitated following dating-app meetings have been reported in the media, and anecdotally noted at increasing frequency by clinical forensic physicians. Limited empirical data suggests there has been a marked increase in real life sexual offences facilitated in this manner. There is little additional information known about the circumstances of these alleged incidents. This retrospective audit of a small forensic examination caseload from an Australian metropolitan clinical forensic medicine service identified that 14% (11 of 76) of alleged sexual assaults where complainants underwent a forensic examination were facilitated following a dating-app meeting. Further analysis of these cases identified that all complainants were female, most under 30 years of age. All alleged a single male perpetrator and in over half of the cases the complainant was impaired. In all cases where it was asked (n = 9), the alleged incident occurred at the first face-to-face meeting. More than half of the incidents occurred at the alleged perpetrator’s private residence. Anogenital injuries were observed at the time of forensic examination in 60% of cases, and 70% had visible body injuries. There was no reported condom use. Only one complainant had no observable injury. This small case series quantified a high proportion of forensic sexual assault examination caseload as being facilitated by dating-app meetings, and identified some common features that may be characteristic of alleged sexual assaults occurring in this manner. The authors propose a larger prospective period of data collection at the time of forensic medical examination, to characterize the features of sexual assaults allegedly occurring following app-based meetings.     

Climatic effects on incidence of sexual assault

This study analysed the daily incidence of sexual assault in Greater Manchester with respect to the local weather conditions throughout the year 2002. Cases seen at the St. Mary's Sexual Assault Referral Centre (including police and self-referred clients) for which the date of the assault was known were included in the study. The daily maximum, minimum, and mean temperature, rainfall, wind speed, and hours of sunshine recorded at Manchester Airport were used in correlation and regression analyses. Maximum temperature and hours of sunshine both had a statistically significant (p<0.05 and 0.01, respectively) positive relationship with the number of sexual assaults committed in a day.     

Vulnerable victims of sexual assault

Sexual assault is one of the heinous crimes of present day society. Although it has always been evident, in recent times there has been a steady increase in the rate of sexual assault cases. The aim of this study was to identify the groups most at risk. Therefore it includes only cases of sex offences and sex offences with kidnapping. Information was obtained by interviewing the victims and accompanying persons, and from records submitted by the investigating officers. Our study reveals sexual assault commonly occurs among the age group of 16-19 years (60.8%), mostly at night (53.23%), inside the house (87%) and usually by a close acquaintance (61%). The majority of the victims were unmarried (84.7%), lived in rural areas (65.2%), were unemployed (93.5%), of less educated or illiterate groups (88%) and found to be mentally fit (97%). The victims were mostly drawn from low socio-economic groups.     

Severity of injuries among sexual assault victims

It is generally accepted that victims of sexual assault sustain bodily injury. This study's objective was to determine specific characteristics and severity of injuries among victims of sexual violence in Belgrade. Retrospectively, we analyzed a subgroup of victims of sexual violence that was legally processed over a five-year period. We evaluated 113 cases of sexual crimes selected from the District Court of Belgrade in order to analyze the medical records. All victims were female, at average 24.1 years old (range 5-80 years). In more than half of the cases (52%) evaluated, a medical examination was completed on the day of assault, while 84% took place within 72 hours post-assault. Due to delayed referral, body examination was not conducted on 12 victims (10.6%). We noted one or more extra-genital injuries in 64 victims (63.4%), no injuries in 36 victims (35.6%), whereas for one victim the medical records were inconclusive. Injuries, predominantly bruises, were located on limbs (32%), face (23%), and torso (7%). Abrasions and contusions were less frequently present, while two victims sustained lacerations. The Clinical Injury Extent Score was used to rate the physical severity of the assault. The majority of victims (44%) sustained light injuries, 18% were moderate, while one victim had severe injuries.     

Early evidence kits in sexual assault: an observational study of spermatozoa detection in urine and other forensic specimens

Purpose

To determine the detection frequency of spermatozoa in early evidence kit specimens and in subsequent full forensic specimens in alleged sexual assault.

Methods

Observational cohort study of 100 consecutive alleged sexual assault cases, presenting in Western Australia between 19th July 2008 and 6th February 2012, with both early evidence kit and full forensic evidence specimen collections. Eighty-eight cases were included in the study. Smears from all forensic specimens were analyzed by light microscopy to determine the detection frequency and structural characteristics of spermatozoa. Patient demographic features, characteristics of the alleged assault and details and timing of forensic collections were also recorded.

Results

Spermatozoa were detected in early evidence kit specimens in 35 % (31/88) and in full forensic specimens in 42 % (37/88) of all cases (irrespective of type of alleged penetration). In alleged penile-vaginal penetration, spermatozoa were detected in early evidence kit specimens in 40 % (21/53) of cases when both first void urine and vulval gauze wipe were collected. Spermatozoa were detected in full forensic specimens in 45 % (31/69) of cases. Spermatozoa were detected in early evidence kit oral rinse specimens in 6 % (1/18) of cases of alleged penile-oral penetration and in early evidence perianal gauze wipe specimens in 33 % (2/6) cases of alleged penile-anal penetration. Spermatozoa were detected in the early evidence kit first void urine specimen in a single case, 11 % (1/9), in which the nature of the alleged assault was unknown. Spermatozoa were detected in early evidence kit specimens and not in full forensic specimens in 3 % (3/88) of cases.

Conclusions

Early evidence kit specimens are effective in recovery of spermatozoa, and in particular urine and vulval gauze wipe are worthwhile early forensic specimens for the detection of spermatozoa. Collection of early evidence specimens led to detection of spermatozoa-positive cases, which were not detected by subsequent full forensic specimen collection.     

Psychological profiles of adult sexual assault victims

This is a retrospective analysis of the psychological and psychiatric history of adult patients who attended the Lancashire Sexual Assault and Forensic Examination Centre between April 1st 2010 and March 31st 2011 for forensic examination. During this time 269 adults attended for forensic examination; the records of these patients were audited for evidence of psychological or psychiatric ill health. Affective disorders were disclosed in 48.7% of cases (depression, depression and anxiety, anxiety, bipolar affective disorder) and 3.0% declared having been diagnosed with a psychotic illness (schizophrenia, psychotic illness, psychotic behaviour). Furthermore, deliberate self-harm was disclosed by 29.4% of complainants and 22.3% of attendees had attempted suicide at least once in their lifetime. This study highlights increased prevalence of mental illness in sexual assault complainants which contributes to increased states of vulnerability. This and further similar research efforts have a role to influence prevention schemes, management strategies and healthcare planning for those individuals who are sexually assaulted.