Doctor is a man of science, he has

no victim to avenge ,no guilty

person to convict and no person to
save.
 Sex offences

DEFINITION:
Offences committed as a result of sexual
acts are known as sexual offences.
Natural Sex offence-Rape
 Introduction

Rape is a type of natural sexual act done by a

male on female considered illegal and
punishable by the law which is different from
county to country . As a natural act sexual
intercourse by a man with woman as per
order of nature that is peno-vaginal
intercourse
 Introduction
Cont…

Normal vaginal intercourse IS UNIFORM

IN CHARACTER in the all humanity
throughout the world with same purpose of
procreation driven by the sexual desire.
But when it will be considered illegal
depends upon the definition set by
the law of that land
 Introduction
Cont…

Medical persons has no authority over

explanation or interpretation of the law and
express their opinion on trial of rape cases
by the law but as a registered medical
practioner they have the moral and legal
duty to the country to help the
administration of justice by providing
medical evidences and scientific
interpretation of medical findings.
 Introduction
Cont…

Natural sexual act is heterosexual

penovaginal intercourse - ‘Coitus’
 Physiology of Coitus
Both partner male and female aroused by sexual
desire prepare for coitus ;
Male develop the unique response of erection of
phallus
female develop some temporary changes in
different secondary sex organs but most
importantly lubrication of vaginal tract by
increased secretion
 Physiology of Coitus
Cont…

Male partner ‘s sexual act normally

completes in three stages
l. Erectio
2.Intromossio
3.Ejaculatio.
 Physiology of Coitus
Cont…

Under ordinary circumstances; A successful

pleasant coitus requires
Sexual desire
Willingness for union
Mutual cooperation and participation.
Natural sex act turns out to be sexual
offence--Rape as per act.
 What is Rape?
375 IPC. Defined rape.
A man is said to commit “rape” who, except in the case hereinafter
excepted, has sexual intercourse with a woman under circumstances
falling under any of the six following descriptions: -

First: - Against her will.

Secondly: -without her consent.

Thirdly: - With her consent, when her consent has been obtained by
putting her or any person in whom she is interested in fear of death
or of hurt.

Fourthly: -With her consent, when the man knows that he is not her
husband, and that her consent is given because she believes that he
is another man to whom she is or believes herself to be lawfully
married.
 What is Rape? Contd..
Fifthly: - With her consent, when, at the time of giving such consent, by
reason of unsoundness of mind or intoxication or the administration by
him personally or through another of any stupefying or unwholesome
substance, she is unable to understand the nature and consequences
of that to which she gives consent.

Sixthly: - With or without her consent, when she is under sixteen years
of age.

Explanation: - Penetration is sufficient to constitute the sexual

intercourse necessary to the offence of rape.

Exception: -Sexual intercourse by a man with his wife, the wife not
being under fifteen years of age, is not rape].[5]
Recent Amendment
Section 375 - Rape: A man is said to
commit "rape" if he—
a) penetrates his penis, to any extent,into the vagina, mouth,
urethra or anus of a woman or makes her to do so with him or
any other person; or
b) inserts, to any extent, any object or apart of the body, not
being the penis,into the vagina, the urethra or anus of a
woman or makes her to do so with him or any other person; or
c) manipulates any part of the body of a woman so as to
cause penetrationinto the vagina, urethra, anus or any part of
body of such woman or makes her to do so with him or any
other person; or
d) applies his mouth to the vagina, anus,urethra of a woman
or makes her to do so with him or any other person,under the
circumstances falling under any of the following seven
 What is Rape? Contd..

‘will’ and ‘consent’ is two most important

component of the definition, not the sexual
intercourse.

will and consent is established by various

other circumstantial evidences
medical examination which may only be
corroborative.
Natural coitus and Rape
Intercourse against ‘Will’ & without consent.

In cases of rape there will be no physiological

response of coitus under ordinary course.
(except clause fourthly in 375 IPC)
No sexual Desire
No Stimulation
No Change in Vaginal tract i.e no dilatation &
lubrication .
And also
No cooperation and participation.
Intercourse against ‘Will’ & without consent.
Contd..
Ordinarily “without consent” means physical
resistance & struggle

“against will” means more chance of genital

and extra genital injury in the part of male
and female both.
 Intercourse against ‘Will’ & without consent.
Contd…
.. :
 Married/ deflorate women
Genital injury however trivial it may be is likely.
Extra genital injury more severe
 Nubile Virgin: Both Genital and extragenital injury,
 Young virgin/child : more severe genital injury.
mainly due to-[ no sex desire . disproportionate size of
adult penis to child vagina.]
 Child without physical maturity or any female
unconscious, severely intoxicated or
incapacitated by fear, naturally do not
develop sexual desire- More chances of
genital injury. .
 Important and interesting

‘Clause fourthly in 375 IPC)’-

One most important and interesting problem it poses
to Medical Examiner and Judiciary.

Here the adult female subject is not denying

repeated consensual sexual intercourse over a
period of time may be for years rather that is the
chief complaint and History.
In these cases Medical examination can only found
evidences of repeated sexual intercourse or
Habitual sexual intercourse.
Whether Law requires medical Examination of those
Females?
 Opinion with caution and care.

Care must be taken before opining that sex

act was against will or without consent .
As
Both partner may have injury marks on their
genitalia or extra genital body parts as a normal
erotic response in consenting vigorous sex act.
Also
It is not unusual that at the onset of puberty in
very early teens some girl may develop interest
and get involved in sex act .
 Laws in relation to Examination of Female
cases
 53(2) CrPC
states that whenever the person of a female is to be examined under this section, the
examination shall be made only by, or under the supervision of a female registered
.
practitioner

 Section 164 A
has been added to provide for a medical examination of the victim of a
rape by a registered medical practitioner employed in a hospital run
by the Government or a local authority and in the absence of such a
practitioner by any other registered medical practitioner.
POCSO Act.; The POCSO Act, 2012 defines a child as any person below
eighteen years of age. The police are also required to bring the matter to the
attention of the Child Welfare Committee (CWC) within 24 hours of receiving
the report
 Sec 164A CrPC –What it states
CrPC (Amendment) Act, 2005,164A . Medical examination of the victim of
rape., [The Code of Criminal Procedure, 1973]
 (1) Where, during the stage when an offence of committing rape or
attempt to commit rape is under investigation, it is proposed to get the
person of the woman with whom rape is alleged or attempted to have
been committed or attempted, examined by a medical expert, such
examination shall be conducted by a registered medical practitioner
employed in a hospital run by the Government or a local authority and in
the absence of a such a practitioner, by any other registered medical
practitioner, with the consent of such woman or of a person competent
to give such consent on her behalf and such woman shall be sent to
such registered medical practitioner within twenty-four hours from the
time of receiving the information relating to the commission of such
offence.
164A contd…
**(4) The report shall specifically record that the consent of the
woman or of the person competent to give such consent on her
behalf to such examination had been obtained.
(5) The exact time of commencement and completion of the
examination shall also be noted in the report.

(6) The registered medical practitioner shall, without delay forward

the report to the investigation officer who shall forward it to the
Magistrate referred to in section 173 as part of the documents
referred to in clause (a) of sub-section (5) of that section.
(7) Nothing in this section shall be construed as rendering lawful any
examination without the consent of the woman or of any person
competent to give such consent on her behalf.
Explanation. – For the purposes of this section, “examination” and
“registered medical practitioner” shall have the same meanings as in
section 53’]
 Medical evidence: Legal Importance
“It is rare for cases of rape to be tried
without medical evidence. Juries
naturally dislike to convict persons of
this serious crime unless statement of
the prosequtrix is supported by medical
facts and opinion. And in practice, the
law demands some type of
corroboration of the girl’s story before a
case is allowed to go a full length before
a jury.” [2]
 Medical Evidence of Rape
Medical Examination is done to provide
Medical Evidence in the court of law.
Medical evidences are essentially evidence
of Forceful Coitus: i. e
Evidence of Sexual Intercourse
Evidence of Absence of Will and Consent .
Medical Examination of Alleged Rape Victim

Locard’s Principle: when two things comes close

there is always a exchange of matters from one
to another.-[ Dr. Edmond Locard (1877-1966). ]
 Objectives of Medical Examination
Examination is done with an objective to:
1. obtain confirmation of allegation
2. link victim to the assailant
3. establish a connection of the victim with the
scene of crime
4. establish the use of force
5. identify the assailant.
 Medical examination
The medical examination of the victim is performed in the
same manner as the clinical examination.
A detailed history must be obtained and a general physical
examination performed. detail recording of findings even
negative important findings are to be recorded.

It may be months or years before the records are needed and only if the records are
adequate originally can the investigator refresh his memory.[1] ]
 Medical examination Contd…
The examination result will be influenced by
 age
 frequency of sexual intercourse
 lapse of time since the alleged attack.

‘Menstruation is not a contra indication for the

examination of female tract’. second
examination may be required after cessation of
period.
 Medical examination
Cont…

1.Preliminaries:
 Requisition requesting medical
examination by the police not below the
rank of S.1 .
 consent,
 Identification,
 female attendant
 Medical examination:
Contd…

CONSENT:
 No rape victim can be examined without her
informed consent.
 Girl above 12 Yrs. Can give valid consent for
Examination
 consent of parents or legal guardian is required - In
case of girl below the age of 12 years and mentally
retarded girl .
 *However no girl should be examined against her
will.-- Minor or major .
 when only male doctor available it is desirable to have written
consent for examination by male Doctor.
 CONSENT: Practical problem
1.Girl below 12 Yrs.-mother giving consent but girl resisting.
2.Girl ready but mother refusing.
3.Medical evidence suggestive of sexual intercourse but
mother refuses examination and report to police.
4.Girl allowed external examination but resisting genital
examination.
5. Girl stating sexual assualt but mother denying.
6.Samples collected but no police wants to collect report.
 CONSENT:
written informed consent be taken before any physical
examination. “Presumption of implied consent that girl
has attended the hospital for some complaint or request
the treatment or she has been brought by her mother or
any legal guardian can be denied latter therefore it is
prudent to have informed written consent from the girl or
guardian after explaining that in the event of a charge
being brought the finding may well become public”{2].
When consent is not available but the matter is of public
interest, the examination should proceed .Under such
circumstances no authority will hold the examiner guilty
of assault.{1].
 Female attendant:
One uninterested adult female attendant must be present
during examination even when done by a female doctor.
(should not be a police)

POCSO Act 2012 Medical examination (Section 27):

As per section 164A of CrPC
• In case of girl child, medical examination by lady doctor
• Medical examination in the presence of parents
• In case parent of the child cannot be present, medical
examination to be conducted in the presence of a woman
nominated by the head of the medical institution.
 Medical Examination:
Physical Examination
EXTRAGENITAL BODY PARTS:

Development of breast, growth of pubic, axillary hairs.

Injury:-
all types of mechanical injury specially nail scratch [ crecentric
abrasion,] bruises, tooth bite,
kiss bruise [intradermal petechial hemorrhages in an elliptical area
enclosed sometimes by lip impression develops due to suction
pressure by mouth.]

Face ,lips anterior neck ,breasts, lower abdomen arms,

wrists, inner thigh are important where injury develops
due to erotic expression, attempt of silencing the victim,
forcing the victim to submission, threaten by attempted
throttling,
 Medical examination:
Physical Examination. Contd..

Examination of Female private parts :

Vulva-
At puberty labia majora- full,fleshy completely
covering the thin cutanious pinkish minora and
vaginal introitus.
vaginal introiturs not visible even on full abduction
of thighs.
In Deflorate woman- majora gaps. Introitus could
be seen on abduction of thighs, fossa navicularis
obliterates, fourchette may rupture.
 Medical examination: Physical Examination

Examination of Female private parts : Contd..

Hymen:
This otherwise insignificant fibrous tissue with the mucous
covering as partition at vaginal introitus is given lot of
importance in case of rape charges.

Hymen may be thin, thick and fleshy and elastic, may be

loose folded ,may have a small central opening anular
shape, semi lunar shape (commonest type),Fimbriated,
septate,even be imperforated.
 Medical examination: Physical Examination

Examination of Female private parts :

Contd..
Hymen:
ln virgo intacta girl some form of hymen is almost always
found, very rarely it may be absent congenitally.
** Hymen ordinarily ruptures in first sexual
intercourse.
**once ruptured it never unites.
on repeated sexual intercourse and after child birth only
thin and small tag of tissue remains [caruncle
multiformes].
 Medical examination: Physical Examination
Examination of Female private parts : Contd.

Hymen: Hymen tear

On sexual penetration hymen generally ruptures
posteriorly at or near 5 o’clock 7 o’clock position, at
post midline, semi lunar type hymen ruptures more
often at 3 o’clock and 9 o’clock position.

Fresh ruptures bleeds or blood clot attaches at

margins .Inflamed swollen till 4-6 days. Generally
heals by 7-10 days.
 Medical examination: Physical Examination
Examination of Female private parts : Contd..

Hymen: Hymen tear

Rarely hymen ruptures without sexual act;
by some accident
by masturbation with instruments ,
medical examination.
In rare cases sexual intercourse is possible
without rupturing the hymen;
in fleshy elastic type hymen.
Loose, folded fimbriated type hymen
(False Virgin)
Medical examination: Physical Examination
Examination of Female private parts : Contd..

Most of the cases Hymen tear is the only

evidence of sexual Intercourse/Penile
penetration ; Recent or Past.

As ordinarily rupture of hymen occurs by

penetration of erected male organ.
 Medical examination: Physical Examination
Examination of Female private parts : Contd…

Vaginal canal:
normally a transverse slit anteroposterior wall apposing and
with coarse rugosity in the mucous covering in virgins -
not much changes occur in 1-2 intercourse but become loose
capacious on repeated sexual act with flattening of rugosity
which occurs also after child birth.
In sexual act friction abrasion ,bruise ,Laceration could be
detected not scratches which indicates digital or instrument
penetration.
Per vaginal digital Examination..Laymen’s term
“Two Finger Test”

Fingers are the most sensitive clinical instrument of a

Doctor for Clinical examination .
Any instrument like Metal rod ,Glass knob ,
Speculum can not be sensitive and neither be less
painful or convenient for the purpose of examination.
If done by the female doctor on a female patient there
should not be any controversy about the usefulness
of pervaginal digital examination.
 Medical Examination

Examination of personal effects and clothing:

Examination of all personal effects worn during

the incident is of tantamount importance for
blood ,seminal stain, tear ,dirt, grass etc.

[cell can be recovered from stains for DNA.

Foreign body to link to the circumstance of crime]
 Medical examination:
Collection of samples:

A)Two Swabs B) Two Smears

A) Two Swabs:
Vulvovaginal swab in sterile cotton swab reaching
posterior fornix & external os. —
i) One- in nomal saline in sterile test tube to see
motility of spermatozoa
[helps to determine TIME ELASPED SINCE SEXUAL ASSUALT]
ii) One- air dried; for semen enzyme and serological
exam,. DNA profiling .
[HELPS IN IDENTIFICATION OF ASSAILANT]
 Medical examination:
Collection of samples: Contd…

B) Two smears.
Smear on slides from vulvo- vaginal swab for
microscopical Examination:
i) one to see spermatozoa
ii) To see gonococcus and bacteriological examination.
[Initial negative test for V.D is important,
from particular strain assailant can be identified.]
 Medical examination:
Samples preserved
C) OTHER ARTICLES AND MATERIALS:
 CLOTH (IF NOT CHANGED)- AIR DRIED.,
 pubic hair- combings and cut
 swab from bite mark,
 blood seminal stain
 scrappings of seminal stain,
 blood stain from the body
 NaiI cutting& scrappings,scalp hair.
In cases of H/O intoxication:
 URINE AND BLOOD SAMLES TO BE COLLECTED.
Dry material packed in envelope, properly sealed and
labeled
 Maintain chain of custody

All the samples, materials collected must be

properly sealed ,labeled and handed over to the
authorized police person with receipt bearing his
signature, designation ,constable no. Date and
time.
Rape is not a medical diagnosis, it is only a legal definition

Evidence of sexual intercourse is not evidence of rape

Absence of sexual intercourse does not rule out rape
Absence of semen or spermatozoa does not exclude
sexual intercourse.
Rape can be committed in absence of any injury
genital or extra genital.ex. Unconscious/Intoxicated.
Injuries are not uncommon on both partner in
consensual vigorous sex act, even found in young
newly married couple.
Interpretation of forensic science laboratory report:

FSL report on collected samples helps the doctor to

give opinion on sexual intercourse, time of sexual
intercourse, identification of assailant/perpetrator
Sexual intercourse-Only confirmatory evidence of
semen is visualization of at least one complete
spermatozoa .detection in the vaginal fluid /swab
/smear confirmes the sexual intercourse under
ordinary circumstances.
Complete sperms have been found on clean cotton
material after five years.[3]
 Sperm Motility
Sperms remain motile for short time after ejaculation.
Motile forms are found in the vagina for one half to six hours after coitus
average time being three hours.[7]
Period of Motility of sperms is variables, it varies in the different parts of genital
tract, different phases of a menstrual cycle, infection in the genital tract,
sexual habit of a woman .
Between the fourteenth and eighteenth day of menstrual cycle sperm motility
lasts the longest in the female genital tract.
Spermatozoa retain their motility much longer in the cervix than in the vagina[9]
Pollock reported motility of sperm in the cervix 48 hrs to seven and half days[8].
Vaginitis and leucoria due to some infection like trichomonas, candida, E.coli
reduces the sperm motility.
Women, especially prostitutes who have engaged in frequent coitus with
different men have produced antibodies that interfere with sperm motility[9 ]
 Identification of perpetrator:
Until recently tool for identification of the perpetrator:
hair matching, ABO antigen grouping of blood,
semen ,saliva stain and diagnosis of S.T.D with
identification of strain of that bacteria.
**Though exclusion is possible in 100% of cases
with those results but positive identification was
only a probability.
there is no completely reliable hair identification
technique available till date[6]
 Identification of perpetrator:

DNA fingerprint
With the advent of DNA FINGER PRINTING almost
accurate positive identification is possible if done on
properly purified sample with correct technique by a skilled
person.
it is possible to determine DNA type extracted not only from
vaginal swabs containing semen but also from vaginal
smears containing spermatozoa.[10]
DNA is stable and remain intact when stored in a dry or
frozen state[10]
FAQ
 Frequently asked questions
Is there any evidence of recent sexual intercourse?
fresh or recent rupture of hymen can easily be known by the
bleeding or stages of healing so also the other injuries in
the genitals present..
FSL report if available motility of spermatozoa or detection
of spermatozoa in the swab or smear gives fairly a good
idea about time of intercourse.
Therefore in absence of any injury - opinion should be
pending reserved till receipt of FSL report.
 Frequently asked questions

Is there any evidence of sexual intercourse at

any time in recent past?-
By the aging of injuries eg.old hymen tear, scar
formation of healed tear or laceration of vulva or vaginal
wall.
Surest evidence of sexual intercourse is conception.
By dating of pregnancy with sonography time of coitus
can roughly be calculated. Evidence of past pregnancy
or abortion indicates coitus sometime in the past.
 Frequently asked questions

Is the woman habituated to sexual

intercourse?-

Old multiple tear or caruncle multifomis, capacious

vagina ,loss of rugosity of vaginal wall. After child
birth almost same findings in the vagina and hymen
could be found but there are evidences of past
pregnancy.
 Frequently asked questions
Was there use of force ?
Extra genital injury; is more common in cases of
deflorate /married woman than genital injury.
Genital Injury; In young child or virgins genital
injuries are more severe than extragenital
injuries.
(In cases of relatively slight or less injuries even including
bruise ,abrasion,nail scratches ,bite abrasions, although the
presumption is that intercourse was by force, the possibility still exists
that it was voluntary though overenthusiastic,unless of course the
victim was a small child[11])
 Frequently asked questions
whether there is existence of any S.T.D ?

-if clinically no diagnosis can be made,

opinion will be given after receipt of FSL
report.
 Frequently asked questions
whether any foreign body is available from
the private parts?

whether relevant medicolegal samples or

articles collected and preserved?
 Frequently asked questions

whether identity of assailant could be established?-

 Exclusion can be made with certainty from the

collected articles.
 But positive identification of the suspect can be
made almost with certainty by the DNA profiling
from the spermatozoa, blood, salivary stain root
of hair follicle etc.
 Opinion: Points to remember
REPORT should contain negative as well as positive
findings.
The doctor should never make a diagnosis of rape.
Medical proof of intercourse is not legal proof of rape.
Rape is not a medical diagnosis, it is only a legal definition
Rape is an accusation easily to be made, hard to be
proved even harder to be defended by the party accused.
[3]
 Duty of a gynecologist/Doctor.

 Doctor’s priority is to save the life of patient with

measures for urgent resuscitation.
 After resuscitation gynecologist will proceed for
collection of samples before any genealogical
examination. Then as usual detail note of the
injury is to be taken. surgical operation if
required detail operative note to be recorded.
 Never neglect to take a second opinion.
 Duty of a gynecologist/Doctor

In case of dying patient;

arrange for dying declaration or take down the statement
yourself in presence of two witness who will sign over the
paper along with you.

no need of detail recording of injuries, advice post mortem

examination.

Unless life saving and absolutely necessary do not

undertake operation hurriedly.

 N.B: Consent from parent or legal guardian is not

essential in emergency
References
Tackling a case of Rape-In Gynaecologist’s
perspective.
Dr.Sobhan K. Das, M.D(cal)
Associate Professor & Head
Dept. of F.S.M,
Email:dasdrsobhank@gmail.com
Dr.Arup K. Majhi, M.D(cal)
Professor & Head
Dept. of Gynae & Obstetrics
B.S .Medical College, Bankura, West Bengal
Published in:
1.Indian Journal of Perinatology and reproductive biology.
Vol-01.No.01. December2010.D.L No.-191 dt.23.11.2010.
Title;Tackling a case of Rape-In Gynaecologist’s perspective.
2. Journal of pediatrics, Obstetrics & Gynaecology.
December 2011. Vol.2 No.-12 page 431-439.
Title:Tackling Rape case:A Gynaecolgists perspective.
 REFERENCES:
1.Gradwhol’s legal Medicine, Edd:.Francis e.camps. Third ed.,1976 Bristol:John Wright
sons ltd. Page 397-400.
2.Taylor’s principles and practice of medical jurisprudence edited-.keith Simpson 12 th
ed .J&A Churchill ltd. vol -2., page 53 -66.
3.Reddy K S. Narayan., The essentials of Forensic medicine & Toxicology, fifteen edition.
1998.
4.Babu S patel et.all.,Rape and Medical examination: A study of 114 cases, Asian journal
of obs &gynae practice,vol.4.no.4
5.All India Major criminal Acts, Central law agency,Allahabad-2,1980
6.Rosen .S.l.:Identification of primate hair.J.Forensic sci.,19:109,1974.
7.Sharpe.N.The significance of spermatozoa in victims of sexual offences,
Can.Med.Assoc. J.,89: 513,1963.
8.Pollock O.J.,Semen and seminal stain., Arch. Pathol.35.:140.1943.
9. Tedeschi., Eckert.,Tedechi,Forensic Medicine,vol-11,W.B.Saunders company,1977.
10.Jason Payne-james., Anthony Basuttil, Williium Smock ,Forensic Medicine:clinical and
pathological aspects ,GMM,san fransicco.london.
11.Pekka sauko, Knight.b.,: Knight’s forensic pathology,3 nd.ed.:Arnold,:2004.
 Actual Scenario at R.G.Kar Medical College
Forensic Medicine Department. In 2015 till
November
•Total No of cases: 48. Minors-34, Adults.-14.
•Consent Not Given for Examination: Minor-22. And Major.-1.
•Consent given: Minor-12.
•No recent injury: (genital or extragenital)- 12 cases.
•Old healed Hymen tears only:9 cases –all in age group: 14-16 years.
•Consent given: Adult-11 cases.
•Consent not given for exam.-1 case
•Do.-Examination done earlier on G&O dept.
•No Injury (genital or Extra genital) in all examined cases but only old healed
hymen tears in all case.
•One girl aged 15 (pregnancy test positive)-consent not given for genital
examination.
•Aged women 25-35yrs brought 7-30 days latter for examination after
complaint.
•No Injury could be detected in a 5 ½ Yrs girl.
THANK YOU.