Pink notes in Legal Medicine (Finals)

Medico Legal Aspects of Sexual Crimes

Virginity a condition of a female who has not experienced sexual intercourse and whose genital
organs have not been altered by carnal knowledge.
Kinds of Virginity
1. Moral Virginity state of not knowing the nature of sexual life and not having experienced
sexual relation. Refers to children whose sex organs and secondary sexual characteristics
are not yet developed.
2. Physical Virginity a woman conscious of the nature of sexual life but has not yet
experienced sexual intercourse. Refers to women who have reached sexual maturity.
a. True Physical Virginity hymen intact with the edges distinct and regular and the
opening are small to admit the tip of the smallest finger;
b. False Physical Virginity condition wherein the hymen is intact but the orifice is wide
and elastic to admit two or more fingers of the examiner with lesser degree of
resistance. Lax hymen.
3. Demi-Virginity a condition of a woman who permits all forms of sexual liberties as long as
they abstain from rupturing the hymen by sexual act. Inter-femora or inter-labia only.
4. Virgo-intacta literally the term refers to a truly virgin woman with no structural changes in
her organ and she is a virtuous woman; include women who had previous sexual act or
even habitually but not given birth.
Anatomy of a female organ
Classification of hymen
a. As to shape and size of opening
1. Annular or circular opening is oval or circular located at the center of hymen.
2. Infantile opening is small, usually linear, fleshy and resistant.
3. Semi lunar or crescentric concavity maybe facing either side or upwards or
downwards.
4. Linear
5. Cribriform
6. Stellate
7. Septate
8. Fimbriated
9. Imperforeate
b. As to number of opening
1. Single
2. Septate
3. Multiple
4. Imperforate
c. As to structure and consistency
1. Firm and with strong connective tissue and plenty of blood vessels
2. Thick yielding hymen with scarce blood vessels
3. Membrane hymen hymen is parchment, like, maybe transparent
Septate 2 openings
Crescentric crescent shaped
Anular circular hymen
Imperforate hymen closed, no opening
Defloration it is the laceration or rupture of hymen as a result of sexual intercourse.

Parts of female genital to be examined:

1. Condition of the vulva craptated or gaping labia majora or minora.
2. Fourchete V sgape or rounding of the base or blunted.
3. Vafinal anal sharpness or obliteration of the rugosities laxity of the walls.
4. Hymen intact or lacerated.
Other causes of hymenal laceration
1. Passage of clotted blood during menstruation
2. Ulceration due to disease
3. Jumping or running
4. Falling on hard or sharp object
5. Local medication
6. Self-scratching due to irritation
7. Masturbation
8. Insertion of foreign bodies
9. Previous operation
Myths
1. Sexually transmitted infections through sharing of same bed, toilet seat or towel;
2. Biking, horseback riding, dancing (split) can cause hymenal laceration
3. Masturbation can cause hymenal laceration.
- Normal masturbation in girls involves clitoral or labial stimulation
- Self injurious behavior
Degree of laceration; extent of damage
1. Incomplete laceration when it does not involved whole width of the hymen, it maybe:
a. Superficial laceration does not go beyond of the whole width of the hymen.
b. Deep involves more than of the width of the hymen but not reaching the base.
2. Complete involves the whole width, but not beyond the base.
3. Compound or complicated laceration involves the hymen and also the surrounding
tissues; it may involve the perineum, vaginal canal, urethra and rectum.
Notches indentation of the hymen simulating laceration; maybe mistaken for laceration.
Duration of laceration
1. Fresh laceration recent origin within 24 hrs
2. Fresh healing with fibrin formulation of edema of the surrounding tissues after 24 hrs to 3-4
days or 5 days
3. Healed laceration or completed edges and with sharp coaptible borders recently healed;
4-10 days
4. Healed laceration with sharp coaptible borders without congestion: 10 days or 2-3 weeks
5. Healed
Complications of laceration
1. Secondary infection gonorrheal infections
2. Hemorrhage severe compound laceration
3. Fistulae formation recto-vaginal or verico-vaginal fistulae may develop in case of
compound laceration
4. Structure scar formation (burns)
5. Sterility prolonged infection will result to sterility
Sexual crimes
1. Rape
2. Seduction
a. Qualified seduction

3.
4.
5.
6.
7.
8.
9.

b. Incestuous qualified seduction

c. Simple seduction
Acts of lasciviousness
Abduction
a. Forcible abduction
Adultery
Concubinage
Prostitution
Corruption of minors
White slave trade

Sexual abnormalities
1. Heterosexual
2. Homosexual
a. Over
b. Latent
3. Tribalism
4. Infanto sexual
5. Phidophile
6. Besto sexual desire for animals; bestiality (zoophilia)
7. Cluto sexual
8. Gerentophilia sexual desire with elder person
9. Necrophilia sexual desire with corpse
10. Incest blood relation
11. Satyriasists
12. Nymphomaniac
13. Sexual anexthesia
14. Dyspareunia
15. Vaginismus
16. Old age
17. Oralism
18. Fellatio (irrumation)
19. Cunnilingus
20. Anilism (anillingus)
21. Sado-masochism
22. Flagellation
23. Sadism (active algo lagnia)
24. Cannibalism
25. Love bites
26. Necro sadism or lust murder
27. Masochism (passive algo lagnia)
Fetishism the real or fantasized presence of an object or bodily parts is necessary for sexual
gratification
Kinds of fetishes
1. Anatomic
2. Clothing
3. Necrophilic
4. Osphesiophilia
a. Urolagnia
b. Coprolagnia
c. Mysophilia
5. Pygnealionism
6. Manikinism

7. Narcism
8. Negative fetish
9. Saboteur fetish
10. Incendiarism
11. Vampirism
12. Sodomy
13. Uranism
14. Frottage
15. Partialism
16. Voyeurism
17. Mixoscopia (scotophilia)
18. Troilism (mnage a tois)
19. Pluralism
20. Coprolalia
21. Indecent exposure
22. Transvestism
23. Transexualism
24. Intersesuality
Medico-legal aspects of injuries:
Due to heat, cold, and electricity
Injury due to heat
- Any excess of temperature over 50 degrees centigrade can cause damage to living
tissue.
1. Dry heat burn
2. Moist heat scalding
3. Erythema and blistering is caused and there is fluid
Burns
1. Dry burns are classified by severity and extent:
a. First degree erythema and blistering (vesiculation)
b. Second degree burning of the whole thickness of the epidermis and exposure of the
dermis.
c. Third degree destruction down to the dermal tissues, sometimes with carbonization
and exposure of muscles and bones.
Estimating the extent of injury
- Rule of nine is used to calculate the approximate extent on the body surface.
- The area of burning may be more dangerous to life than depth.
- If the area exceeds 50% the prognosis is very poor.
- Old people may die only with 20% burns.
Causes of death in burns
1. Rapid death
- Actual destructive effects of heat
Asphyxia
Shock due to pain
Inhalation of hot gas burning the interior of air passage
Carbon monoxide toxicity and other noxious gas
2. Delayed death
- Dehydration
- Electrolyte imbalance
- Renal failure
- Toxemia from substances absorbed from the burned area

Infection

Injury due to cold

1. Hypothermia exposure to low temperature
Signs:
28 degrees Celsius or less almost certain to die even with treatment
Below 32 degrees celcius shivering ceases
35 degrees shivering is constant
Body shows pink areas, sometimes slightly brown or pink with distinct
Frost bite
Hypothermia of the extremities frostbite, it is really the infraction of the peripheral digits with
edema redness and later necrosis of the tissue.
Electrical injury
- Current
- All electrocution, fatal or otherwise originates from the public power supply which is
delivered at either 110 or 240 volts; it is rare for death to occur at less than 100 volts.
- Usually the entry point is the hand and exit is to earth (or ground) it will cross the thorax
unexpected and sudden death from natural cause.
- Where natural death is very rapid, virtually instantaneous cause is cardio vascular;
- If a person collapses and is clinically dead when someone nearby runs to assist him,
cause is cardiac arrest.
Causes of sudden and unexpected death
a. Cardio vascular system
- Coronary artery disease
- Coronary insufficiency
- Complications of atheroma
- Coronary thrombos
- Myocardial infraction heart attack
- Lesions in the cardiac conducting system
- Ruptured myocardial infract
- Myocardial fibrosis
b. Hypertensive heart disease
- Aortic stenosis
- Senile myocardial
- Primary myocardial
- Diseases of the arteries
Atheromatous aneurysm
Dissecting aneurysm of the aorta
Syphilitic aneurysm
Intracranial vascular lesion
c. Respiratory system
- Pulmonary embolism
- Massive hemoptysis from cavitating pulmonary tuberculosis or from malignant tumor
- Chest infection
d. Gastro intestinal system
e. Gynecological conditions
- Abortion vagina shock
- Ruptures ectopic gestation
f. Asthma
-over use of adrenergic drugs

g. Epilepsy - Status epilepticus - a dangerous condition in which epileptic seizures follow one
another without recovery of consciousness between them.
Medico legal aspects of pregnancy and abortion
Pregnancy 270-280 days
- Product of conception
1.
2.
3.
4.
5.

Legal importance
Claim for breach of promise or charge of seduction
Alleged criminal abortion
Civil disputes
Excused attendance in court
Charges of infanticide
Legal termination of pregnancy
1. Performed by medical practitioner
2. Carried out in health service hospital
3. Two doctors must examine the woman
4. Termination must be notified to medical officers of the appropriate government department
5. Circumstances/reason for termination of pregnancy
a. Endanger life of a woman
b. Endanger physical health
Abortion willful killing of the fetus or violent expulsion of the fetus from the natural womb and
which results to the death of the fetus. Maybe natural, therapeutic or clinical.
Methods:
-drugs and toxins
-instrumentation cauterization
-general violence
-local interference
-syringe aspiration
Causes of abortion
-death of fetus congenital abnormality, poisoning, diseases
-abnormality of the uterus
-emotional condition
-abortificient drugs
-trauma direct or indirect
-hormonal deficiency
-acute specific fever and high temperature
Fatal effects of illegal abortion
1. Hemorrhage from local genital trauma
2. Sepsis
3. Shock
4. Air embolism
5. Complications such as leg vein or pelvic vein thrombosis, pulmonary embolism,
disseminated intravascular coagulopathy, renal failure.
Death and injury in infants
Still births child is more than 28 weeks, gestational age, which after being completely expelled
from the mother did not breathe or show any signs of life.
Causes

1.
2.
3.
4.
5.

Prematurity
Fetal hypoxia
Placental insufficiency
Intra urine infection
Congenital defects

Infanticide killing of a child less than 3 days old

Child abuse syndrome physical, mental, and sexual abuse of children by parents or guardian.
Child abuse is also called child or baby battering or non-accidental injury
Features:
- Infants can be of any age
- Most fatalities under 2 years
- Any social class
- Lower middle class most at risk
- Lesions are in the skin and skeleton
Child sexual abuse involvement of dependent develop mentally immature children and
adolescents in sexual activities they do not truly comprehend, to which they are unable to give
informed consent.
Sudden death of infant syndrome (SIDS) crib death or cot death
Features:
1. Takes place between 1-7 month with a peak at 2-3 months
2. Slight predominance in male
3. Incidence is markedly greater in one of a twin pair whether identical or not
4. Seasonal variation in zone, more on colder
5. Higher risk in disadvantageous families.
Physical abuse or human rights torture
1. Skin with redness, swelling, intradermal bruising, subcutaneous bruising
2. Double slavery line
3. Where skin is lacerated
4. Falanga (feet are beaten by a thin rod)
5. Burns from hot irons
6. Cutting and piercing
7. Electric torture
8. Damage to ears
9. Suffocation
Alcohol abuse
Effects:
30-50 % - impairment of driving and similar skills
50-100% - reduced inhibitions, talkativeness, laughter, slight sensory disturbance
100-150% - in coordination, unsteadiness, slurred speech
150-200% - obvious drunkenness, nausea and ataxia
200-300% - vomiting, stupor, possibly coma
300-350% - danger of apirating vomit, stupor or coma
Over 350% - progressive danger of death from respiratory paralysis
Symptomatic changes after ingestion of alcohol
-stage of excitement
-stage of confusion or in coordination
-stage of narcosis or coma