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India's two finger test after rape violates women and should be eliminated
from medical practice

Article  in  BMJ Clinical Research · May 2014

DOI: 10.1136/bmj.g3336 · Source: PubMed

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BMJ 2014;348:g3336 doi: 10.1136/bmj.g3336 (Published 16 May 2014)
Views & Reviews
PERSONAL VIEW
India’s two finger test after rape violates women and
should be eliminated from medical practice
A doctor inserting two fingers into the vagina to assess a woman’s sexual behaviour—and therefore
whether she invited assault—is unscientific, unethical, and unhelpful, writes Nisreen Khambati.
New national guidelines outlawing the test should be implemented quickly throughout India’s health
facilities
Nisreen Khambati medical student, Faculty of Medicine, University of Southampton, Building 85,
Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, England
The brutal gang rape of a student in Delhi in December 2012
triggered international outrage and catalysed progressive legal
amendments in India, including harsher punishments for
perpetrators and a wider definition of sexual assault.1 However,
necessary changes to the health system have been slower.2
Despite doctors’ responsibility to provide medical and
psychological help, some in India have been criticised for
providing insensitive care to victims of rape.3 In particular,
attention has focused on the “two finger test,” a disturbing
practice conducted by some doctors during medical
examinations.
This test, which originated in the 18th century, involves
examining the hymen and the laxity of the vagina to ascertain
information about the victim’s sexual history.4 Insertion of one
finger into the vagina with difficulty is interpreted as meaning
that the victim was a virgin, whereas easy insertion of two
fingers suggests that she is “habituated to sexual intercourse.”5
Clearly, this test has no scientific value; the absence of the
hymen and laxity of the vaginal orifice may occur for reasons
unrelated to sex.6 And even if the woman has had previous
sexual experience, this is irrelevant to whether she consented
to an assault.
The two finger test violates a rape victim’s physical and mental
health: it is painful and mimics the original penetrative assault,
causing trauma through “re-rape.”4 7 Moreover, doctors’
interpretations of the test can frame whether the woman’s
complaint is considered true or false in court.4 Biases in the
judicial system can portray a “habituated” woman as one who
would not refuse sex, or who could falsely accuse a man of
rape.7 Consequently, defence lawyers use an “affirmative” two
finger test to question a woman’s character and to refute
allegations that sex was non-consensual.4 Such patriarchal
assumptions have contributed to victims losing cases.4-7
nk13g09@southampton.ac.uk
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Page 1 of 2
VIEWS & REVIEWS
Many doctors in India have openly denounced the two finger
test, but others continue to perform it on women and children.1-8
A 2010 report by the international non-governmental
organisation Human Rights Watch analysed 153 court cases
and collated interviews from doctors, lawyers, and victims of
rape. It concluded that the test remained a component of doctors’
examinations in several Indian states, in rural and urban
hospitals.4
Discriminatory beliefs about gender within the Indian medical
profession may contribute to the continued practice of this test.
Some doctors hold stereotypical views that attach blame to
victims and undermine the neutrality of the examination—such
as beliefs that women lie about rape, which can translate into a
need to verify rape through vaginal examination.9
These biases can be reinforced by medical education: the two
finger test appears in many medical textbooks, encouraging
doctors to treat rape cases with suspicion.5 7 And a recent article
in a respected Indian medical journal wrongly claimed that the
test helped to prove or disprove rape and could protect wrongly
accused men against false charges.10
Such gender bias, disguised as caution, shifts the focus of the
examination from giving medical assistance to assessing the
truth of a woman’s allegation. Exacerbating this problem is the
lack of specific training that medical students receive about
examining victims of sexual violence.4 6 And poor training may
further allow doctors’ personal gender prejudices to interfere
with good medical practice.9
The two finger test is devastating for victims’ health and for
prosecution outcomes; however, recent legal developments may
bring about some change. In March the union health ministry
formally introduced a set of guidelines and protocols for the
medical examination and for care of victims of sexual violence.11
These were aligned with World Health Organization guidelines12
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 BMJ 2014;348:g3336 doi: 10.1136/bmj.g3336 (Published 16 May 2014)
and, crucially, abolished the use of the two finger test in all
health facilities.
These new guidelines are promising, but replacing the existing
procedures in all hospitals will take time. Given that health is
the responsibility of state governments,13 it is important that all
new state guidelines match the standards set by the central
government. Implementing the guidelines in health facilities is
the next challenge: this will require increased practical training
on rape examinations as a part of the medical curriculum, as
well as the revision of textbooks in accordance with the new
government protocols. Arguably the most important challenge,
yet perhaps the most difficult, will be to eliminate gender
prejudices in the medical profession and remind doctors that
their over-riding priority lies in providing healthcare, rather than
in looking for evidence that rape occurred.
The two finger test is just one of the problems that afflict
services for women who have been raped,3 6 and change must
be accompanied by systemic reforms throughout the health
system in policy and practice.3 The Mumbai based,
non-governmental Centre for Enquiry into Health and Allied
Themes has implemented a comprehensive health system model
of sexual assault for use at three public hospitals in Mumbai,
employing guidelines that omit the two finger test, encourage
prompt medical treatment, and focus on rape victims’
psychosocial needs.14 This model is encouraging and could be
replicated more widely.
The number of highly publicised rapes in India since the Delhi
gang rape of December 2012 shows that discussions must shift
from simply increasing prison sentences for perpetrators to
ensuring that systems are available to support the victims. The
current focus on sexual violence in India provides a unique
opportunity to improve services for women who have been
raped; we must not let this opportunity go to waste.
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Page 2 of 2
VIEWS & REVIEWS
Competing interests: I have read and understood the BMJ Group policy
on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Not commissioned; not externally peer
reviewed.
See Anita Jain’s blog at http://blogs.bmj.com/bmj/2014/03/10/anita-jain-
on-the-paradox-of-rape-in-india/.
1 Gill AK, Harrison K. Sentencing sex offenders in India: retributive justice versus sex
offender treatment programmes and restorative justice approaches. Int J Criminal Justice
Sci 2013;8:166-81.
2 Yee A. Reforms urged to tackle violence against women in India. Lancet 2013;381:1445-6.
3
www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60912-5/fulltext.
Jain A. Preventing and managing violence against women in India. BMJ 2013;346:f229.
4 Human Rights Watch. Dignity on trial. 2010. www.hrw.org/reports/2010/09/06/dignity-trial-
0.
5 Agnes F. To whom do experts testify? Ideological challenges of feminist jurisprudence.
Econ Polit Wkly 2005;40:1859-66. www.jstor.org/stable/4416570.
6 Contractor S, Venkatachalam D, Keni Y, Mukadam R. Responding to sexual assault: a
study of practices of health professionals in a public hospital. 2011. www.cehat.org/go/
Publications/Home.
7 Baxi P. The medicalisation of consent and falsity: the figure of the habitué in Indian rape
law. In: Kannabiran K, ed. The violence of normal times. Women Unlimited, 2005: 266-311.
8 Human Rights Watch. Breaking the silence. 2013. www.hrw.org/reports/2013/02/07/
breaking-silence.
9 Prasad S. Medicolegal response to violence against women in India. Violence Against
Women 1999;5:478-506.
10 Jha M, Majumder B, Bose T, Bhullar DS, Oberoi SS, Sandhu SS, et al. Rape law latest
trends: Criminal Law (Amendment) Act 2013 and Supreme Court on right to privacy. J
Punjab Acad Forensic Med Toxicol 2013;13:45-8.
11 Mascarenhas A. New guidelines for sensitive handling of rape victims. Indian Express 17
March 2014. http://indianexpress.com/article/india/regional-india/new-guidelines-for-
sensitive-handling-of-rape-victims/.
12 World Health Organization. Guidelines for medico-legal care for victims of sexual violence.
2003. www.who.int/violence_injury_prevention/publications/violence/med_leg_guidelines/
en/.
13 Bhat R, Jain N. Analysis of public expenditure on health using state level data. 2004. http:
//econpapers.repec.org/paper/iimiimawp/wp01831.htm.
14 Centre for Enquiry Into Health and Allied Themes. Establishing a comprehensive health
sector response to sexual assault. 2012. www.cehat.org/go/Publications/Home.
Cite this as: BMJ 2014;348:g3336
© BMJ Publishing Group Ltd 2014
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