Forensic Medicine: Rape - Physical Examination (1)

Physical Examination of Victim of Rape

After taking the informed written consent from the victim or from one of the the parents/guardians, a
complete and thorough physical examination should be done by the doctor. It should be done in one time
examination with no amount of modesty, to avoid the psychological trauma to the victim.

A. Clothing
To be stripped by herself or with the help of the female hospital attendant.
Each item of clothing worn at the time of offence should be inspected by the examining doctor for any
areas of soiling or damage especially in the crutch area of panties for blood and seminal soiling.
(UV lamp will be helpful)

B. General Clinical Examination

The victim’s height, build & weight
Routine examination of all bodily systems
Recording of all clinical findings, both normal & abnormal
Signs of pre-existing diseases, injury or intoxication by alcohol and other drugs

C. Signs of Struggle
If the woman had struggled to the utter most, the following injuries may be found:
(1) Grasping injury - on the neck – small, circular finger tip bruises
(2) Restraining injury - similar bruises on hands, wrists, arms, inner surface of thighs, knees and
ankles
(3) Larger bruises - on inner surface of thighs – in separating the legs
(4) Abrasions - finger nail scratches – over face and back
(5) Lip injuries - due to blows on face, by kissing, in preventing screaming and teeth injuries
such as looseness and chipping
(6) Finger nails - may be ragged and broken
(7) Love bites - on the neck, breasts, chest wall, lower abdomen and upper thighs, but they
are not indicative of lack of consent
Physical findings should correspond to the history obtained if the woman is telling the truth.

D. Examination of the Genital Area - in lithotomy position with good light

(1) Pubic hair - any matting by dry casts of seminal deposits, if present, the matted area is to
be cut away for lab: exam:
- any loose hair ( by combing )
- taking control samples – one or two small bunches for root characteristics
(2) Injury to Labia - not a common finding, mere redness of the labia minor is not indicative of
recent sexual activity, may be due to lack of personal hygiene in young girls
- swab taking - from introitus, perineum and anal margin before any digital
contact by the doctor
(3) Hymen - any fresh hymenal injury, any bleeding from genitals -may be due to
recent Vg injury or due to menstruation – which can be differentiated by -
(a) microscopic exam: - menstrual blood dose not clot, with a large no.
of bacteria, exfoliated Vg epithelium & endometrial cells
(b) electrophoresis - menstrual blood - with extraband due to menstrual
antigens

Signs of physical penetration :

Recent hymen tear
Circumferential bruising & abrasion around the orifice at the root of hymen
Bruising of the Vg
Abrasion of the Vg mucosa
Frank laceration of the Vg
Detection of the foreign bodies e.g. pubic hair of the accused, condom
GC vulvo-vaginitis
Forensic Medicine: Rape - Physical Examination (2)

Once a hymen has been torn, it is rather unusual to find a second recent tear by subsequent
intercourse. Hymen is beautifully examined by grasping, pulling and keeping the doctor's hands in
parallel with the fingers instead of separating the labia apart.

(4) Vg Swabs - After the hymen has been carefully examined, before any digital examination
of the Vg, two further swabs must be taken to detect the seminal traces and
spermatozoa
Low Vg Swab - After separating the inner labia, by passing a swab into Vg canal without
touching the labia or perineum, to avoid contamination
High Vg Swab - After gently introducing the small Vg speculum, by passing a swab into
Vg canal to a point well above the beak of speculum, under direct vision,
to avoid contamination

At least 6-8 slides should be prepared from each swab in the form of a thin film & fixed for
microscopic examination such as :

(a) Detection of semen - Florence Test - to detect choline in semen

- Acid Phosphatase Test

(b) Detection of spermatozoa - by H & E stains - at least one complete speratozoan is

needed for the diagnosis
- motile - within 6 hrs after ejaculation
- intact - within 48 hrs
- identifiable - within 4 days

(c) Detection of gonorrhoea - by Gram's stain.

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