Updated Rape Victim Examination PPT of Dr. Sharda Jain

1. An Update on Medico
Legal aspect
Examination of Rape
Victim:
What a Lady Doctor
Should Know in Delhi / NCR
Dr. Sharda Jain
Director :-
Sec General : Delhi Gynae Forum
Founder chairman : Gynae pushpanjali

2. DEDICATED
to
NIRBHAYA
16/12/12
&
Women of India

3. Sexual assault and rape cases are increasing at an
alarming rate in India
h
6t
& can Happen
c1
e
D
to anyone shattering her life completely
(She can be your Daughter, Sister, Friend & Even Mother !!)

4. SAFDARJUNG HOSPITAL
Dec. 2011- Dec. 2013
N – 310
• Less then 10 years – 24
11-20 years – 169
Over 20 years -117

5. SAFDARJUNG HOSPITAL
Dec. 2011- Dec. 2013
N – 310
3 like Nirbhaya
Calling them rape victim is an over simplifications
of their suffering –
Required referral to team of specialists

6. Rape Needs to
STOP

7. Victims Need to Speak Up
rst
Fi
AK
PE
S
Up
-

8. nd
co
Se
How Society
Views Rape Victims Need to change

9. ird
Th
Rapist
Should
Not
Go
Scot Free

10. Lousy
Fourth
Medical
Care/
Exam.
Of Rape
Victim
has to
change !!

11. Every Lady Doctor Has to Get Trained in
Rape Victim Exam & Care -
WHY ???

12. Delhi High Court – Judgments
April 2009
• Special room for examination of Rape
victim
• Directing uniform examination protocol
• Use a standard kit for
Collection of evidence
• Protocol of treatment
Film & Kit

13. Present Facilities in Delhi
• GOOD – Safdarjung Hospital
AIIMS
ESI Hospital
LHMC
• Activists claim that facilities are not
available across all Govt hospitals & in
some cases the doctors are unaware of
the protocol

14. Delhi High Court - Judgment
2013
Following Judgment of division bench of DELHI HIGH
COURT comprising of chief justice sh. D Murgeshan and
justice sh.V.K. Jain stating that the government must
issue direction to all hospital including
those in Private sector
- not to deny emergency treatment to rape victims
- free of cost.
Dept of Health and Family welfare NCT of
Delhi has directed nursing homes and private
hospital not to refuse emergency treatment
to rape Victims / give care
Failing which - face punishment.

15. Lets Know the LAW
New Definition Of RAPE
(According to 2013 amendment)
•Penetration of penis, to any extent, into the
vagina, mouth, urethra or anus of a women
or makes her to do so with him or any other
person; or
•Insert, to any extent, any object or a part of the
body, not being the penis, into the vagina, the
urethra or anus of a women or makes her to do
so with him or any other person;

16. Lets Know the LAW
Cond.
New Definition Of RAPE
(According to 2013 amendment)
•Manipulation of any part of the body of a
women so as to cause penetration into the
vagina, urethra, anus or any part of body of
such women or makes her to do so with him
or any other person
Or
•Applies his mouth to the vagina, anus urethra
of a women or makes her to do so with him or
any other person, under the circumstances
falling under any of the following seven
descriptions:

17. Lets Know the LAW
Cond.
New Definition Of RAPE
(According to 2013 amendment)
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
women she is interested in fear of death or of hurt.
FOURTH – 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.

18. Lets Know the LAW
Cond.
New Definition Of RAPE
(According to 2013 amendment)
FIFTHLY – with her consent when, at the time of giving such consent, by
reason of unsoundness of mind or intoxication or the administration by
hem 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 eighteen
years of age
SEVENTHLY – when she is unable to commutate consent
2.INJURIES ON VICTIMS BODY HAS NO RELEVANCE

19. Judgment of Kerala High Court 1969
• Held a sexual act committed only
between thighs amounts to an offence
under section 377. “ the word “insert”
means “place, fit, thrust’ so if the male
organ is inserted or ‘thrust’ between
thighs there is ‘penetration’ to
constitute unnatural offence
• Courts have termed imitative acts of
intercourse as acts of sexual perversity

20. PRESENT RAPE LAW
The scope has been broadened much
beyond penile vaginal acts
CLASSIFICATION OF OFFENCE
Congnizable, non- bailable ,
non compoundable
(can’t be settle even with permission of court)

21. WHAT SECTION 377 SAYS
• you all know LG
BT rights in the eyes SC
•Oral & Anal Sex - a criminal offence
under law upheld by SC even in married
woman
Days are gone when women use to feel dirty
& were not sure who to turn or lacked
courage to lodge a complaint

22. Appeal
3 things are important 1st Rape victim of sexual assault or rape is
received by sympathetic and sensitive doctor, 2nd appropriate
medical Exam./care & treatment , 3rd clinical evidence saved.

23. 3 Most Important
Things Needed
•Trained Doctor & her team
• Special kit for examination
• Protocol of Treatment to prevent
STD/ Pregnancy is crucial

24. What You Can do
Before Reaching
Hospital ?
As soon as one comes across a victim
Of Sexual assault, the first step is to
ensure SAFETY
• Take her to safe and secure place call the
police if danger from the assailant is still there.
• Call a close friend or relative- someone who
will offer unconditional support.

25. INSTRUCTIONS TO THE VICTIM
What You Can Do Before
Reaching Hospital ?
• One must take care not to clean up before
taking them to hospital. The victim should
not bath, go to the bathroom, comb hair,
change clothes or brush teeth before
undergoing a medical examination.
• This will help to preserve all the evidence.

26. Principle of Emergency Care
The doctor’s job at the emergency room is not to
determine if the rape has happened or not.
Rape is a legal term
– a crime –
and whether this crime has been committed or
not will be decided by the Honorable court.

27. Principle of Emergency Care
• The attitude of the medical staff
should be compassionate and not
judgmental
• Life threatening emergency, if
present needs urgent attention

28. Guidelines for Medical Examination
As per new law 2013
• Victim : the first aid medical treatment to the
victim of rape and vitriolage shall be provided
promptly and FREE OF COST by all hospital
public or private
• Medical examination of a female victim shall be
conducted by a FEMALE REGISTERED
MEDICAL PRACTITIONER, in absence there
of , in presence of a female registered medical
practitioner

29. Guidelines for Medical Examination
As per new law 2013
POLICE REQUISITION /FIR is
not mandatory for seeking
medical care and treatment of
the victim.

30. The Principal Features of the
Examination are:1.
2.
3.
4.
5.
6.
Informed consent
Preliminary data
The statement of the victim and others separately
Collection of clothes of victim
Signs of struggle on clothes and body
Examination of the genitals for:• Local signs of violation
• Genital injuries
• Presence of spermatozoa and other micro organisms
Any evidence of STD
5. Collection of laboratory specimens
6. Inference
7. Advice on follow-up

31. INFORMED CONSENT
of the victim should be taken in
writing in presence of a witness if she
above the age of 12 years (In India) if
she is under the age of 12 years or a
mentally subnormal person, the
written consent of the parents

32. PRELIMINARY
DATA

34. The statement of the victim in her words must be written down
as much as possible “WORD FOR WORD”. The amount of
violence used, the position of the assailant, and the mode of
attack should be elicited. It is necessary to inquire if vaginal,
oral, or rectal contact occurred. Her statement should be
noted with reference to:•Pain
•Haemorrhage
•Sensation as to penetration and emission and
•The appearance of discharge
•If she cried for help, or was too terrified to do so, or she
fainted
Enquiry should be made of the events after the all eged
assault, e. g, if she has changed her clothing, bathed or
passed urine. Any delay in making complain to the authorities
should have a proper explanation. A record should be made of
the statement of others who accompany her. The degree of
agreement of the various statements is important.

36. EVERY CONTACT LEAVES A TRACE

37. Collection of Clothes
of victim including under
linen

39. Guidelines for Injuries
As per new law 2013
• Sign of Struggle on Clothes & Body
are IRRELEVANT According to New Law
• Injuries are seen in only one third cases.
• Common sites of extra genital trauma are
mouth, throat, wrists, arms, breast and
thighs. It is essential to do a careful
recording of the findings if there
presents.

40. The women usually
scratches the assailant
during the struggle and
this may result in injury
to her nail which should
be recorded. The debris
under nail should be
removed and examined
for the presence of tags
of epithelium, blood,
fibers, etc, of the
assailant
Nails Scrapping

42. Guidelines for Medical Examination
As per new law 2013
• Two finger admissibility test on a women
victim shall not be performed
and
• Recording of “victim is habituated to
sexual inter course or not” shall not form a
part of report at all.

43. Two Finger Test
There is a lack of clarity on issue such as
whether or not to use finger test for
assessment of injuries,
noting any discharge &
gathering of samples
Raj Mangal Prasad,
Director of NGO Pratidhi

44. Menstruation is not a bar
for Examination
“MENSTRUATION IS NOT
BAR TO ILLEGAL
SEXUAL INTERCOURSE”.

46. Soon after act, the torn marging
are sharp and red, and bleed on
touch. Even when examined after
3 to 4 days of offence, the edges
of laceration are congested and
swollen. The surrounding tissues
are tissues are also swollen and
tender.

49. Collection of Forensic Sample
Followings samples are required to be
collected in sexual abuse cases
• Microscopic examination of vaginal slides (motile and
immotile sperm)
• Vaginal swab (vulva , low vaginal, high vaginal) to
stress here that it should be made a routine
• Nail scrubbing (to look for epithelium of the assailant)
• Hairs from mons pubis (to look for seminal stain,
foreign hair)
• Seminal stain (blood grouping)
• Ultraviolet test for detection of seminal and saliva
stains (optional)
• Blood (blood grouping, Bhcg , STDs , testing drug
intoxication)
• Urine (to test for suspected pregnancy, drug testing)

51. Motility of Sperm – Prepare a
hanging drop Preparation
Motile sperms can visualized up
to four – five hours
The smears are fixed with drop of alcohol

52. Swabs and Smears
Vagina
• Vaginal swab (vulva , low vaginal,
high vaginal) to stress here that it
should be made a routine
• Dry or Saline

53. Swabs and Smears
• Mouth
Swab from under the tongue and buccal
area near molars. Take one swab from
each area and prepare the smear
• Rectum
Take one sample from the external orifice
and another from the 2-5 cm area around
external orifice

54. Essential for preparing smearing –
instruction used to obtain a smear:
• Clean microscopic glass slides of good quality,
preferably with frosted ends
(0.96-1.06 mm. thickness).
• Suitable glass marking pencil or a diamond
marker for identification of slides.
• Paper clips to separate the slides.
• Fixative 95% ethy alcohol or 100% methy
alcohol
• Laboratory from with clear identification of the
patients and history

55. For Crucial Evidence in
Rape cases
Implementation of
NATIONAL PROTOCOL
• of rape victim examination,
• collection of forensic evidence – sampling
labeling &
• accurate documentation

56. In Sexual Abuse Victims
Screening Recommended
• Pregnancy test
• HIV, STD TEST
• Blood and urine for addiction or
substance abuse such as: heroin ,
opium, benzodiazepine and alcohol

57. Collection of Evidence
• Even if the victim is NOT SURE, whether she
wants to report the attack, it is still important
to collect and preserve evidence so it can be
accessed at a later date, if necessary.
• Evidence if not collect within 48 to 72 hours
of the incident is often unrecoverable or
invalid.

58. Optional in Virgins & Children

59. PUNISHMENT FOR NON COMPLIANCE
for we doctors –
Exam/ Care/ Evidence collection
Whoever, being in charge of a hospital , public
or private , whether run by the central
Government, local bodies or any other person,
contravenes the provisions of sections 357c of
the code of criminal procedure , 1973(2 of
1974), shall be punished with imprisonment for
a term which may extend to one year or with
fine (166B – IPC)

60. Rape is a Rape !!

61. Hard to disprove

62. Treatment AIM
• Pregnancy prevention
• Sexually Transmitted
Disease Prevention
• Emotional Support

63. Prevention of pregnancy
Emergency Pill : levonorgestrel 0.75 mg one
pill orally every 12 hours for two doses
UPT : to be repeated at 1,2 weeks &
MTP : if need be

64. Sexually transmitted diseases
Incubation period of common infections
•
•
•
•
•
•
•
Gonorrhea
Trichomonas
Chlamydia
Warts
Herpes
Herpes vaginosis
Syphilis
3-4 days
1-4 weeks
7-14 days
several months
2-14 days
2-14 days
3 months

65. Universal STD Prophylaxis
Metrogyl 2gm orally - single dose
Azithromycin 1g - orally single dose
Ceftriaxone 250 mg I/M single dose

66. Optional
• Hepatitis B vaccination
• Oral HIV pep (Post exposure
Prophylaxis) for 4 weeks

67. Emotional Support
Sexual assault victim need unconditional
emotional support as they may be struggling
with emotions of
Anger,
Fear,
Guilt,
Shame and anxiety

68. Emotional Support
The Victim May Suffer From
• Sleep disturbances
• Lack of appetite
• Depression and nightmare
• Physical pain

69. Counseling
Most victims find counseling helpful in
the process of recovering and moving
on with their life.
The care a patients initially receives influences her recovery from the
trauma suffered due to rape
Follow up is must

70. Please Remember
Girls can not stop rape just by changing
their own behavior
violent people never stop unless they are
Punished
Please join hands with Delhi
Gynaecologists forum’s campaign to
do great medical examination & care

71. FILM
On Medical Examination of Rape
Victim Prepared by MOWCD/
IMA Youtube
https://www.youtube.com/watch?v=0MAwMISPYt0

72. Girls must learn
self defense
self defense
self defense

73. Thank You