Examination of the Accused in a Case of Rape

Legal Basis

• The examination must be carried out on a written order of the Court or investigating officer.
• Where consent is sought, it should be duly attested by a witness with time, date, and address.
• The police must not allow the accused to go to the bathroom unsupervised before examination, to prevent washing off stains.

Preliminary Data

• Name, age, occupation, and address
• Who brought the accused and when
• Identification marks (at least two); attach a recent photograph
• Identification by a close relative
• Time and date of examination (must be exact)
• Brief history - note any account the accused gives, especially if he refers to injuries, use of force, or claims of consent

Physical Examination

1. General Assessment

• Note the size and physique of the accused - this helps assess the victim's ability to offer resistance and explains the genital injuries she sustained.
• Note mental condition and any signs of drunkenness or intoxication.
• Include a complete examination of the nervous system and history of any mental illness or neurological disorders.

2. Signs of Struggle on Body

• Search for injuries inflicted by the victim during the alleged struggle - bite marks, scratch marks (fingernail marks on face, neck, arms, back), bruises.
• Note all injuries with description of size, shape, colour, and estimated age of injury.
• Classic findings include: bite marks on the breast/chest area, parallel bruise marks on the back.

3. Examination of Clothing

• Examine for:
  • Missing buttons or torn fabric
  • Blood stains or seminal stains
  • Foreign hairs or foreign fabric fibers
  • Lipstick or make-up soiling
  • Mud stains, grass, or soil
  • Clothing worn at the time of the alleged offence must be preserved separately in paper bags for forensic analysis.

Local Examination of the Genitals

Pubic Area

• Examine pubic hair for seminal stains and blood stains.
• Dry blood stains should be scraped with a clean blunt scalpel and preserved.
• Comb pubic hair to collect foreign hairs (from the victim).

Examination of the Penis

1. Smegma - Examine under the prepuce. Smegma is a thick, cheesy secretion (desquamated epithelial cells + smegma bacilli) with a disagreeable odour.
   • Presence of thick, uniform smegma coating under the prepuce or around the corona glandis is inconsistent with recent intercourse - it is rubbed off during coitus and takes ~24 hours to re-accumulate.
   • Absence of smegma supports recent intercourse.
2. Torn frenum - Consistent with recent intercourse. The frenulum may tear due to forcible introduction of the penis into the vagina, or due to size disproportion.
3. Vaginal epithelial cells on the penile surface - Look for these under microscopy unless a condom was used.
4. Venereal disease - Look for syphilitic chancre or venereal discharge; cross-check with the victim's findings.
5. HIV status of the accused should be determined.

Assessment of Potency

• Palpate the testes, epididymis, and examine the spinal cord and penis for sensation.
• Palpate prostate and seminal vesicles per rectum. Apply pressure to seminal vesicles and milk along urethra to bring semen to the meatus - examine for spermatozoa.
• Tests to assess erectile function if needed: intracavernosal papaverine injection, nocturnal penile tumescence testing.
• If no disease or abnormality is found, there is no reason to conclude the man is incapable of sexual intercourse - "potency is a matter of inference to be drawn from negative findings" (Parikh).
• As Casper states: "the possession of virility and the power of procreation neither requires to be, nor can be, proved to exist by any physician."

Specimens to Collect from the Accused

• Blood grouping is particularly valuable when the female is a non-secretor - the greatest possibility of matching the semen from the vagina to the accused exists in this scenario.

Opinion Formulation

1. Whether the accused is capable of performing sexual intercourse (potency)
2. Whether there are any signs of recent sexual intercourse
3. Whether injuries on the accused are consistent with a struggle
4. Whether any venereal infection is present
5. Findings relevant to age of the accused (maturity)

Key Medico-Legal Points

• Examination must be prompt - delay degrades evidence.
• The accused's account (especially claims of consent or postcoital fighting) should be noted but does not alter the medical examination protocol.
• All findings must be documented with photographs where possible.
• The report must be objective - the doctor's role is not to determine guilt but to document findings.

Samples Collected from a Rape Victim (Survivor)

A. Clothing

• The victim should disrobe over a sheet placed on the floor to collect any falling debris.
• Clothing must not be washed or dried before submission.
• If the victim has already changed, the clothes worn after the assault are also collected.

B. Debris and Trace Evidence

• Scan the entire body from head to toe using an Alternate Light Source (ALS) at 450 nm UV wavelength - semen and saliva fluoresce under UV.
• Collect debris (grass, mud, fibres, foreign objects) using tweezers, tape, or a lint roller.
• Each piece is packaged separately in a labelled envelope.

Note: A Wood's lamp (< 390 nm) is not recommended as a substitute for ALS - it is too non-specific.

C. Biological Evidence from Body Surface

• Swab any area of fluorescence under ALS.
• Swab bite marks or areas of sucking on the body.
• Swab breasts, neck, thighs, and any area the victim identifies as being licked or kissed.
• Use moistened swabs, air-dry before packaging.

D. Fingernail Evidence

• Use a rosewood stick, broken tongue blade, or moistened swab to scrape beneath fingernails.
• Alternatively, clip the nails and collect clippings.
• Purpose: to recover the assailant's skin, blood, or tissue if the victim scratched him.
• Package, label, and seal each hand separately.

E. Hair Evidence

Pubic Hair Combings

• Place a collection sheet under the buttocks.
• Use a plastic comb to comb through pubic hair toward the sheet.
• If pubic hair is absent or trimmed, use a lint roller.
• Collects foreign hairs from the assailant.
• Package the sheet and comb together.

Pubic Hair Pulling (Reference Sample)

• Pull < 25 pubic hairs (without cutting) to obtain the root for victim's reference DNA.
• Painful - collected only if specifically requested by police/court.

Head Hair Pulling (Reference Sample)

• Pull ~25 head hairs from different parts of the scalp to obtain roots.
• For victim's reference DNA comparison.

F. Genital Examination and Swabs

External Genital Swabs

• Swab the vulva and perineum.
• Use the retraction and separation technique to expose the posterior fourchette and fossa navicularis for injury and evidence.
• If pubic hair is matted (with semen), cut the matted section with scissors and preserve it.
• Swab using moistened swabs; package, label, and seal.

Internal Genital Swabs

• Vaginal swabs - Insert swab into the posterior fornix and gently twirl.
• Cervical swab - Insert swab into the cervix and gently twirl.
• Collect any foreign objects found (e.g., tampon, condom).
• These swabs are examined for:
  • Spermatozoa (motile and non-motile)
  • Seminal plasma (acid phosphatase, p30/PSA)
  • Blood grouping of semen
  • STI cultures (gonorrhoea, Chlamydia)

Key Points on Vaginal Swabs:

• Spermatozoa may be detected in the vagina for up to 72 hours after intercourse (longer in the cervix - up to 5-7 days).
• Two swabs are typically taken: one for a wet mount (immediate microscopy for motile sperm) and one for a dry smear (fixed and stained).
• Vaginal smear is stained with Papanicolaou or Haematoxylin-Eosin to detect spermatozoa and vaginal epithelial cells.

G. Anal Examination and Swabs

• Gently retract the anus with slow, steady pressure to allow natural dilation.
• Inspect for injuries (tears, abrasions - typically at 6 o'clock position in lithotomy).
• Insert swabs and gently twirl; collect rectal swabs.
• An anoscope can be used for better visualization.
• Collected when anal penetration is alleged or suspected (or in cases involving children).

H. Oral Swabs

• Collect buccal/oral swabs when oral penetration (fellatio, cunnilingus) is alleged.
• Swabs from the buccal mucosa and tonsillar pillars.
• Spermatozoa can be detected in the mouth for up to 6 hours after the assault.

I. Blood Samples

J. Urine Sample

• Collected for toxicology (especially if drug/alcohol-facilitated assault is suspected).
• Also for pregnancy testing (hCG).

K. Vaginal/Cervical Smears - Summary

Special Examination Techniques

Toluidine Blue Dye (TBD)

• Applied to external genitalia before speculum insertion.
• Adheres to nuclei in damaged epithelial cells - enhances detection of genital tears.
• Does not interfere with DNA testing.
• Wiped with 1% acetic acid or baby wipes to remove excess (prevents false positives).

Colposcopy

• Magnification of 4x to 30x for examining anogenital structures.
• Can be equipped with still/video camera for documentation.
• Superior to gross visualization for detecting injuries.
• Recommended when available; photodocumentation alone is an acceptable alternative.

Preservation and Chain of Custody

• All samples are air-dried before packaging to prevent fungal/bacterial overgrowth.
• Use paper bags, never plastic.
• Each item is labelled with: patient name, date and time of collection, nature of specimen, collector's name.
• A chain of custody form documents every person who handles the evidence.
• The sealed kit is handed directly to law enforcement with signatures.
• Refrigerate (not freeze) biological samples until submission.

Summary Table

Samples Collected in Rape Victim - Based on Time Since Assault

At a Glance - Time-Based Summary

1. Rape 4 Hours Ago - MAXIMUM EVIDENCE WINDOW

Biological Samples (All Collected)

• Vaginal swabs - Motile spermatozoa likely present; non-motile spermatozoa abundant
• Cervical swabs - Spermatozoa persist here longer than vagina
• Wet mount smear - for motile spermatozoa (must be done within minutes of collection)
• Dry smear (fixed) - for non-motile spermatozoa and acid phosphatase
• Body surface swabs - Under ALS; semen/saliva on skin, bite marks, neck, breasts
• Oral swabs - If oral assault occurred (spermatozoa detectable up to 6 hours in mouth)
• Anal swabs - If anal assault
• Nail scrapings - Assailant's skin/blood under nails
• Pubic hair combings - Assailant's hair
• Clothing - Semen, blood stains at maximum yield
• Blood - Toxicology (GHB, drugs detectable < 24 hr), blood grouping, DNA reference
• Urine - Toxicology (drugs detectable up to 120 hours = 5 days)

Physical Findings

• Acute genital injuries - fresh tears of hymen, fourchette abrasions, bruising of vulva/vaginal walls
• Extragenital injuries - fresh bruises, bite marks, scratch marks

Investigations

• STI baseline cultures (gonorrhoea, Chlamydia)
• HIV baseline, Hepatitis B, syphilis serology
• Pregnancy test (baseline)

2. Rape 2 Days Ago (48 Hours) - DIMINISHING BIOLOGICAL WINDOW

What Can Still Be Collected

• Vaginal swabs - Non-motile spermatozoa may still be present (motility is gone after ~6-12 hr); PCR for semen DNA still possible
• Cervical swabs - Spermatozoa can persist up to 5-7 days in the cervix - this is the most important swab at this point
• Clothing - If not washed, this is the highest-yield specimen beyond 24 hours; DNA from semen on fabric survives much longer
• Underwear - Even if not worn during the assault, may carry DNA if contact occurred
• Pubic hair combings - May still trap foreign hairs
• Nail scrapings - If victim has not washed hands

What Is Likely Gone

• Motile spermatozoa (degrade within 6-12 hours)
• Oral swab yield (spermatozoa detectable in mouth for only ~6 hours)
• Body surface biological evidence (if victim has bathed)
• Seminal acid phosphatase activity (degrades rapidly)

Physical Findings

• Genital injuries are healing - bruising changing colour, abrasions epithelializing
• Hymen tears beginning to heal at edges
• Extragenital bruises in various stages of healing

Investigations

• STI testing - gonorrhoea/Chlamydia cultures
• Urine toxicology - still viable (drugs detectable up to 120 hours = 5 days after assault)
• Pregnancy test

3. Rape 1 Month Ago - FORENSIC EVIDENCE LARGELY GONE

What Can Be Collected

• Blood - STI serology (HIV, syphilis, Hepatitis B - now past incubation windows, so results are meaningful)
• Pregnancy test - Pregnancy from the assault is detectable and must be addressed
• STI cultures/PCR - Gonorrhoea, Chlamydia, HPV
• Psychological assessment - PTSD screening, acute stress disorder, depression

Physical Findings

• Genital injuries are healed - may leave:
  • Healed hymenal notches/transections
  • Scarring of fourchette or posterior commissure
  • Old bruising is gone; only scars remain
• A normal examination does not exclude rape - most genital injuries heal completely within 1-4 weeks with no residual finding

What Is Gone

• All spermatozoa
• Seminal fluid markers
• All acute injuries
• Trace evidence from body or clothing (unless clothing is preserved and unwashed)

4. Rape 1 Year Ago - HISTORICAL CASE

What Can Be Collected / Assessed

• Blood serology - HIV (if not already treated), syphilis, Hepatitis B/C, HPV
• Psychological assessment - PTSD, chronic depression, sexual dysfunction, somatic complaints
• Pregnancy - If a child was born as a result, DNA paternity testing is possible
• Gynaecological sequelae - Chronic pelvic pain, dyspareunia, pelvic inflammatory disease, infertility

Physical Findings

• Normal genital examination in the vast majority of cases - healed completely
• Rarely, old healed hymenal transections at 3, 6, or 9 o'clock may be present but are non-specific
• Psychological signs - PTSD, hypervigilance, avoidance behaviour

Medico-Legal Role at 1 Year

• Documentation of psychological sequelae
• Corroboration of history through circumstantial evidence
• STI/pregnancy outcomes linked temporally to the assault

Key Principles to Remember

1. The earlier, the better - evidence degrades rapidly; examination should never be delayed unnecessarily.
2. Clothing is the longest-surviving evidence source - always collect if not washed.
3. Cervical swabs outlast vaginal swabs for spermatozoa (5-7 days vs ~72 hours).
4. PCR-based techniques have extended the DNA window to potentially 7 days from the traditional 72 hours.
5. A normal examination never excludes rape - most injuries heal completely in 1-4 weeks.
6. Urine toxicology for drug-facilitated assault has a window of up to 120 hours (5 days) - collect whenever this is suspected even at 2 days.
7. Psychological/psychiatric sequelae persist long-term and are collectible evidence at any time point.