POCSO Act, 2012

Definition and objective

Sexual offences covered

1. Penetrative sexual assault (Section 3)
   Penetration of vagina, mouth, urethra or anus by penis, object, or any body part, and oral sexual acts.
2. Aggravated penetrative sexual assault (Section 5)
   More serious offence due to circumstances such as assault by police, public servant, family member, doctor, teacher; repeated assault; assault on a child below 12 years; or causing pregnancy, grievous harm, etc.
3. Sexual assault (Section 7)
   Sexual touching of vagina, penis, anus or breast, or making the child touch these parts, with sexual intent, without penetration.
4. Aggravated sexual assault (Section 9)
   Sexual assault in specified aggravated circumstances, including by a person in authority or against a vulnerable child.
5. Sexual harassment (Section 11)
   Includes sexual words/gestures, showing pornography, stalking, repeated contact, threatening to circulate sexual images, or inducing a child for pornographic purposes.
6. Use of child for pornography (Section 13)
   Involvement of a child in any form of media for sexual gratification.

Important provisions

• Child means any person below 18 years.
• The Act is gender neutral: child victim and offender may be of any gender.
• A minor’s apparent consent does not make a sexual act legally valid under POCSO.
• Mandatory reporting: Any person with knowledge or apprehension of a POCSO offence must report it to the Special Juvenile Police Unit or local police (Section 19). Failure to report is punishable (Section 21).
• Identity of the child must not be disclosed by media (Section 23).
• Child-friendly statement recording: preferably at the child’s home/place of choice and not in a police station, with no contact with the accused during investigation/trial.
• Special Courts are designated for speedy trial (Section 28). Evidence should ideally be recorded within 30 days and trial completed within one year, as far as possible.
• The child and family are entitled to legal assistance, compensation, privacy and protection.

Medical examination: relevance to OBG practice

• Medical examination can be performed even before registration of FIR/complaint.
• It must follow the medico-legal procedure under Section 164A CrPC.
• For a girl child, examination should be done by a woman doctor.
• Examination should occur in the presence of a parent, guardian, or a person trusted by the child. If unavailable, a woman nominated by the head of the institution should be present.
• Provide emergency care first: treatment of injuries, pregnancy risk assessment, STI/HIV prophylaxis where indicated, psychological support and documentation.
• Obtain appropriate informed consent/assent as applicable, maintain dignity and privacy, avoid repeated examination, collect and preserve forensic samples, and prepare detailed medico-legal documentation.

Punishment

• Penetrative sexual assault: rigorous imprisonment, generally minimum 10 years, may extend to life imprisonment, with fine.
• Aggravated penetrative sexual assault: more severe punishment, including life imprisonment; in specified circumstances, death penalty may apply.
• Sexual assault, sexual harassment and pornography-related offences also carry imprisonment and fine, with enhanced penalties for aggravated/repeat offences.

Conclusion

Scar Endometriosis

Definition

Etiopathogenesis

• Caesarean section, most common
• Hysterotomy or laparotomy
• Laparoscopy port sites
• Episiotomy scar, rarely

Clinical features

• History of previous caesarean or pelvic surgery
• Painful swelling/nodule in or near the scar
• Cyclical pain and increase in size/tenderness during menses, the classical presentation
• Mass may be firm, fixed, pigmented or occasionally bleed
• Symptoms can begin months to years after surgery
• May coexist with pelvic endometriosis, though not always

Sites

• Pfannenstiel incision scar
• Midline laparotomy scar
• Umbilicus
• Laparoscopic port scar
• Episiotomy scar

Differential diagnosis

• Incisional hernia
• Suture granuloma
• Lipoma
• Abscess
• Hematoma
• Keloid
• Desmoid tumour
• Soft-tissue sarcoma
• Sister Mary Joseph nodule

Diagnosis

1. Previous uterine/pelvic surgery
2. Scar mass
3. Cyclical pain

• Ultrasonography with Doppler: first-line, shows a heterogeneous hypoechoic solid lesion with variable vascularity.
• MRI: best for defining size, depth, rectus sheath/muscle involvement and surgical planning.
• CT may be useful for extensive lesions.
• FNAC/core biopsy may demonstrate endometrial glands, stroma and hemosiderin-laden macrophages, but is not routinely essential if excision is planned. There is a theoretical risk of needle-tract implantation.
• Definitive diagnosis is histopathological after excision.

Treatment

• Excise the lesion intact with about 1 cm margin of normal tissue where feasible.
• Remove involved fascia/muscle/peritoneum if necessary.
• Large fascial defects may require mesh repair.
• Send specimen for histopathology to confirm diagnosis and exclude rare malignant transformation.

Complications

• Recurrence after incomplete excision
• Large abdominal wall defect after radical resection
• Rare malignant transformation, usually clear-cell carcinoma

Prevention during caesarean section

• Avoid contamination of wound by endometrial tissue
• Exteriorize uterus where appropriate
• Change gloves/instruments after uterine closure
• Thorough irrigation of wound before abdominal-wall closure
• Careful closure of uterine and abdominal-wall layers