Rape / Rapeseed (Brassica napus)

Key Uses

• Edible oil - Canola oil is one of the most consumed vegetable oils globally, known for its low saturated fat content and high oleic acid levels.
• Animal feed - The protein-rich meal left after oil extraction is used as livestock feed.
• Biodiesel - A major feedstock for biofuel production in Europe and North America.
• Industrial lubricants - Traditional (high erucic acid) rapeseed oil is used in high-performance industrial applications.

Rapeseed vs. Canola

Agronomy

• Grown as a winter or spring annual
• Seeding rate: 5-14 lb/acre depending on method
• Excellent for erosion control and weed suppression
• Produces natural biotoxins during decomposition that suppress soil pathogens and nematodes
• Third-leading source of vegetable oil worldwide

Production

Rape - Forensic Medicine and Toxicology (FMT)

Legal Definition

Objectives of Medical Examination

1. Search for physical signs (injuries) that corroborate the victim's history
2. Collect and preserve all physical (trace) evidence for laboratory examination
3. Treat the victim for injuries, risk of sexually transmitted disease (STD), and pregnancy
4. Prevent or minimize permanent psychological damage

Pre-Examination Precautions

• Police should advise the victim not to change clothes, bathe, or douche prior to examination
• Examination should be carried out without delay - minor injuries fade rapidly, vulval swelling may disappear in hours, and sperm detectability diminishes with time
• Examination can generally be conducted up to 7 days following the assault (some guidelines extend this)

General Procedure

1. Requisition: Examination is performed on requisition from the investigating police officer or Magistrate. No woman can be forced to submit to examination against her will.
2. Informed consent: Written, witnessed consent must be obtained from the victim. If under the age of consent (12 years in India) or of unsound mind, consent of parent/guardian is required.
3. Identification: Victim identified by the escorting constable; identification marks recorded.
4. Preliminary data: Name, age, occupation, marital status, residence, date/time, place of examination, by whom requisition was given.
5. Witnesses: Examination conducted in the presence of a third person, preferably a female nurse or female relative. In India, examination should be by a female doctor; a male doctor may proceed only if no female doctor is available and only in the presence of a female attendant.
6. Statements: The victim's statement is recorded word for word, separately from any accompanying persons.

The Statement

• Amount of violence used, position of assailant, mode of attack
• Whether vaginal, oral, or rectal contact occurred
• Pain, hemorrhage, sensation of penetration and emission
• Whether she cried for help, was too terrified, or fainted
• Events after the assault (clothing changes, bathing, urination)
• Any delay in reporting (should have a proper explanation)

Examination Proper

A. Clothes

• Each item removed while the victim stands on clean paper (to collect falling trace evidence)
• Examined for: blood, seminal, mud, grass, grease stains; tears; missing buttons
• Clothing dried, stored in paper bags (not plastic - prevents mold), sent to laboratory
• Seminal stains fluoresce under ultraviolet (UV) light
• Foreign hair, fibers on clothing preserved for comparison with accused

B. General Body Examination

• Undress completely; examine under UV light for seminal stains
• Photograph all injuries (large and close-up), especially the sexual area
• Document all marks of violence with regard to appearance, extent, situation, and probable age

• Petechiae on face/conjunctivae - indicate partial asphyxia from forcible restraint
• A second examination at 48 hours is useful as deep bruises may be more visible later

C. Genital Examination

• Fresh tears: bleeding, congestion, edges irregular and tender
• 8-24 hours: margins oedematous with sero-sanguineous oozing
• 2-3 days: pain and congestion with blood-stained fluid
• After 3-4 days: edges congested and swollen
• Healed: V-shaped tears become U-shaped defects within months
• Tools for hymen examination: Glaister-Keene rods/globes, Foley's catheter with balloon, hymenoscope

• 10% aqueous solution applied to posterior fourchette and fossa navicularis
• Identifies genital and perianal injuries not visible on naked eye examination
• Positive (blue uptake) at tears - assists in identifying recent lacerations

• Bruising of vaginal mucosa occurs with penile penetration (more often anterior wall lower third / posterior wall upper third)
• More consistent with penile than digital penetration
• Without preliminary lubrication (non-consensual), more severe bruising/abrasion results
• Frank vaginal wall laceration is rare in women of child-bearing age but occurs in: young children, post-menopausal women, cases with gross size disproportion, insertion of foreign objects

D. Swab Collection

Findings by Victim Category

Virgin

• Hymenal tears with fresh bleeding and congestion
• Spermatozoa in vaginal secretion is a positive sign of sexual intercourse
• More severe genital trauma expected due to smaller introitus and lack of prior stretching

Sexually Active Adult Woman

• Hymen may be completely destroyed; vaginal orifice dilated; mucosa wrinkled and thickened
• May show little or no genital damage unless considerable violence was used
• Chief evidence: signs of violence elsewhere on body + spermatozoa in vagina or on clothing

Children

• Adult penis cannot usually penetrate the deeply situated hymen in young children
• Typically only redness and tenderness of vulva; hymen usually intact
• With great violence: rupture of vaginal vault, visceral injuries, possibly death
• Circumferential tears of vestibular mucosa are characteristic (absent in digital penetration)
• Full penile penetration produces extensive hematoma, anterior and posterior vaginal wall tears, possible bladder or anorectal canal involvement

STDs at Risk After Rape

• Chlamydial infection (most common)
• Gonorrhoea (cervical culture recommended; Gram-negative intracellular diplococci on smear)
• Syphilis (blood test; dark-field microscopy of any suspect sore)
• Genital herpes
• Genital warts (HPV)
• Trichomoniasis
• Hepatitis B and HIV (if assailant suspected to be infected; T-cell count drop at 3 weeks is a warning sign)

The Inference (Medico-Legal Opinion)

1. Scene examination
2. Signs of struggle on clothes and body
3. Presence of blood and/or seminal stains on clothes and body
4. Presence of seminal matter in the vagina
5. Injuries to genitals consistent with forcible intercourse
6. Presence of spermatozoa (motile or non-motile)
7. Age of injuries consistent with the alleged time of assault
8. Drug/alcohol findings consistent with inability to give valid consent

Locard's Principle of Exchange

• The assailant deposits material on the victim (semen, hair, fibers, soil)
• The victim deposits material on the assailant (blood, hair, skin cells under nails, fibers from clothing)
• Both may deposit material at the scene

SANE / SART (USA Context)

• SANE (Sexual Assault Nurse Examiner) - forensically trained nurse who conducts the medical-forensic examination
• SART (Sexual Assault Response Team) - coordinates medical, legal, and social services for the victim

Post-Rape STD Prophylaxis and Pregnancy Prevention - Current Clinical Guidelines

Primary source: CDC STI Treatment Guidelines, 2021 (MMWR Vol. 70, No. 4) - current standard of care.

Why Presumptive Treatment?

1. STI Prophylaxis Regimens (CDC 2021)

Standard Regimen (Adults and Adolescents)

• Neisseria gonorrhoeae (ceftriaxone)
• Chlamydia trachomatis (doxycycline)
• Trichomonas vaginalis and bacterial vaginosis (metronidazole)
• Incubating syphilis (ceftriaxone)

Note on doxycycline: A negative pregnancy test is required before prescribing doxycycline or tetracycline (contraindicated in pregnancy). In pregnant patients, use erythromycin as an alternative for chlamydia coverage. Metronidazole can cause nausea and vomiting - stagger administration by a few hours if given alongside emergency contraception to avoid vomiting affecting EC efficacy.

Alternative for Chlamydia (if doxycycline unavailable)

If Ceftriaxone Unavailable

2. HIV Post-Exposure Prophylaxis (HIV-PEP)

Key Principles

• Must be started as soon as possible, within 72 hours of exposure
• Course: 28 days
• PEP has NO benefit if started >72 hours post-exposure
• Based on extrapolation from occupational needlestick data (81% risk reduction with 28-day ZDV course)
• Risk of HIV from sexual assault is heightened vs. consensual sex due to tissue trauma/mucosal disruption

Risk Assessment Before Offering PEP

• Is the assailant known HIV-positive?
• Is the assailant in a high-risk group (IDU, MSM, sex worker)?
• What orifice was penetrated (rectal >> vaginal for HIV risk)?
• Was there visible trauma/bleeding?

Recommended HIV PEP Regimen (from CDC/DHHS nPEP Guidelines)

Practical Logistics

• Provide an initial 3-7 day starter pack at the first visit, with a prescription for the full 28-day course
• Providing the entire 28-day supply at the initial visit improves adherence, especially when follow-up is uncertain
• Refer to: National Clinicians' Consultation Center PEP Hotline: 1-888-448-4911
• Uninsured patients: enroll in manufacturer patient-assistance programs

After PEP Completion

• Survivors who took HIV PEP should be evaluated for HIV PrEP after completing the course and testing HIV-negative

3. Hepatitis B Prophylaxis

• Hepatitis B vaccine at time of examination (first dose), with follow-up doses at 1-2 months and 4-6 months
• Give as soon as possible (within 24 hours ideally)

• Hepatitis B Immune Globulin (HBIg) + vaccine simultaneously at separate sites
• HBIg is NOT recommended if first presentation is ≥14 days after assault

• Test hepatitis B surface antibody; re-vaccinate if negative

4. HPV Vaccination

• Recommended for all survivors aged 9-26 years (some guidelines extend to age 45)
• Initiate at the first visit; complete the series at follow-up
• Note: HPV vaccines do NOT provide therapeutic benefit to existing infections, but protect against future exposures

5. Pregnancy Prevention (Emergency Contraception)

First Priority: Rule Out Existing Pregnancy

• Urine or serum beta-hCG before administering EC
• ECPs are ineffective (but not harmful) if the woman is already pregnant

Emergency Contraception Options (in order of efficacy)

CDC U.S. MEC classification for sexual assault: Category 2 for most ECPs (benefits outweigh risks), noting that routine presumptive treatment for chlamydia, gonorrhea, and trichomoniasis should also be initiated. Cu-IUD is Category 1 unless concurrent STI.

Note on Metronidazole + EC

6. STI Testing at Initial Examination (Selective)

• NAAT for C. trachomatis and N. gonorrhoeae (vaginal/cervical/rectal/pharyngeal as appropriate)
• Serum: HIV, hepatitis B (HBsAg, HBsAb), syphilis (RPR/VDRL)
• Wet prep or NAAT for T. vaginalis
• Urine or serum beta-hCG (pregnancy test)
• Consider toxicology (urine/blood) if drug-facilitated assault suspected

7. Follow-Up Schedule

8. Recent Evidence Updates (2023-2025)

Quick Reference Summary Card

POST-RAPE PROPHYLAXIS CHECKLIST

□ Pregnancy test (beta-hCG)
□ EC - LNG (≤72h) / UPA (≤120h) / Cu-IUD (≤5 days, most effective)

STI PROPHYLAXIS
□ Ceftriaxone 500 mg IM stat (1 g if ≥150 kg)
□ Doxycycline 100 mg PO BD × 7 days (if not pregnant)
□ Metronidazole 500 mg PO BD × 7 days

HIV PEP (if indicated - within 72 hours)
□ TDF/FTC + raltegravir or dolutegravir × 28 days
□ Hotline: 1-888-448-4911

VACCINATIONS
□ Hepatitis B vaccine (dose 1) if unvaccinated
□ HPV vaccine (ages 9-26) if not completed
□ HBIg if assailant known HBsAg+ and survivor non-immune

FOLLOW-UP
□ <1 week: PEP check, test results
□ 1-2 months: Hep B dose 2, HIV retest
□ 4-6 months: Hep B dose 3, final HIV test