9.10 Female Sexual Assault

Question 1

Rape vs Sexual assult

Answer 1

Rape - when a person forces another to have sexual intercourse or penetration without permission

Sexual assault - sexual violation without consent

Question 2

Define sexual penetration

Answer 2

Act which causes penetration of any body part or object

Question 3

Define sexual violation

Answer 3

Any act which causes direct or indirect contact of genital organs or objects of the perpetrator to the victims genital organs

Question 4

Define rape

Answer 4

• Girls under age of 12 years cannot legally consent to sexual intercourse (therefor it will be rape)
• girls between the age of 12-15 years can be the victims of statutory rape

Question 5

Clinical steps to follow when assessing a rape/sexual assault victim

Answer 5

• Introduce yourself – name and qualification
• make sure pt is clinically stable
• Take a detailed medical history
• Verbal history of the alleged incident
• Explain the nature and purpose of the examination:
  
  • to collect evidence for court purposes
  • medical examination including genital and anal regions
  • to collect samples/ do tests
• Obtain written consent:
  
  • use own consent form or use the SAP 308 form
  • for medical evidence to be collected and used in court of law
• Do the full medical examination (chaperone to be present)
• Take samples by using the Rape kit
• Record detailed examination findings on the J88 form in duplicate and additional notes if limited space on J88

Question 6

J88 form

Answer 6

• copy should be kept for a period of 3 years
• include sketches of the injuries sustained on the medical notes as well

Question 7

What should the history taking include?

Answer 7

• Date, time and location of attack
• Perpetrator familiar to the patient
• Information about the assailants( what they wore/scars/birthmarks etc)
• The use of threats/ restraints/ weapons
• The type of sexual contact:
  - vaginal/oral/rectal ➡️? If a condom was used
• Any extragenital injuries sustained
• Occurrence of bleeding ➡️from the patient or the assailant
• If ejaculation occurred and the location
• If the patient did any of the following after the attack:
  
  • douching or bath
  • use of a tampon or sanitary pad
  • urinate or defecate
  • change of clothing
    -eating/drinking
  • use of toothpaste/ mouthwash/ enemas/ any drugs
• LNMP/ use of contraception eg IUCD
• Date of previous consensual coitus

Question 8

Physical examination of rape / sexual assault victim

Answer 8

From top to toe
- Examine the clothing
- tears/marks of mud or grass/stains of blood or semen
- General appearance
- Areas to examine:
-Upper arms/ forearms/ hands
-Face/ears/lips
-Scalp
-Neck
-Breasts
- Abdomen
- Back (look for lacerations -> can indicate that pt was dragged)
- Thighs and legs
- Hips and buttocks
- External genitalia (start anterior {clitoris} end posterior {anus})

• if find any bruising or marks = measure it

Question 9

The rape kit - full body exam sequence:

Answer 9

1. D3 Reference Hair Samples – collection of both scalp and pubic hair
2. D5 Clothing Collection kit – collection of the victim’s clothes for additional evidence
3. D2 DNA Evidence collection from body kit – looking for perpetrators bite marks/blood/saliva/debris from the victim’s body
4. D1 Adult SAECK – to collect swab samples from the genital area of the victim