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LEGAL MEDICINE
1.3B MEDICO-LEGAL ASPECT OF SEX CRIMES

RAPE
Three elements are necessary for rape of a female:

Carnal knowledge (need not to be penetrate, touch around

genital area is enough)

Force

Commission without consent

REPUBLIC ACT NO. 8353 - ANTI RAPE LAW
RA 8353 - Act known as "The Anti-Rape Law of 1997.
Article 266-A. Rape: When And How Committed. - Rape is committed:
1) By a man who shall have carnal knowledge of a woman under any of
the following circumstances:
a) Through force, threat, or intimidation;
b) When the offended party is deprived of reason or otherwise
unconscious;
c) By means of fraudulent machination or grave abuse of authority;
d) When the offended party is under twelve (12) years of age or is
demented, even though none of the circumstances mentioned above be
present.
2) By any person who, under any of the circumstances mentioned in
paragraph 1 hereof, shall commit an act of sexual assault by inserting his
penis into another person's mouth or anal orifice, or any instrument or
object, into the genital or anal orifice of another person.

MEDICO-LEGAL EXAMINATION
Written Request (without this investigation can not be proceed)
Consent (incase of Father or mother are the victim.
Investigator can sign)
Data of the Subject/Complainant
General Physical Examination:

General Survey

Mental Status

Physical Findings
Ano-Genital Examination

External Genitalia, Hymen, Discharge, Internal

Examination
GENITAL EXAMINATION
ANATOMY

ANO-GENITAL INJURY TYPES

Abrasion
Contusion or Bruise
Hematoma
Laceration
HYMEN INJURY

Contusion
Hematoma
Laceration

Fresh
Healing
Healed

BEI SAMONTE Page 1 of 2

LEGAL MED

1.3B MEDICO-LEGAL ASPECT OF SEX CRIMES

NORMAL EXAMS IN CHILD SEXUAL ABUSE
1. Nothing happened
2. Something happened which did not cause injury
3. Something happened which may have caused injury, which has healed

Figure 1.A 14-year-old 12 hours after assault. Marked submucosal

hemorrhages are present on the lower half of the hymenal membrane.
Note the fresh-cut edge of a hymenal laceration at the 3 o'clock position.
Figure2. Four days after assault. The major portion of the submucosal
hemorrhage has resolved, exposing evidence of hymenal lacerations at
the 3 o'clock and 8 o'clock positions.
Figure3. Sixteen days after assault. Evidence of the acute injuries has
disappeared, leaving only a cleft at the 8 o'clock position.
Healing starts the moment the injury was inflicted --- but for the purpose
of standardization, NHQ crime lab 24hrs fresh/acute. 24hrs to 7days to
21 days healing. 3days to 7 days to 30days healed, cannot be dated
accurately.
Whereas most signs of an acute injury were gone within 7 to 10 days, the
changes in the depth and the configuration of a laceration continued for
up to 3 weeks in the prepubertal girl and 4 weeks in the adolescent girl.
McCann et.al, American Academy of Pediatrics,2007

LABORATORY EXAMINATIONS
Swab for presence of semen for cases within 24 hours
DNA for acute case
Acid Phosphatase or Prostate Specific Antigen
Pregnancy test / ultrasound

Microscopic examination of vaginal swabs/TMG

Trichomonas (exam is wet mount)
Monilia (exam is KOH prep)
Gram stain
Culture for gonorrhea and chlamydia when resources are available
Serology for STD (VDRL, Hep B, HIV)
INTERPRETATION
Definite evidence of sexual contact

Positive presence of spermatozoa

Pregnancy

STD

REASONS FOR THE ABSENCE OF PHYSICAL FINDINGS

Touching, fondling, oral contact
Insertion of finger or an object into vulva or anus
Masturbation
Other genital contact; intercrural
Deliberate avoidance to inflict injury- skillful perpetrator, incest
Difference in the interpretation of the word Penetration
Elasticity of the hymen and anus Redundant hymen
Delay in disclosure : 36% had genital trauma when examined
within 24 hours to 13% after 24 hours

Genital Trauma when assaulted by stranger (25%) vs.

known assailant (12%)
Prepubertal age heal fast, heal back to normal

DISCOURAGED TERMS IN SA EVALUATION

1. Virgin State
2. Intact Hymen
3. Size of hymenal opening --- the emotional value of collecting
evidence should always be weighed against the emotional cost of the
procedure and examination of the child
MYTHS
1. Sexually transmitted infections through sharing the same bed, toilet
seat or towel.
2. Biking, horseback riding, dancing (split) can cause hymenal laceration
3. Masturbation can cause hymenal laceration

Normal masturbation in girls involves clitorral or labial

stimuation

Self injurous behaviors in 97 mentally retarted individuals

resulted in NO genital or anal injuries

MEDICAL GENITAL EXAM + INVESTIGATION

Most important
Statement of child
Police investigation to corroborate story
- Collateral interviews
- Gather evidence at the site

Clear evidence of recent blunt penetrating/force trauma

Laceration of hymen, acute

Contusion of hymen

Laceration of Posterior Fourchette

Perianal lacerations

No evident ano-genital injury at the time of examination.

Further investigation, such as careful questioning of the child,
is required.
Does not exclude sexual abuse/ rape.

BEI SAMONTE

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