i) There should be no delay in the examination:

Valuable time should not be lost when a woman complains of rape. She should be brought immediately for medical examination.

The police should bring the alleged rape victim as soon as possible. Detail statements may be taken by the police after the medical examination.

Medical evidence is very important in cases of rape,as there should be “independent corroboration” of the victims story by other evidence.

ii)Being Sensitive:

One should be very sensitive while examining a rape victim. The examiner should realize the gravity of the situation. The woman may even need psychological/psychiatric care later in life.

iii)Must be examined only if referred properly:

Any medico legal examination should be undertaken only when there is proper referral (such as MLEF issued by the police or court/magistrate in Sri Lanka).

It is not necessary for the doctor to examine a rape victim brought by her husband or relative without reporting it to the police.

Alternatively the emergency unit of the nearest police station can be called to the hospital/clinic if she presents there first (done in some countries).All these measures are to reduce the delay in examining the patient.

iv) Presence of a female chaperone during examination:

It is unethical for a male doctor to examine a female patient in the absence of a female chaperone. In the absence of a hospital nurse a female relative or a female friend of the woman should be present. However it is not suitable to have a female police officer as admissibility of evidence obtained may be challenged.

v)Obtain written consent:

Written consent should be obtained. The examnation the doctor is going to conduct should be explained in detail to the victim. She should also be informed that the reports will be issued to the police/courts and she also has a right to refuse examination.

Her consent should not be influenced by others.The victim must be mentally capable (incapable persons/mentally retarted/psychiatric individuals cannot give valid consent). In such cases the consent of the parents or guardian is essential. For girls below 18 years of age ,consent of the parents/guardian is essential.

vi) History:

History should be obtained separately from the victim, witnesses, police,parents etc.

It should include the full name ,age address, national id card no. The correct age is very important, to determine if she is a minor.

A quick assessment of her mental state should be done, so that one can decide if she is of sound mind to give a reliable history.

Important aspects of the history include the history of the act (eg how many assailants ,is the assailant known to her,was he under alcohol,were any weapons used, was a condom used,was she forced to do oral sex,any anal intercourse etc), menstrual and sexual history.

The time of the incident should be noted ,as it is important as the signs expected on examination may vary as time passes.

To be continued in the final part :Rape Management Part 3

References:

Pages 758 to 759. Chapter 17. Rape.Gynaecology. CMDT 2006. Current Medical Diagnosis and Treatment 2006.45 th Edition. Edited by Lawrence M. Tierney,Jr. Stephen J McPhee, Maxine A. Papadakis.

Pages 122 to 134.Chapter 19 .Sexual offences. Forensic Medicine and Medical Law. Notes on Forensic Medicine and Medical Law.Dr Hemamal Jayawardena .2nd edition. Former lecturer in charge.Department of Forensic Medicine.University of Kelaniya.Sri Lanka.

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