Potency_test.pptx.journal.topic:forensic

impotence test, opinion

1. Comprehensive Review and Recommendations for Evaluation of Sexual Potency of Male in Context of Current Indian legal system REVIEW ARTICLE J Indian Acad Forensic Med. 2023 Jan-Mar 45 (1) Authors: Akhade SP, Kothari P, Sabale PR, Chavali KH. Assistant Professor, Additional Professor, Professor, 1. Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Raipur. 2. Department of Urology. Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai. 3. Department of Forensic Medicine & Toxicology. Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai. 4. Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Raipur.

2. INTRODUCTION The sexual potency of a male is the ability to achieve an adequate erection to be able to perform sexual intercourse and consummate Medicolegal evaluation for potency in the Indian context (as per section 53A CrPC) Law prevalent in India prior to 2013 described rape as sexual intercourse with a woman without her consent, by force, fear, or fraud and peno -vaginal intercourse was an essential component Even after the amendment of law, the practice of referral of the accused for evaluation of potency ( popularly k/a “Potency test”) continues till this day

3. CURRENT PRACTICE OF THE ACCUSED-POTENCY TEST In India, most examinations conducted in government-run primary healthcare facilities, Community Health Centres and district hospitals by MBBS doctors Standard routine opinion in the double negative form stating that “There is nothing to suggest that the examined person is incapable of performing sexual intercourse”

4. INDICATIONS FOR MEDICOLEGAL EVALUATION OF SEXUAL POTENCY IN MALES Criminal Civil Sec 375(A) IPC [ victim alleges in her statement] Dissolution of marriage d/t impotence Section 3 (a) of POCSO Act Compensation d/t loss of sexual function vide Section 320 IPC Physical assault vide Section 320 IPC

5. STEPS FOR EVALUATION OF POTENCY IN MEDICOLEGAL CASES 1. Sexual, Medical and Psychosocial history 2. Physical examination 3. Investigations 4. Office Sildenafil Test (OST) / Intra-penile examination 5. Ancillary Tests Penile Doppler (for confirmation of severe impotence) Rigi scan (Nocturnal Penile Tumescence Rigidity) Dynamic Infusion Cavernosometry Cavernosography (DICC) 6. Evaluation for psychiatric co-morbidities 7. Framing the Opinion

6. Relevant History (relating to sexual arousal to stimulus & libido) General Physical Examination Blood investigation Consent for visual/self stimulation No Yes Civil cases Stop further assessment Criminal cases further proceed as Sec 53 CrPC Not responding to visual/ self stimulation Responding to visual/ self stimulation Office Sildenafil Test + Stimulation (visual, self, vibrator) Potent No further assessment is required Erection (Turgid, well sustained) No Intracavernosal injection of vasoactive drug (low dose- 0.1 ml) Potent No further assessment is required Yes Erection (Turgid, well sustained) Yes Potent No further assessment is required Psychogenic or neurogenic cause of impotence or false claim No Incremental doses of Intracavernosal injection of vasoactive drug Erection (Turgid, well sustained) d-pcdu PSV < 25 CM/SEC confirms No Yes Further interpretation depending on dose required Note: CAUTION: Incremental doses to be given in separate setting as supraphysiologic doses can lead to priapism requiring intra-penile injection of adrenaline to achieve detumescence. (Should be done under strict supervision of urologist) Yes

7. CELLULAR PATHWAYS IN ERECTILE FUNCTION

8. DYNAMIC PENILE COLOUR DOPPLER ULTRASOUND (D-PCDU) Peak systolic velocity (PSV) more than 35 cm/sec indicates arterial sufficiency and PSV less than 25 cm/sec suggests insufficiency In association with a normal arterial response, an end diastolic velocity (EDV) >5 cm/second is accepted as the measurement at which a venous leak is present

9. NOCTURNAL PENILE TUMESCENCE AND RIGIDITY (NPTR) TESTING VIA RIGISCAN

10. HORMONE ASSAYS

11. CONCLUSION If a person is found responsive then the opinion could be framed in an affirmative manner, such as “The findings of examination suggest that the person examined is physiologically capable of performing sexual intercourse” If a person is found responsive but is detected to have a psychogenic cause for the impotence, then opinion could be framed in the following manner - “The findings of examination suggest that the person examined is physiologically capable of achieving penile erection sufficient to perform sexual intercourse. However, he is found to be suffering from _______ psychiatriac disorder that could have bearing on his potency” If the person is found unresponsive, opinion can be framed on the following lines : “The findings of examination and investigations suggest that the person is not capable of achieving and / or maintaining penile erection. This impotence is found to be due to ___________ (etiology) and is likely to be reversible/irreversible”

12. RECOMMENDATIONS The potency examination of accused should only be conducted if the person charged under sections (Sec 375(A) IPC) and Sec 3(a) of POCSO Act i.e. sexual assault by penetration of penis in any orifice of the survivor and claiming impotence as a defense To put forth a framework for scientifically evaluating impotence / sexual dysfunction among the persons sent for justified medicolegal evaluation of potency and giving an opinion that would be more scientific and objective than the usual practice of giving a guarded opinion in the double negative format