SEXUAL OFFENCES- Module Osce requirmenets

need to know based on presfines

1. SEXUAL OFFENCES 2
CONSENT
I,
………………………………………………………….…………………………
consent to and authorize (Print full name, patient, parent/guardian)
Dr.
……………………………………………………………………………………
….. and/or the medical staff of (Print full name)
…………………………………………….………….Health Centre/Hospital
to obtain a medical history, to perform
a physical examination and administer treatment on
………………………………………………………….(myself)
(Patient’s name if parent/guardian signs)
………………………………………… (Patient,parent/guardian)
………………………………………… (Witness)

2. SEXUAL OFFENCES 2
` CONSENT
For taking Forensic samples and to notify Police.
I further authorise the aforementioned Physician and/or staff of this
Health Centre/Hospital to take the necessary samples for the
Centre of Forensic Sciences Laboratory, to notify the Police of this
occurrence and to turn over to the Police all Forensic Samples and
information necessary for the investigation of this occurrence.
…………………………………( Parent/guardian/patient)
………………………………… (Witness)
Did Police accompany patient to hospitalYes No
Police Station: …………………………………….
Officer’s Name:………………………………...…
Officer’s Number: …………………………………
Telephone Number: …………………………...…

3. SEXUAL OFFENCES 2
Instructions to Medical Officers
1.Print Clearly
2.Describe what is present
3.Do not use abbreviations
4.Send sexual offences form with
Specimen(s)

4. SEXUAL OFFENCES 2
MEDICAL EXAMINATION DEMOGRAPHICS FOR
RAPE CASES
Name: ……………………… Age ………….……
Address: ………………….……………………..…
Date of Birth: ……………… School…………….
Sex: …….….. Race: ……….…………..
Marital Status: ………………
Occupation: …………………
Education Level: ……………

5. SEXUAL OFFENCES 2
HISTORY
Incident:
1.Brief account of circumstance:
Place & Transport
Clothing (type & removal extent)
Activities involved in @ time
Weapon(s) / Threat
Time length of Abuse
Level of conciousness

6. SEXUAL OFFENCES 2
HISTORY
2.Date(s) and time(s) of incident
3.Number and Sex of Assailant(s) for each
incident (if multiple)
4.If victim under 18, relationship of
assailant(s) to victim (Family member,
neighbour, school mate, taxi driver)

7. SEXUAL OFFENCES 2
5.Type of sexual contact:
Genital ………………………
Oral ……….…………………
Anal …..……..………………
Did ejaculation occur? Before, during,
after
Were any other objects used?

8. SEXUAL OFFENCES 2
6.Were condoms used:
Yes [ ] No [ ]
7.Physical abuse other than sexual
•Binding
•Choking
•Kicks, cuffs, slaps, trauma to specific areas
•Bites
•Weapon assault

9. SEXUAL OFFENCES 2
8.Vaginal or rectal bleeding since
incident?
9.Since assault did patient:
Bathe ……………Douche …………...........
Wash …..…….....Urinate ………………….
Defecate ……….. Eat or Drink …….……...
10.Did patient injure the assailant in anyway
e.g., scratch, bite, kick

10. SEXUAL OFFENCES 2
GYNAECOLOGICAL HISTORY:
1.Gravida ………………Para………………
2.L.M.P.……………Normal ………………..
3.If pregnant, how long? …………………...
4.Date and time of last sexual intercourse
prior to incident

11. SEXUAL OFFENCES 2
GYNAECOLOGICAL HISTORY:
5.Date and time of intercourse since incident
6.Contraceptive practice: None …………………..
IUD …….….………… Other …..……….………..
7.Prior gynecological surgery: Hysterectomy:
………………………….……………………….
B.T.L. ………..….…….. Other ………………….
8.Vaginal discharge: Previous ……………………
Since …………………………………….

12. SEXUAL OFFENCES 2
GENERAL MEDICAL HISOTRY:
1.Drug Allergies
2.Past Medical Problems
3.Current Medical Problems
4.Last Tetanus Toxoid
5.Venereal Disease or other infection

13. SEXUAL OFFENCES 2
PHYSICAL EXAMINATION:
A: GENERAL
1.General Description
2.Mental and Emotional Status
3.General Body surfaces: Torn Clothing

14. SEXUAL OFFENCES 2
4.Evidence of alcohol or drugs:
(needlemarks, breath ordour etc.)
5.Description of Trauma: Indicate
abrasions, lacerations, contusions,
fractures, haematomas, burns, marks on
hands, belts, ropes etc., (can use
drawings)
6.Do fingernails have dirt, blood, debris
underneath?

15. SEXUAL OFFENCES 2
Genital-Rectal Examination:
1.Evidence of general trauma to perineum and
genitalia (label drawing/describe)
2.Are fresh/dried blood or secretions present?
3.Hymen is …………... absent …………..……
untraumatized …….….…..…………
traumatized (describe opening, age, location,
type of injury…………......................

16. SEXUAL OFFENCES 2
4.Speculum examination: (use no lubricant). Not
in prepubertal patient if no evidence of
excessive bleeding or trauma to external
genitalia. Vaginal mucosa (haematoma,
lacerations) ……………….….Cervix……………..
………………………Secretions (quantity, colour)
…………………………………….
5.Bimanual examination: Cervix
…….…………………… Uterus
…………………Adenexa ………………..………
6.Anus …………………………….…………………

17. SEXUAL OFFENCES 2
LABORATORY TESTS:
a.Swabs
Vaginal: External Low High
Perineal
Anal: External Internal
Penile:
Other: Secretory areas

18. SEXUAL OFFENCES 2
b.Blood:(2-5 mL –unclotted blood)
a) ABO
b) HIV and VDRL
c.Saliva:(5 mL after mouth wash)
d.Others:Hairs (20-25) ……………………..
Pubic………………………
Head …………………………..
Finger nail cutting……………………

19. SEXUAL OFFENCES 2
TREATMENT:
1.Venereal Disease Prevention Drug and
Dose
2.Prevention of Pregnancy

20. SEXUAL OFFENCES 2
3.Other medication:
Tetanus Toxoid …………………………….
Antibiotics …………..……………………….
Analgesics/anti-inflamatory ………………
4.Suturing………………………….
Dressing …………………………

21. SEXUAL OFFENCES 2
DISPOSITION:
Refer:Medical Social Worker
Urology
Surgery
G.O.P.C.
To return ……………………. days
Other

22. SEXUAL OFFENCES 2
QUESTIONS???
THANK YOU!!!

23. SEXUAL OFFENCES

24. SEXUAL OFFENCES
MEDICAL OFFICER:
Name of Medical Officer
…………………………………………………….
Telephone No.……………………….
Address…………………………………………
…………………………………………………..

25. SEXUAL OFFENCES
CHILD SEXUAL ABUSE:
• Child will usually be brought in by the Police.
If not, please request that this be done or call
the Police.
• Get history from police (or adult
accompanying child).
• Do necessary examination and complete
appropriate forms.
• Take required specimens and have Police
Officer sign as having received same.
• Refer to Medical Social Worker Child
Guidance Clinic –645-2640.

26. SEXUAL OFFENCES
ADULT RAPE:
• Victim is usually accompanied by the Police.
If not, ask that the incident be reported to the
Police.
• If there are ancillary injuries, the Police may
need to take photographs.
• Get history from the Police and the victim.
• Do necessary examination and complete
appropriate forms.
• Take required specimens and have Police
Officer sign as having received same.
• Refer to Medical Social Worker or Rape Crisis
Centre –622-7273; 622-1079.

27. SEXUAL OFFENCES
PHYSICIAN’S RESPONSIBILITY:
A.MEDICAL OFFICER SHOULD BE
NOTIFIED BY THE POLICE OR A
NURSE CONCERNING THE CASE:

28. SEXUAL OFFENCES
1.Obtain history from Police Officer
2.Assess briefly for significant vaginal or rectal
bleeding or other injury requiring immediate
treatment.
3.Refer to hospital if gynaecological or/and
surgical consultation is/are required.

29. SEXUAL OFFENCES
B.ENCOURAGE PATIENT TO
PRESS CHARGES –IF NO POLICE
INVOLVEMENT AS YET.
C.TAKE HISTORY FROM VICTIM
WHILST FULLY CLOTHED.

30. SEXUAL OFFENCES
1.Interview victim alone unless someone is
needed for support.
2.Use vocabulary that is appropriate to the
victim.
3.Ask for a description of the incident.
4.Record carefully statements made to you.
Begin history with “The Victim States”.

31. SEXUAL OFFENCES
D.PREPARE VICTIM FOR EXAMINATION:
1.Explain what will be done, in a gentle manner.
2.Allow parent, nurse or police of same gender
to remain, if presence is supportive.
3.Express your understanding of the patient’s
anxiety.

32. SEXUAL OFFENCES
E.PERFORM EXAMINATION AS ON
MEDICAL EXAMINATION FOR RAPE
CASES FORM.

33. SEXUAL OFFENCES
General Examination:
Appearance
Talk / Speech
Dress
Note Mental and Emotional state of
victim.

34. SEXUAL OFFENCES
Examine whole body surface –documenting
all marks of violence.
Contusions (esp. look at thighs, buttocks, back,
neck & wrists)
Abrasions
Lacerations
Missing hair
Look for secretion areas ears, navel, nostrils,
sternal notch & under breasts

35. SEXUAL OFFENCES
GENITAL EXAMINATION:
Follow these suggestions to increase
uniformity of description and to assist in
providing useable supportive evidence in
court.

36. SEXUAL OFFENCES
1.Extent of examination is dictated by the
age of victim, type of assault and degree
of injury.
2.Consider examination under general
anaesthesia (EUA) if injuries are extensive
or cooperation of the victim is lacking.
(Consult with/refer to Gynaecology).

37. SEXUAL OFFENCES
3.Describe genital / perineal injuries in detail
indicating relative size and position of
injury (see examination form).
4.Look for redness, swelling, abrasions,
hematomas, lacerations and scars.

38. SEXUAL OFFENCES
EXAMINE THE HYMEN:
•The thin redundant membrane originating
from the edge of the vaginal entrance with
a variety of natural openings which are:
usually centrally placed and
measuring
0.5 cm through 6 weeks
0.7 cm through 8 weeks
1.0 cm through 9-10 years.

39. SEXUAL OFFENCES
2.Usually demonstrable in prepubescent
females, but may be torn from causes,
other than intercourse or manipulation,
such as athletic activity. Conversely,
manipulation or penetration may occur
without damaging the hymen.

40. SEXUAL OFFENCES
3.Sample wording of descriptive
statements are:
”The hymen is visualized. The centrally
placed opening measures 0.5 cm.
No tears or scars are noted”.
” There is a recent tear of the hymen at the 6
O’clock position with minimal bleeding –
compatible with recent trauma”.

41. SEXUAL OFFENCES
”No hymen visible”.
”Only remnants of hymenal tissue are noted
around the enlarged introitus compatible with
a sexually active female”.

42. SEXUAL OFFENCES
Examine anus and rectum, observing the
following:
•Presence of pubic hair, faecal soiling, Vaseline or other
lubricant on buttocks/anus. Collect and label specimen.
•Recent anal sodomy is indicated by:
anal swelling –lasting 3-4 days
tears or bleeding
•Skin tags may persist 3-4 weeks afterthe assault

43. SEXUAL OFFENCES
4.If anal sodomy is alleged or suspected:
take an anal swab
perform a digital rectal examination (DRE) -
frank blood suggests internal damage with
foreign body.
5.Sphincter tone:
May be normal after initial episode of
penetration
May be in spasm, not admitting examination
finger for 3-4 hours
Markedly decreased or absent sphincter tone
with gaping of the anus is compatible with
repeated sodomy over a period of time.

44. SEXUAL OFFENCES
VAGINAL OR RECTAL BLEEDING
REQUIRES VAGINOSCOPY OR
SIGMOIDOSCOPY (GYNAECOLOGICAL
OR SURGICAL CONSULTATION)
DON’T BE AFRAID TO ASK FOR CONSULT

45. SEXUAL OFFENCES
MEDICAL TESTS FOR FORENSIC
SCIENCES CENTRE:
SWABS:-use only dry sterile cotton
wool swabs with tubes:
swabs in media destroy the
sperms.

46. SEXUAL OFFENCES
Vaginal–external and internal (low and high):
USE ONLY WATER AS
LUBRICANT FOR SPECULUM
Anal –external and internal
Penile–external (from suspect)
Mouth and any other areas, suspicious for presence
of sperm.

47. SEXUAL OFFENCES
• Motile sperm is demonstrable in the
vagina about up to 6 hours and in the
mouth/anus up to about 3 hours after the
Incident.
• Non-motile sperm is demonstrable in the
vagina up to about 24 hours and in the
mouth/anus up to about 6 hours after the
incident.
• Absence of sperm does not rule out
penetration as some males produce little
or no sperm or the perpetrator may
withdraw before ejaculation.

48. SEXUAL OFFENCES
2.BLOOD:
A specimen from the victim –used for
grouping –ABO. Once the victim’s blood
group is determined, any other type of
blood group substance, identified from
vaginal swab, may be that of suspect.

49. SEXUAL OFFENCES
Two (2) clotted specimens –for VDRL and
HIV –to be submitted to Queen’s Park
Counselling Centre & Clinic (QPCC & C)
and Trinidad Public Health Lab (TPHL)
respectively.
In suspect consents, blood may be also taken
from suspect.

50. SEXUAL OFFENCES
3.SALIVA:
Salvia from the victim is to be
collected in any clean container–
usedto determine whether or not the
person is a secretor of blood group
substances. If blood group substances
are present in the saliva, then they will
also be present in vaginal secretions.

51. SEXUAL OFFENCES
4.OTHERS:
Hair (head and public) –obtained by
combing pubic area and placing in small
plastic bags. If possible, comparative
clippings from the head should be also
submitted.

52. SEXUAL OFFENCES
Fingernail cutting –depends on history. If
victim has scraped suspect with fingernails,
then take cuttings and place in small plastic
bags.

53. SEXUAL OFFENCES
REMEMBER:
1. Label specimens properly:
Name, gender, victim/suspect
Date and time taken
Type of specimen –vaginal
swab, anal swab etc.

54. SEXUAL OFFENCES
1.Complete sexual offences form
2.Give form and specimens to attending
Police Officer.

55. SEXUAL OFFENCES
TREATMENT MODALITIES
1.SEXUALLY TRANSMITTED DISEASE
PREVENTION:
ADULT:
Metronidazole 2.0 gm orally IMMEDIATELY
(bacterial vaginosis prophylaxis)
Doxycycline 100 mg orally twice daily for 10 days
(chlamydial and gonococcal prophylaxis)
Erythromycin 1.5 gm orally IMMEDIATELYand 500 mg
po qid for 4 days (if allergic to penicillin or
PREGNANT)–instead of doxycycline.

56. SEXUAL OFFENCES
TREATMENT
HIV post exposure prophylaxis:
Zidovudine (AZT) 300 mg orally twice daily for 4
weeks
OR
Combivir (300 mg AZT and 150 mg 3 TC
(Lamivudine) 1 tablet twice daily orally for 4 weeks

57. SEXUAL OFFENCES
TREATMENT
CHILDREN:
Amoxil 1.5 gm and Probenecid 0.5 gm orally
IMMEDIATELY (<8 years)
Doxycycline 2 mg/kg/day up to 100 mg orally for 10 days
(>8 years)
Erythromycin 400 mg orally IMMEDIATELY and 200 mg
orally 4 times daily for 4 days (if allergic to penicillin)

58. SEXUAL OFFENCES
2.PREVENTION OF POSSIBLE PREGNANCY:
Postinor (0.75 mg levonorgestrel) 2 tabs.
orally IMMEDIATELYand 2 tablets 12 hours
later
OR
Nordiol 21 (0.25 mg. levonorgestrel and
.05 mg. ethinyl estradiol) 2 tablets orally
IMMEDIATELYand 2 tablets 12 hours later.

59. SEXUAL OFFENCES
TREATMENT
3.OTHER MEDICATIONS:
Tetanus toxoid (0.5 ml) if needed
Antibiotics (topical) for wounds
Analgesics / anti-inflammatory agents
Sedative
4.OTHER TREATMENT GIVEN:
Suturing and/or dressing of wounds.
Counselling

60. SEXUAL OFFENCES
FOLLOW-UP AND REFERRAL:
•Ask victim to return for review in six (6)
weeks time for Urine Pregnancy Test
(UPT), HIV serology and VDRL results
•Refer to Gynaecology Out Patients Clinic
(GOPC) or Genitourology Clinic (Male) if
necessary

61. SEXUAL OFFENCES
• Refer to Psychiatrist, as indicated.
• Refer all cases to the MEDICAL SOCIAL
WORKERwho will screen and refer to Rape
Crisis Centre, as necessary.
• Refer to Rape Crisis Centre: 622-7273;
622-1079, IF URGENT.

62. SEXUAL OFFENCES
QUESTIONS???
THANK YOU!!!