Rape | Medical Science Optional Notes for UPSC PDF Download

Rape-Definition

IPC SECTION 375
(a) Penetrates his penis into the vagina, mouth, urethra or anus; or
(b) Inserts any object or any part of his body (not being his penis), or applies his mouth into the vagina, mouth, urethra or anus; or
(c) Manipulates any part of her body so as to cause penetration into the vagina, urethra or anus, under the following circumstances:
(i) Against her will
(ii) Without her consent
(iii) With her consent,
When: 

1. Fear 
2. Impersonation 
3. Intoxication 

(iv) With or without her consent, when she is under 18 yejits of age or when she is unable to communicateconsent.

Exceptions 

• Medical intervention or procedure will not constitute rape.
• Sexual intercourse by a man with his wife not being under 15 years of age is not rape

Rape-Medicolegal Examination

Stepwise Approach

• First Response and Emergency Care
• Build a connection with the survivor and acquire consent with full information.
• Thoroughly gather the individual's medical history.
• Conduct a comprehensive examination covering general and local aspects of health.
• Assessing age through physical, dental, or radiological means, if requested by the investigating agency.
• Record-keeping
• Addressing and treating injuries
• Collecting evidence
• Properly packaging, sealing, and transferring evidence to law enforcement
• Screening and preventive measures for sexually transmitted diseases, HIV, Hepatitis B, and pregnancy
• Offering psychological assistance and counseling

Physical Examination

• Assessing orientation in time and space, monitoring pulse, blood pressure, respiration, temperature, and observing the state of pupils.
• Noting any indicators of intoxication resulting from the ingestion or injection of drugs/alcohol.
• Conducting an examination of the oral cavity to identify signs of bleeding, discharge, tears, edema, or tenderness.
• Inspecting clothing for stains (blood, seminal fluid, sand, or grass), soiling, tears, and loss of buttons, while documenting the location and type of damage.
• Recording the stage of sexual maturation of breasts.
• Limiting examination of extra-genital trauma to areas such as breasts, extremities, neck, buttocks, and oropharynx. Injuries are best documented using body charts.
• Identifying marks of violence, especially contusions and abrasions, with a focus on fingernail abrasions that may be present.

Local Examination

• Positioning the patient in the lithotomy posture on the examination table, ensuring adequate illumination and full exposure of the relevant areas.
• Examining pubic hair for matting caused by seminal fluid or blood, as well as checking for the presence of foreign hair.
• Identifying acute injuries in the genital or anal regions, including abrasions, bruising, edema, and lacerations, summarized by the acronym TEARS (tears, ecchymosis, abrasions, redness, and swelling).
• Noting that hymenal laceration typically occurs during initial intercourse, and in a virgin, it serves as a primary indicator of this experience.
• Observing that hymenal tearing commonly takes place posterior-laterally or in the middle (5 to 7 o'clock position).

 Specimens Prepared for Laboratory Examination:

• Clothing: Scrutiny for tears, stains, and foreign materials.

• Scrapings from dried bloodstains: Evaluation of blood grouping and DNA characteristics.

• Scrapings from dried seminal stains: Analysis of grouping, sperm presence, acid phosphatase, semen-specific glycoprotein (P30), and DNA profiling.

• Hair: Examination of tangled pubic hair, foreign hair, and plucked/cut hair from the pubis and scalp.

• Nails: Inspection for broken nails and gathering of scrapings from beneath the nails.

• Bite mark examination: Acknowledging the uniqueness of bite marks, akin to fingerprints.

• Blood: Thorough analysis covering blood grouping, alcohol and drug content, VDRL, HIV, and DNA profiling.

• Swabs from any soiled skin areas, bite marks, mouth, pharynx, vagina, and anus to detect the presence of spermatozoa, microorganisms, P30 glycoprotein, and sexually transmitted diseases.

• Conduct a urine pregnancy test.

• Age estimation: If law enforcement requests, consider recommending radiographs of the wrist, elbow, shoulders, and pelvis, along with a dental examination for age estimation.

• In case of any suspected fracture, it is recommended to obtain X-rays for the relevant area of the body.

Nirbhaya act (Criminal Law Amendement Act 2013)

• The definition of rape has been modified.
• Penetration is now defined as "penetration to any extent," and the absence of physical resistance is considered in constituting an offense.
• The age of consent has been raised to 18 years.
• The punishment has been strengthened.

Safe Kit

• Comprehensive guidance for the examiner
• Documentation forms
• Catchment paper
• Glass slides
• Nail cutter, comb, scissors
• Sealing wax, labels, wooden stick for collecting fingernail scrapings
• Cotton swabs for collecting biological evidence
• Envelopes or boxes for individual samples of evidence

Sexual assault forensic evidence kit

• Spacious sheet for the patient to undress on.
• Paper bags for gathering clothing.
• Disposable gloves.
• Sterile or distilled water.
• Container for urine samples.
• Dental floss without wax.
• Tubes or vacutainers for various blood samples (EDTA, plain, NaF).
• Syringes and needles for blood extraction during examination.
• Fresh clothing and personal hygiene items (for the survivor's use afterward).

Vital Reaction

In the affirmative phase, adenosine triphosphatase and esterase activities elevate within the initial hour following an injury, amino-peptidase within two hours, acid phosphatase within four hours, and alkaline phosphatase within eight hours.