Introduction

Sexual assaults create significant health and legislative problems for every society. All health professionals who have the potential to encounter victims of sexual assaults should have some understanding of the acute and chronic health problems that may ensue from an assault. However, the primary clinical forensic assessment of complainants and suspects of sexual assault should only be conducted by doctors and nurses who have acquired specialist knowledge, skills, and attitudes during theoretical and practical training.

There are many types of sexual assault, only some of which involve penetration of a body cavity. This chapter encourages the practitioner to undertake an evidence-based forensic medical examination and to consider the nature of the allegation, persistence data, and any available intelligence.

The chapter commences by addressing the basic principles of the medical examination for both complainants and suspects of sexual assault. Although the first concern of the forensic practitioner is always the medical care of the patient, thereafter the retrieval and preservation of forensic evidence is paramount because this material may be critical for the elimination of a suspect, identification of the assailant, and the prosecution of the case. Thus, it is imperative that all forensic practitioners understand the basic principles of the forensic analysis.

Thereafter, the text is divided into sections covering the relevant body areas and fluids. Each body cavity section commences with information regard-

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

ing the range and frequency of normal sexual practices and the relevant anatomy, development, and physiology. This specialist knowledge is mandatory for the reliable documentation and interpretation of any medical findings. The practical aspects—which samples to obtain, how to obtain them, and the clinical details required by the forensic scientist—are then addressed, because this takes priority over the clinical forensic assessment.

The medical findings in cases of sexual assault should always be addressed in the context of the injuries and other medical problems associated with consensual sexual practices. Therefore, each section summarizes the information that is available in the literature regarding the noninfectious medical complications of consensual sexual practices and possible nonsexual explanations for the findings. The type, site, and frequency of the injuries described in association with sexual assaults that relate to each body area are then discussed. Unfortunately, space does not allow for a critical appraisal of all the chronic medical findings purported to be associated with child sexual abuse, and the reader should refer to more substantive texts and review papers for this information (1-3).

Throughout all the stages of the clinical forensic assessment, the forensic practitioner must avoid partisanship while remaining sensitive to the immense psychological and physical trauma that a complainant may have incurred. Although presented at the end of the chapter, the continuing care of the complainant is essentially an ongoing process throughout and beyond the primary clinical forensic assessment.

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