Medical Evidence

When obtaining the relevant forensic samples, the forensic practitioner should inspect the male genitalia with particular reference to the following points:

1. Pubic hair should be described in terms of its coarseness, distribution (Tanner stages 1-5), and color. A note should be made if the pubic hair appears to have been plucked (including bleeding hair follicles), shaved, cut, or dyed.

2. Congenital abnormalities, such as microphallus and cryptorchidism. Penile length in the flaccid state is said to vary from 8.5 to 10.5 cm (measured from the anterior border of the symphysis along the dorsal surface to the distal tip of the penis), with a documented range of 6-14 cm (153).

3. Acquired abnormalities, such as circumcision, Peyronie's disease, balanitis xerotica obliterans, vasectomy scars, phimosis, tattoos, and piercing.

4. Signs of infection, such as warts, discharge, erythema, and vesicles.

5. Foreign bodies may be worn around the base of the penis, sometimes also encircling the scrotum, in an attempt to increase and sustain penile tumescence. Such devices may result in local and distal genital trauma (penile tourniquet syndrome)

(157). In several case reports, children have had human hairs wrapped around the penis; these hairs may be virtually invisible because of edema or epithelialization

(158). Kerry and Chapman (159) have described the deliberate application of such a ligature by parents who were attempting to prevent enuresis.

6. Assessment of injuries. After consensual sexual intercourse, lacerations of the foreskin and frenulum, meatitis, traumatic urethritis, penile edema, traumatic lymphangitis, paraphimosis, and penile "fractures" have all been described (160163). Accidental trauma is more common when there is a pre-existing abnormality, such as phimosis (160). Skin injury may be incurred if the genitals are deliberately bitten during fellatio (160). Although the precise incidence of male genital trauma after sexual activity is unknown, anecdotal accounts suggest that it is rare to find any genital injuries when examining suspects of serious sexual assaults (164).

In children the genitalia may be accidentally or deliberately injured, and the latter may be associated with sexual abuse (165). Bruises, abrasions, lacerations, swelling, and burns of the genitalia of prepubescent males have all been described (165,166).

10. Perianal Area and Anal Canal

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