2. Sexual assault and rape cases are increasing at an
alarming rate in India
Sexual Assault can Happen
to anyone shattering her life completely
(She can be your Daughter, Sister, Girl Friend & Even Mother !!)
3. Sexual Assault is a serious problem and must
not be taken lightly
by DOCTORS
4. Recent Statistics
1 in 6 to 1 in 3 women will be raped during her
lifetime (Anderson, 2009; Luce, 2010).
Up to 40% of these women have been found to be
sexually assaulted more then once (kilpatrick,
1992).
Many rapes are unreported, ↑ 70% because of a
victim’s feeling of shame and guilt. (India)
5. Delhi High Court - Judgment
Following Judgment of division bench of DELHI HIGH
COURT comprising of chief justice sh. D Murgeshan
and justice sh.V.K. Jain stating that the government must
issue direction to all hospital including those in Private
sector - not to deny emergency treatment to rape
victims.
Dept of Health and Family welfare NCT of Delhi has
directed nursing homes and private hospital not to refuse
emergency treatment to rape Victims / give care
Failing which face punishment.
7. A brutal crime rape
or sexual assault
leaves the victim in
an emotionally and
physically
vulnerable state
Every Lady doctor has
to get trained in Rape
Victim exam & care
8. Lets Know the LAW
New Definition Of RAPE
(According to 2013 amendment)
1. Penetrates his penis, to any extent, into the
vagina, mouth, urethra or anus of a women
or makes her to do so with him or any other
person; or
•Insert, to any extent, any object or a part of the
body, not being the penis, into the vagina, the
urethra or anus of a women or makes her to do
so with him or any other person;
9. •Manipulates any part of the body of a women so
as to cause penetration into the vagina, urethra,
anus or any part of body of such women or makes
her to do so with him or any other person
Or
•Applies his mouth to the vagina, anus urethra of a
women or makes her to do so with hem or any
other person, under the circumstances falling
under any of the following seven descriptions:
Lets Know the LAW Cond.
New Definition Of RAPE
(According to 2013 amendment)
10. FIRST – Against her will
SECONDLY – without her consent
THIRDLY – with her consent, when her consent has been
obtained by putting her or any person in women she is interested
in fear of death or of hurt.
FOURTH – with her consent, when the man knows that he is not
her husband and that her consent is given because she believes
that he is another man to whom she is or believes herself to be
lawfully married.
Lets Know the LAW Cond.
New Definition Of RAPE
(According to 2013 amendment)
11. FIFTHLY – with her consent when, at the time of giving such consent, by
reason of unsoundness of mind or intoxication or the administration by
hem personally or through another of any stupefying or unwholesome
substance, she is unable to understand the nature and consequences of
that to which she gives consent.
SIXTHLY – with or without her consent, when she is under eighteen
years of age
SEVENTHLY – when she is unable to commutate consent
2.INJURIES ON VICTIMS BODY HAS NO RELEVANCE
Lets Know the LAW Cond.
New Definition Of RAPE
(According to 2013 amendment)
12. It is important that victims of sexual assault or rape is received by
sympathetic and sensitive doctor, appropriate medical care &
treatment and clinical evidence saved.
13. Adequate attention victims to
emergency medical, emotional, and
legal needs
• Trained Doctor & her team
• Special kit for examination
• Treatment to prevent STD/
Pregnancy is crucial
Most Important
14. What you can do before
reaching hospital ?
As soon as one comes across a victim
Of Sexual assault, the first step is to
ensure SAFETY
• Take her to safe and secure place call the
police if danger from the assailant is still there.
• Call a close friend or relative- someone who
will offer unconditional support.
15. • One must take care not to clean up before
taking them to hospital. The victim should
not bath, go to the bathroom, comb hair,
change clothes or brush teeth before
undergoing a medical examination.
• This will help to preserve all the evidence.
Instructions to the Victim
What you can do before
reaching hospital ?
16. Emergency Care
The doctor’s job at the emergency room is not to
determine if the rape has happened or not.
Rape is a legal term
– a crime –
and whether this crime has been committed or
not will be decided by the Honorable court.
17. Principle of Emergency Care
• The attitude of the medical staff
should be compassionate and not
judgmental
• Life threatening emergency, if present
needs urgent attention
18. Our Aim should be
• Immediate treatment of any physical injuries
• Detailed physical examination – for abrasions , bruises
and laceration. Presence or absence of injuries are no
sign of protest on consent
• Injuries are seen in only one third cases.
• Common sites of extra genital trauma are mouth, throat,
wrists, arms, breast and thighs. It is essential to do a
careful recording of the findings if there presents.
19. Guidelines for Medical Examination
As per new law 2013
• Victim : the first aid medical treatment to the
victim of rape and vitriolage shall be provided
promptly and free of cost by all hospital public or
private
• Medical examination of a female victim shall be
conducted by a female registered medical
practitioner, in absence there of , in presence of
a female registered medical practitioner
20. • Police requisition /FIR is not mandatory for seeking
medical care and treatment of the victim.
• Two finger admissibility test on a women victim
shall not be performed
and
• Recording of “victim is habituated to sexual inter
course or not” shall not form a part of report at all.
Guidelines for Medical Examination
As per new law 2013
21. Punishment for non Compliance
for we doctors
Whoever, being in charge of a hospital ,
public or private , whether run by the
central Government, local bodies or any
other person, contravenes the provisions
of sections 357c of the code of criminal
procedure , 1973(2 of 1974), shall be
punished with imprisonment for a term
which may extend to one year or with fine
(166B – IPC)
22. In sexual abuse victims
screening recommended
• Pregnancy test
• HIV, STD TEST
• Blood and urine for addiction or substance
abuse such as: heroin , opium,
benzodiazepine and alcohol
23. Collection of Evidence
• The doctor should collect hair semen, clothing
fibers and other evidence of the attacker.
• Even if the victim is not sure, whether she
wants to report the attack, it is still important to
collect and preserve evidence so it can be
accessed at a later date, if necessary.
• Evidence not collect within 48 to 72 hours of the
incident is often undercoverable or invalid.
24. Collection of Evidence
• All specimens collected during the examination
should be carefully sealed and dated.
• Evidence should kept in a locked box in the
emergency department until a police officer
arrives.
• The officer should transport the evidence to the
nearest crime laboratory
25. Collection of Forensic Sample
Followings samples are required to be
collected in sexual abuse cases
• Blood (blood grouping, testing drug intoxication)
• Urine (to test for suspected pregnancy, drug testing)
• Seminal stain (blood grouping)
• Nail scrubbing (to look for epithelium of the assailant)
• Hairs (to look for seminal stain, foreign hair)
• Vaginal swab (vulva , low vaginal, high vaginal) to stress
here that it should be made a routine
• Microscopic examination of vaginal slides (motile and
immotile sperm)
• Ultraviolet test for detection of seminal and saliva stains
26. Swabs and Smears
Vagina
Take a dry or saline wet swab according to observation
a. Labial Part
b. External orifice
c. Deep Vaginal Swab
d. From Cervix
e. From things public , rectal or affected area if required
For spermatozoa, smear are prepared from the external genital
Organs . The smears are fixed on the slide one drop of alcohol
27. Swabs and Smears
• Mouth
Swab from under the tongue and buccal
area near molars. Take one swab from
each area and prepare the smear
• Rectum
Take one sample from the external parts
and another from the 2-5 cm area external
orifice
28. Essential for preparing smearing –
instruction used to obtain a smear:
• Clean microscopic glass slides of good quality,
preferably with frosted ends
(0.96-1.06 mm. thickness).
• Suitable glass marking pencil or a diamond
marker for identification of slides.
• Paper clips to separate the slides.
• Fixative 95% ethy alcohol or 100% methy
alcohol
• Laboratory from with clear identification of the
patients and history
29. Motility of Sperm – Prepare a hanging
drop Preparation
• Place a drop of vaginal pool secretion on a
cover slip
• Apply a circular band of clay over a glass
slide
• Put an inverted cove slip over it
• Look under a microscope
• Motile sperms can visualized up to four –
five hours
30. Various Tests
• Pregnancy test (Urine or serum)
• Serum hepatitis B surface antigen (HBsAg)
assay
• VDRL test.
• Culture for neisseria gonorrhoeae
• Microscopic evaluation of vaginal discharge
saline prep
• If HPV PEP is planned, than CBC, serum liver
function test, and serum creatinine level.
32. Prevention of pregnancy
Emergency Pill : levonorgestrel 0.75 mg one
pill orally every 12 hours for two doses
UPT : to be repeated at 1,2 weeks & MTP if
need be
33. Sexually transmitted diseases
Incubation period of common infections
• Gonorrhea 3-4 days
• Trichomonas 1-4 weeks
• Chlamydia 7-14 days
• Warts several months
• Herpes 2-14 days
• Herpes vaginosis 2-14 days
• Syphilis 3 months
34. Metrogyl 2gm orally - single dose
Azithromycin 1g - orally single dose
Ceftriaxone 250 mg I/M single dose
Universal STD Prophylaxis
36. Emotional support
Sexual assault victim need unconditional
emotional support as they may be struggling
with emotions of
Anger,
Fear,
Guilt,
Shame and anxiety
37. Emotional Support
The Victim May Suffer From
• Sleep disturbances
• Lack of appetite
• Depression and nightmare
• Physical pain
38. Counseling
Most victims find counseling helpful in the
process of recovering and moving on with
their life.
The care a patients initially receive
influences her recovery from the trauma
suffered due to rape
Follow up is must
39. Please Remember
Girls can not stop rape just by changing
their own behavior
violent never stop unless they are
Punished
Please join hands with Delhi Gynaecologists
forum’s campaign to do great medical
examination & care
42. Top reasons of increasing
Sexual Assault & Rape Victims in India
DR. Sharda Jain / Malti
Slide share. net
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FILM
On Medical Examination of Rape Victim
Prepared by MOWCD / IMA
Youtube
13
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