Sexual assault : the medical-legal examination / Sharon R. Crowley.

Format:

Book

Author/Creator:

Crowley, Sharon R.

Language:

English

Subjects (All):

Rape victims--Medical examinations.

Rape victims.

Forensic nursing.

Sex Offenses.

Forensic Medicine--methods.

Genitalia--anatomy & histology.

Rape.

Medical Subjects:

Sex Offenses.

Forensic Medicine--methods.

Genitalia--anatomy & histology.

Rape.

Physical Description:

xvii, 227 pages, 16 pages plates : illustrations (some color) ; 25 cm

Place of Publication:

Stamford, Conn. : Appleton & Lange, [1999]

Summary:

This book provides a complete reference manual for all health professionals who perform emergency sexual assault exams. The contents will cover the protocols of the exam, as well as the legal and medical considerations of the exam, so that physical evidence will hold up in a court of law. Colposcopic and full-color photographs clearly illustrate physical injuries found in sexual assault victims. The author considers both the

Contents:

Incidence Data 2

International Association of Forensic Nurses (IAFN) 2

The Team Approach to Sexual Trauma 2

International Endeavors 2

Advantages of a Team Approach 4

Members of the Multidisciplinary Team 4

Law Enforcement 4

Victim Advocate 4

Criminalist 5

District Attorney (DA) 5

SART Director/Program Coordinator 5

Forensic Examiner 5

Sexual Assault Nurse Examiners (SANEs) 6

Requisite Skills and Knowledge 7

2. The Psychological Aftermath of Sexual Trauma 11

Defining the Problem 12

Incest 13

Acquaintance Rape 13

Stranger Rape 13

Rape Trauma Syndrome 13

Posttraumatic Stress Disorder 15

Past History of Abuse: Somatic Complaints 16

Adolescent Examination Issues: Male and Female 16

The Adolescent Male Victim of Assault 18

Recognition of Abuse in Adolescent Males 19

The Male Victim of Sexual Assault 20

The Pregnant Victim of Assault 21

Rape of the Older Woman 22

Gay and Lesbian Victims of Sexual Trauma 23

The Gay Male Victim of a Gay Male Assailant 23

Lesbian Rape 24

Special Circumstances: Female Genital Mutilation 25

3. Genital Anatomy 31

Female Genital Anatomy 31

The Vulva 31

Perineum 32

Labia Majora 33

Labia Minora 35

Clitoris 36

Vestibule 36

Hymen 38

Vagina 38

Cervix 41

Uterus 42

Fossa Navicularis 43

Posterior Fourchette 43

Anus 45

Rectum 46

Male Anatomy 46

The Penis 46

Prostate 48

Scrotum 48

Epididymis 49

Vas Deferens 49

The Testes 49

Sperm 49

Postmenopausal Changes in Anatomy 50

Ovaries 51

Labia Majora and Labia Minora 51

Vagina 51

Bladder and Urethra 52

Other Organ Changes 52

Human Sexual Response 52

Excitement Phase: Female Response 53

Excitement Phase: Male Response 53

Plateau Phase: Female Response 53

Plateau Phase: Male Response 54

Orgasmic Phase: Female Response 54

Orgasmic Phase: Male Response 54

Resolution Phase: Female Response 54

Resolution Phase: Male Response 57

Human Sexual Response in the Postmenopausal Woman 57

Human Sexual Response: Implications 58

Anal Intercourse 58

4. The Medical

Legal Examination 63

Developing a Style 64

General Patient Assessment 64

Victim Interview 65

Physical Examination 66

Clothing 66

Collection of Clothing 66

Head and Neck 66

The Eyes 67

The Mouth 69

The Neck 69

Upper Extremities 70

Chest and Trunk 70

Breasts 70

Abdomen 70

Lower Extremities 70

The Genital Examination 71

Optional STD Testing 72

Examination Positions 72

Public Hair 73

Labial Separation 74

Labial Traction 74

Inspection of Hymenal Borders 74

The Speculum Examination 75

Preparation of Vaginal Swabs and Slides 77

Anal and Rectal Examination 78

Insertion of the Anoscope 80

Physical Finding in Sexual Assault 80

Injury in Sexual Assault 83

Genital Injury in Adolescent Female Victims 86

Findings in Postmenopausal Rape Victims 86

False Allegations of Rape 87

Patterns of Genital Injury 88

Technology to Evaluate Trauma 89

Photography 89

Camera Functions 89

Photographic Protocols and Techniques 90

Evaluation of Nongenital Trauma 91

Description of Bitemarks 91

Procedures for Collection of Evidence from Bitemarks 92

Swabs of Bitemarks 92

Photography of Bitemarks 93

Lighting 93

Bitemark Impressions 93

Colposcopy 94

The Electromagnetic Spectrum 95

The Wood's Lamp 97

The Alternate Light Source (ALS) 98

5. Physical Evidence in Sexual Assault Cases 103

The Nature of Physical Evidence 103

Evidence Kits 104

Specimens for Evidence of Semen, Sperm, and Genetic Typing 105

Oral Specimens 106

Vaginal Specimens: Preparation of Slides and Swabs 106

Acid Phosphatase 108

P[subscript 30] (Seminal-specific Glycoprotein) 109

Rectal Specimens 109

Penile Specimens 109

Aspirates or Washings 109

Other Evidence to the Crime Laboratory 109

Clothing 109

Fingernail Scrapings 110

Foreign Materials 110

Collection of Moist Secretions 110

Collection of Dried Stains 110

Collection of Crusted Stains 111

Condoms 111

Matted Pubic Hair 111

Public Hair Combings 111

Swabs of Bitemarks 111

Reference Standards 112

Blood Alcohol and Urine Toxicology 112

Preservation of Evidence 113

Storage 113

DNA in Sexual Assault Cases 114

Conventional Serology 114

DNA 114

Results: Significance of a Match 115

Restriction Fragment Length Polymorphism (RFLP) 116

Polymerase Chain Reaction (PCR) 117

Combined DNA Index System (CODIS) 117

Flunitrazepam (Rohypnol) and Gamma Hydroxy Butyrate (GHB) 117

6. The Rapist: Aspects of Deviant and Criminal Sexuality 123

Criminal Investigative Analysis 124

Interview of the Victim 124

Physical Behavior of the Offender 124

Approach Used by the Offender 124

Level of Force 125

Maintaining Control of the Victim 125

Victim Resistance 125

Verbal Behavior of the Offender 126

Sexual Behavior of the Offender 126

Bondage 127

Sexual Dysfunction 127

Paraphilias 128

Rapist Typologies 130

Power

Reassurance Rapist 130

Assertive Rapist 131

Anger

Retaliatory Rapist 131

Excitation Rapist 131

The Serial Rapist 131

The Criminal Sexual Sadist 132

Appendix A. Physical Evidence for Submission to Criminalistic Laboratories 137

Appendix B. Sexual Assault Examination: Evidentiary Checklist 141

Appendix C. Tanner Stages 145

Appendix D. Dictation Format for Adult and Adolescent Sexual Assault Examinations 147

Appendix E. Suspect Examination Protocol 149

Appendix F. Medical

Legal Form for Documentation of Sexual Assault Examination 153

Appendix G. Medical

Legal Documentation Form and Nursing Care Plan for Sexual Assault Victims 167

Appendix H. Sexual Assault Response Team (SART) Continuous Quality Improvement (CQI) 177

Appendix I. Sexually Transmitted Diseases (STDs) 179.

Notes:

Includes bibliographical references and index.

ISBN:

0838585337

OCLC:

39614683