Sexual Violence in Adolescents 2012 Tadulako

8/20/2019 Sexual Violence in Adolescents 2012 Tadulako

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Sexual Violence in

AdolescentsYudha Nurhantari

2010


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• Tujuan

• Memahami pengertian kekerasan isik danseksual

• Memahami kepentingan medikolegal

• Memahami prosedur dan etikapemeriksaan


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!ntroduction

• Sexual "iolence is a glo#al pro#lem

• Majorit$% &omen men and children #oth

sexes• Negati"e impacts on health%

1' (eproducti"e and sexual health %

un&anted pregnanc$) ST!)*!V) adoption orisk$ sexual #eha"iors


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• 2' mental health serious+long lasting%

depression) su#stance a#use) post

traumatic stress disorder) suicide'


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Sexual "iolence

• a term co"ering a &ide range o acti"ities)

including rape,orced sex) indecent assault

and sexuall$ o#sessi"e #eha"iour

• a&are o the legal deinitions o sexual

"iolence &ithin their o&n jurisdiction the

age o consent and marriage'


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-einition ./e&kes et al)2002

• an$ sexual act) attempt to o#tain a

sexual act) un&anted sexual comments or

ad"ances) or acts to traic &omens

sexualit$) using coercion) threats o harm

or ph$sical orce) #$ an$ person

regardless o relationship to the "ictim3'


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4alse agreement to sexual

acti"it$%• threats o ph$sical "iolence)

+ threats o &ithholding #eneits .such as a

promotion at &ork or a good grade)+ ps$chological pressure or #lackmail

• una#le to gi"e consent% a mental disa#ilit$

incapacitated due to the eects o alcoholand,or drugs)


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Men as victims of sexual

violence

• Men most commonl$ experience sexual

"iolence in the orm o %

5 recepti"e anal intercourse65 orced mastur#ation o the perpetrator6

5 recepti"e oral sex6

5 orced mastur#ation o the "ictim'


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Sexual 7ences

• According to 89*:) coitus ma$ occur&ithin .2;;or non marital.2;ithin marital% injured or caused death to

the underage &ie• TheMedico legal purpose, e"idence %

1' signs o coitus

2' signs o "iolence ?' estimation o age


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Sign o coitus

@oitus is penis penetration .completel$or partiall$into "agina'The e"idence are depends on %

1' sie o the penis 2' degree o penetration ?' shape and elasticit$ o h$men


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Djaculate

• -etect the sperm the #est e"idence

• -etect the component % :?0) acidphosphatase en$me) kholin) spermin)

• The a#sence o ejaculate %

1' no coitus

2' coitus &ithout ejaculation

?' coitus using condom


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Time Dstimation

• Sperm % ound aging'

@omplete healing % =+10 da$s


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Signs o Violence

• Eite marks) hematoma) a#rasion

• Mouth) lips) neck) #reast) &riest) emur)and genitalia

• Need toxicological examination chemical "iolence


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Age estimation

• 89*: art' 2;< and 2;= under 12 orunder 1B $o

• ph$sical de"elopment) secondar$ sexual

signs) teeth) #one) cranial suture usion• Marrige competence

#iolog$% menarche

la& % 1C $'o'


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*omosexual

• a sexual oences under age .89*:2F2 or married histor$

• Dxamination

1' Male % age estimation) ejaculate) anus.unnel shape) m' sphincter ani relaxed'

2' 4emale % age) signs o genital

manipulation #$ hands or instrument


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Assessment and examination

• o#taining inormed consent

• A medical histor$

• a top+to+toe3 ph$sical examination• a detailed genito+anal examination

• recording and classi$ing injuries

• collection o indicated medical specimensor diagnostic purposes


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!normed consent

• is a central issue in medico+legal matters1'Dxamination) including examination o the genitalia andanus'

• 2' @ollection o specimens or medical in"estigations to

diagnose an$ medical pro#lems'• ?' @ollection o specimens or criminal in"estigation'

•


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medical histor$

• Relevant medical/surgical/psychiatric

history

• Relevant gynaecological history

• Allergies

• Medications/immunization status

• History of offence from patients andother parties

• Current symptoms


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descri#ing &ounds

• consider% site) sie) shape) surrounds)

colour) contours) course)contents) age)

#orders and depth'


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>ound classiication

• A#rasion% disruption o the outer la$er o theskin'

• Eruise% an area o haemorrhage #eneath theskin'• Gaceration% splitting or tearing o tissues

secondar$ to #lunt trauma'• !ncision% a cutting t$pe o injur$ &ith .usuall$

clear) regular margins'• Sta#% a &ound o greater depth than length)

produced #$ a sharp o#ject'


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Step 1

• patients general appearance and demeanour'

• Start &ith the patients hands6 this &ill reassure

the patient'

• Take the "ital signs)

• !nspect #oth sides o #oth hands or injuries'

7#ser"e the &rists or signs o ligature marks'

Trace e"idence ma$ need to #e collected .some jurisdictions reHuire ingernail scrapings'


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Step 2

• !nspect the orearms or deense injuries%

#ruising) a#rasions) lacerations or incised

&ounds'

• An$ intra"enous puncture sites should #e

noted'


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Step ?

• The inner suraces o the upper arms and

the armpit or axilla need to #e careull$

o#ser"ed or signs o #ruising'

• Victims &ho ha"e #een restrained #$

hands oten displa$ ingertip #ruising on

the upper arms '


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Step <

• !nspect the ace' Elack e$es and the signs o

#leeding nose

• The mouth should #e inspected careull$)

checking or #ruising) a#rasions and lacerationso #uccal mucosa'

• :etechiae on the hard,sot palate ma$ indicate

penetration'

• @heck or a torn renulum and #roken teeth'

• @ollect an oral s&a#) i indicated'


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Step B

• !nspect the ears and #ehind the ears) or

e"idence o shado& #ruising the ear has

#een struck onto the scalp'

• 9se an otoscope to inspect the eardrum'


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Step C

• Ientle palpation o the scalp ma$ re"ealtenderness and s&elling) suggesti"e ohaematomas'

• *air loss due to hair pulling during the assaultma$ cause large amounts o loose hair to #ecollected in the glo"ed hands o the examiner6alternati"el$) a gentle com#ing ma$ reco"er an$loose hair'

• Dlectrostatic orces can) ho&e"er) cause largeamounts o loose hair to #e retained in the headuntil the patient next takes a sho&er or #ath'


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Step =

• Eruising on the neck can indicate a lie+

threatening assault' !mprint #ruising ma$

#e seen rom necklaces and other items o

je&eller$ on the ears and on the neck'

• Suction+t$pe #ruising rom #ites should #e

noted and s&a##ed or sali"a #eore #eing

touched'


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Step ;

• The #reasts and trunk should #e examined &ith

as much dignit$ and pri"ac$ as can #e aorded'

• !n"estigate the presence injur$'

• Ereasts are reHuentl$ a target o assault andare oten #itten and so ma$ re"eal e"idence o

suction #ruises or #lunt trauma'

• ! the #reasts are not examined) the reasons ornot doing so should #e documented


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Step F

• The patient can then #e reclined or an

a#dominal examination)

• an inspection or #ruising) a#rasions)

lacerations and trace e"idence'

• A#dominal palpation should #e perormed

to exclude an$ internal trauma or to detect

pregnanc$'


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Step 10

• !nner thighs are oten the target o ingertip

#ruising or #lunt trauma .caused #$ knees'

• There ma$ #e a#rasions or lacerations to the

knee and the eet• !t is important to inspect the ankles .and &rists

"er$ closel$ or signs o restraint &ith ligatures'

• The soles o the eet should also #e examined'


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Step 11

• Dxamine the #uttocks and o the #ack o

the legs

• e"idence should #e collected &ith

moistened s&a#s .or semen) sali"a)

#lood or t&eeers .or hair) i#res) grass)

soil'

• -ocumented the presence o tattoo


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• The use o >oods lamps to detect semenon areas o skin &here this is suspected is

no longer recommended clinical practice do not luoresce semen as &ell aspre"iousl$ thought) and more relia#le

methods o detecting semen .e'g' s&a#sshould thereore #e used


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The genito-anal examination

• in the lithotom$ position

• make the patient eel as comorta#le and

as relaxed as possi#le


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Ienital examination

• The external areas o the genital region andanus should #e examined) !nspect the monspu#is'

• The "aginal "esti#ule should #e examinedpa$ing special attention to the la#ia majora) la#iaminora) clitoris) h$men or h$menal remnants)posterior ourchette and perineum'

• A s&a# o the external genitalia should #e taken#eore an$ digital exploration or speculumexamination is attempted


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Step 2

• ! an$ #right #lood is present) it should #e

gentl$ s&a##ed in order to esta#lish

• its origin) i'e' &hether it is "ul"al or rom

higher in the "agina'


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Supporting examination

• Seminal detection% :?0)

• Sperm detection


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• collection o orensic specimens

• la#eling) packaging and transporting oorensic specimens to maintain

• the chain o custod$ o the e"idence

• therapeutic opportunities

• arranging ollo&+up care

• storage o documentation

• pro"ision o a medico+legal report


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Ethical issues

• Autonomy 'The right o patients to makedecisions on their o&n #ehal' All steps taken inpro"iding ser"ices are #ased on the inormedconsent o the patient'

• Beneficence. The dut$ or o#ligation to act in the#est interests o the patient'

• Non-maleficence' The dut$ or o#ligation to a"oid

harm to the patient'• Justice or fairness' -oing and gi"ing &hat is

rightull$ due'


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Diagnostic tests specimen

collection and forensic issues

• The primar$ aim o a orensic examination

is to collect e"idence that ma$ help pro"e

or dispro"e a link #et&een indi"iduals

and,or #et&een indi"iduals and o#jects orplaces'


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• collect careull$) a"oiding contamination6

• collect specimens as earl$ as possi#le6 =2 hoursater the assault the "alue o e"identiar$ material

decreases dramaticall$6• la#el all specimens accuratel$6

• dr$ all &et specimens6

• ensure specimens are secure and tamper proo6

• maintain continuit$6

• document details o all collection and handlingprocedures'


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Ta!ing a "lind vaginal s#a"


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Ho# to perform a s#a" of the

mouth for spermatozoa


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• -ocumented all inding to the medical

record

• Visum et (epertum projustia) &ritten

e"idence

• Dxpert &itness explain in the court


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!nanticide


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Tujuan

• Memahami pengertian inanticide

• Memahami kepentingan medikolegal

• Memahami tujuan pemeriksaan

• Memahami memperkirakan maturitas)umur #a$i,inant

• Memahami perkiraan #a$i lahir mati atau

hidup'


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!nanticide

According to 89*: ?


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The role o orensic pathologist

• Assist in identi$ing the mother .i she isunkno&n

• Dstimate the maturit$ o the child

• Dsta#lish &hether the child &as ali"e atthe time o #irth

• To determine the cause o death natural

or unnatural


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Dstimation o maturit$

4ull term .


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• Testes are palpa#le in the scrotum6 "ul"alla#ia closes the "aginal opening

• The um#ilicus is mid&a$ #et&een

xiphisternum and pu#is• -ark meconium present in the large ints'

• *aase .@ro&n+heel and Streeter .@ro&n+

coccigeus rule


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Age (month) Haase Streeter1 1x1=1

2 2x2=4 0,23

3 3x3=9 6,10

4 4x4=16 11,60

5 5x5=25 6,40

6 6x5=30 20,80

7 7x5=35 24,70

8 8x5=40 28,30

9 9x5=45 32,10

10 10x5=50 36,20


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>as the child ali"e at #irth J

• *$drostatic test) loating the lungs in&ater' Sink still#orn ) loat #reathed

• @ollapsed al"eoli had not #reathed

• -etection o air in the stomach• :ro#lems% putreaction) resuscitation


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The cause o death

• Natural % diseases) atal a#normalities)pre+immature age

• 9nnatural death%

1'Suocation direct application to theace to close the nose and mouth

2'Strangulation

?'*ead injur$% thro&ing) dashing

Documents

Sexual Violence in Adolescents 2012 Tadulako