Sexual offenses Factors influencing sexual behavior - PowerPoint Presentation

1. Sexual offenses

2. Factors influencing sexual behavior Necessity of sex Normal and socially accepted manner Abnormal and socially unaccepted mannerSexual offenses are acts of sexual intercourse or sexual interference with person or animal against provision of law .

3. Classification Natural sexual offenses :Rape Incest Adultery Unnatural sexual offenses :Homosexuality : sodomy lesbianism Beastiality i.e. sex with lower animals Other perversions

4. Section 4 Zina : a man and a woman are said to commit zina if they willfully have sex without being validly married to each other . Explanation : penetration is sufficient to constitute the sexual intercourse necessary to the offence of zina . Section 6Zina bil jabr : a person is said to commit zina bil jabr if he or she has sexual intercourse with a woman or man as the case may be , to whom he or she is not validly married in any of the following circumstances :

5. A ) without the will of victim B ) without the consent of the victimC ) with consent of victim when consent has been obtained by putting victim in fear of death or of hurtD ) with consent of the victim , when offender knows that the offender is not validly married and the consent is given because victim believes that offender is another person to whom the victim is or believes herself to be validly married .

6. Explanation : will and consent are two different attributes . Every act done against the will of a person is done without consent also but an act done without consent is not necessarily against the will . E.g. a girl aged 12 year cannot give valid consent for sexual act but it cannot be said to have occurred against her will . Submission does not necessarily means consent but consent involves submission.

7. Examination in sexual assaults Objectives :1 ) to know the type of sexual assault 2 ) to know the extent of damage both physical and psychological Authorization : police , courts , administrative authority like government or head of organization . Consent Identification ---N.I.C third party identification 2 permanent I.D marks History --general , obstetrics , specific –about incident .

8. Clothes examination Mental status General physical examination ---height , weight , built , vitals ,injuries ,bruises ,bite marks ,abrasions , nail scratches , stains ---semen , blood , saliva , vegetation , soil , oil , loose hairs , entangled hair Systemic examination to rule out possibility of subsequent false plead by assailant on ground of physical inability or any systemic disease.

9. Local examination : Four steps 1 ) inspection 2 ) bilateral traction 3 ) digital examination 4 ) speculum examination Inspection : note the condition of labia minora , majora , mons pubis and adjacent parts of thigh for redness , swelling , lesions , bleeding , discharge from vulva . Bruises , scratches , stains and loose hairs should be looked for .

10. Bilateral traction : of labia makes hymenal edges visible .a female with intact hymen is called virgo intacta . Intact hymen closes vaginal orifice only partially . It is a membranous structure 1 mm thick varying from thin parchment like to fleshy and firm . Its edges may be straight , irregular , partly folded or fimbriated .

11. Types of hymen : Semi lunar with a large opening Annular with relatively small opening Septate with two openings Imperforate with no openingFirst intercourse ruptures the hymen . Laceration of the hymen is the main sign of loss of virginity ----DEFLORATION . The site and extent of tear is important . The findings can be elicited by placing both thumbs at 3 or 9 0’ clock position and applying lateral traction to introitus . This stretches the hymen at 6 and 12 o ‘ clock position and any tear at these areas become visible .

12. Determination of location is facilitated by use of glaister keen glass rod by placing lit end of the rod on the inner side of hymen and moving it along the edges . Old tears are brighter and bleeding tears are blurred . Digital tears are incomplete and situated either anteriorly or posteriorly whereas tears due to sex are complete and situates postro laterally . If victim is virgin digital and instrumental examination should not be done .

13. Digital examination : determine size , tone , tenderness or laxity of vaginal canal . The difference of tone and extent of rugosities is an index to differentiate habituated vagina to a non habituated one . Specular examination : should be performed in sexually experienced women only .can directly inspect the condition of vaginal mucosa , rugosities , injury , cervix .

14. Examination of male genitalias in assailant:Vaginal epithelium may be stick onto glans penis which can be detected by painting it with dilute iodine solution . Vaginal epithelium stains dark brown .

15. Collection of specimens Clothes entire lot ( bearing stains and soiling )Loose and matted hairs Swabs 1 ) from body : a ) seminal stains (areas other than vagina ) b ) salivary stains from the bite marks2 ) from vagina : a ) from introitus , perineum b )from lower vagina ( separating the labia minora and passing a swab just into the area above hymenal boundary . c ) from higher vagina

16. 3 ) from anal margins 4 ) from posterior fornix Scrapings from the under surface of nails ( epithelium of assailant in non consenting victims ) Urine for screening of drugs and venereal diseases Control specimens : blood plucked hairs two each a ) head hair b ) pubic hair saliva

17. Opinion Sample :On basis of clinical examination and report of chemical examiner which says ‘ vaginal swabs shows sperms’ findings are consistent with recent sexual intercourse . Summary : Presence of spermatozoa and other micro organisms : normally sperms remain motile in vagina for about 6-8 hours , occasionally 12 hours .

18. Non motile forms are detectable for about 24 hours and occasional reports are 48-72 hours . Rarely 96 hours .Sperms remain motile in uterine cavity for 3-5 days ( cannot be detected on vaginal swabs ) Non motile forms may be found in female genital tract for weeks to months after death To demonstrate the presence of sperms , vaginal contents are aspirated by blunt ended pipette

19. Intact spermatozoa are rarely found in vagina after 72 hours after coitus .Rape is an allegation , easily made , hard to prove and harder to disprove . examination of assailant of rape :Objective : capable of doing sex Authorization –police or court Consent Identification History –general behavior , mental status , normal perverted , signs of drunkenness , marital relationship

20. History of incidence –history of taking bath , change of clothes , going to toilet Clothes examination – tears , stainsGeneral physical examination –injuries on whole body Local examination –inspection ---injuries on genitals , scars if any –venereal diseases , chancre , lesions , discharge , blood group , HIV infection Opinion : from the examination there is nothing to suggest that accused is incapable of performing sexual act .

21. Sodomy Anal examination ---knee elbow position Steps : Inspection –bruise , fissure , inflammation , seminal stains , normal anal orifice is slit like opening and surrounding skin shows natural folds due to corrugators cutis ani muscles . Local signs of first anal intercourse is redness , bleeding , tear of anal skin and under lying sphincter . Anal tears and fissures may extend to anal mucosa .

22. Bilateral traction : of anal sphincter locates the position of anal tears visible as triangular damages having basis towards the centre of the canal . Digital examination –painful , gives size , tone and extend of dilatation of anal sphincter . A habitual canal is lax showing absence of normal anal folds and margins appear smooth . Anal canal is patulous and may be infected .

23. Specular examination : is done with an appropriate size proctoscope to visualize anal mucosa for bleeding , bruising and soiling . Bruising appears as dark brown areas. Collection of specimens in sodomy : Clothes examination Swabs from the body A )Seminal stains B) salivary stains from bite marks Swabs from a ) perianal area b ) anal area c)low rectal area Loose hairs from perianal area

24. Specimens from assailant : in addition to swabs from other parts of body , swabs from A) external urethral opening B ) glans penis C ) corona and rim of glans D ) penile shaft

25. PervasionDefinitionSadismSexual pleasure from acts of cruelty upon partner, usually of opposite sexMasochismSexual pleasure from pain or injury received at hands of partner, usually of the opposite sex. HomosexualitySexual gratification through stimulation by willing partners of the same sex.Lesbianism Sexual gratification among females through mutual sexual stimulationTranssexualismDesire to adopt the opposite sex TransvestismSexual gratification by wearing the dress of the opposite sexPedophiliaSexual love directed towards prepubescent children VoyeurismSexual gratification by looking at naked members of the opposite sexExhibitionism Sexual pleasure by exposing sex organs to the members of the opposite sexBestialityTransference of object of sexuality from human to animalNecrophiliaDesire for and use of dead body for sexual pleasure.FetishismTransference of object of sensuality from human to belongings of the opposite sex. Table 4.8: Sexual perversions To qualify as perversions the desire should be morbid, taking precedence over desire for normal sexual intercourse.

26. Pregnancy Is a state that occur in female when an ovum is fertilized by sperm. Reproductive period of female is 15 -45 years . Question of pregnancy arises in following cases Civil cases : 1 ) to avoid attendance in a court of law as a witness –when delivery may be imminent .2 ) feigned pregnancy soon after death of husband to claim succession to estate 3 ) to assess damage in breech of promise of marriage 4 ) when a woman black mails a man and accuses him that she is pregnant by him

27. 5 ) in cases of slander of an un married woman , widow 6 ) to secure greater compensation when husband dies through negligence of others 7 )To get more relief in cases of divorce Criminal cases :To reduce capital punishment . The high court can postpone or commute it to life imprisonment Motive for suicide or homicide for un married girls or widowsIn cases of alleged criminal abortion

28. Alleged conceivement of birth , pregnancy or infanticide Pregnancy and its M/L issues : 1 ) age of conception (15 -45 years ) Exceptions 12 -50 years 2 ) period of gestation 10 lunar months /40 weeks /280 days Courts have accepted maximum duration up to 345 days

29. Confirmation of pregnancy depends upon history and findings .Common indications Amenorrhea Morning sickness Enlargement of abdomen Changes in breast : enlargement darkening of nipples and areola enlargement of Montgomery tubercles

30. Pigmentation of skin extending from pubics to umbilicus –linea nigra Irritable bladder Softening of lower uterine segments—hegar’s sign ---8-10 weeks Intermittent uterine contractions and relaxations---brextons hick sign –3rd or 4th month

31. Changes in vaginal mucosa after 4th month : increase in vaginal secretions darkening of mucus membrane of vagina from pink –violet –blue as a result of venous obstruction . It is seen after 4th week and is known as jackquemier’s sign or chadwick’s sign .Changes in cervix : Cervix softens from second month and is well marked after 4th month ---goodell’s sign

32. Ballottement means ‘ to toss up like a ball’ . It is positive during 4th and 5th month because fetus is small in relation to liqour amnii .Gradual enlargement of abdomen Month of gestation size of uterus Three 4-5 inchesFour 5-6 inchesFive 6-7 inches Six 8-9 inches Seven 10-11 inchesEight 11-12 inchesNine 12-14 inches

33. Perception of fetal movement-quickening -4 to 5 month Fetal heart sounds perceptible after 4 monthUterine souffle ..it is a soft blowing murmur heard by auscultation which is synchronous with maternal pulse --4th month due to passage of blood through uterine vessels

34. Lab findings :Detection of HCG in urine Detection of gestation sac on U/SDetection of fetal bones on X rays Twin pregnancy issues include identical and fraternal twins and are normal phenomenon . There are two forms of twins which are important in M/L cases :

35. Super fetation : means fertilization of two ova both liberated at different ovulations . There is sufficient medical evidence that this possibility exists but law does not entertain this possibility .Super fecundation : refers to fertilization of two ova , both liberated during the same period of ovulation but impregnated as a result of two separate acts of coitus .

36. Signs of delivery in living –recent :Abdomen is laxed Uterus is palpable as a hard globe about 5 inches above the pubis It sinks behind the pubis after about 10 days Injuries to the birth canal i.e. tears in vagina or episiotomy Lochia : rubra for first three days blood stained containing decidual debris , vaginal epithelium , peptones and cholesterol crystalsDuring the next three days it become pale and serous- lochia serosa. Next three days yellowish- greenish – whitish –lochia alba

37. Signs of delivery in dead : presence of corpus luteum in non pregnant woman up to 10 days after its formation and in pregnant up to 5th gestational month Inner wall of uterus shows signs of detachment of placenta Size of uterus after delivery is 22-30 cm in length 5 cm thick and weighs 900 grams . After 2 -3 days ---18 cm long , 4 cm thick and 600 gm weight . After 1 week --- 12-15 cm long 3 cm thick and 450 gm After 6 week normal size ---6-8 cm , 2cm –100 gms

38. InfanticideMeans unlawful destruction of newly born child . M/L implications of new borns are :Still born Live birthPeriod of gestationAge of fetus

39. Proof of still birth (A stillbirth is the death or loss of a baby before or during delivery. Both miscarriage and stillbirth describe pregnancy loss, but they differ according to when the loss occurs) Evidence of maceration –aseptic autolysis of fetus, death in utero –remains in uterus for 3-4 days Spaulding sign –over riding of skull bones Smell is sweetish , color purple red , feel is fluctuant , body contour—flattening of the body Lungs –functionless , do not fill the chest cavity , small hard , do not crepitate . Edges are sharp resembling those of liver .

40. Digestive tract and circulatory system may help in evaluation of still birth .Placental infarcts on histological examination .

41. Feature Unbreathed lungBreathed lungSize Small (1/7th of body weight )Large 4 -6 times biggerColor Uniform deep violet Mottled and lighter Consistency Hard and non crepitant Spongy elastic and crepitant Edges Sharp Rounded Air sacs Not visible Visible and of uniform sizeCut surface Not froth on squeezing Show froth on squeezingFloatation test NegativePositive Microscopy Alveoli collapse Alveoli expanded Hydrostatic testSpecific gravity of non respired lung is 1050 (greater than water )sink in water Specific gravity is 950 so float in water

42. Hydrostatic or floatation test may be falsely positive due to presence of gases of decomposition and falsely negative due to pneumonic consolidation Proof of live birth :Presence of food and air in GI tract . The child during labor while attempting to be swallow air . Floatation test thus can be performed on stomach and a portion of intestine after tying at both ends of segments taken from tract . Evidence of presence of air can also be demonstrated by opening it under water and by radiology .

43. Foramen ovale and ductus arteriosus are patent at birth and gradually close by 3rd week .Caput secundum in case of head presentation disappears by 3rd day Meconium –dark green material of intestinal secretions and amniotic fluid in intestine of full term fetus for 3-4 days Drying of umbilical cord starts in 3-4 days and sloughs off by 8th day .Vagitus uterinus : is cry of child after inspiration while still in birth canal.

44. Law related to abortion. killing of fetus / miscarriage : isqat e haml and isqat e janin Statute law of miscarriage in Pakistan takes into consideration stages of gestation, making the offense more serious if it is done at the later stage of pregnancy Isqat e haml : causing a woman with child whose organs has not been formed to miscarry without good faith for the purpose of saving life of the woman or providing necessary treatment (338 A)

45. Isqat e janin : causing a woman with child whose organs has been formed to miscarry without good faith for the purpose of saving life of the mother .

46. Abortion Killing of fetus is illegal and is called misscarageEvacuation of pregnant uterus is Abortion.Spontaneous Induced Theraputic abortionCriminal abortion causes of spontaneous abortion :Fetal causes : genetic factors chromosomal abnormalities Maternal causes : local abnormalities of uterus : retroversion fibroid hypoplasia advanced heart diseases severe anemia diabetes nephritis infection

47. Methods for inducing criminal abortion Abortificient drugs : ecbolics –which contract the pregnant uterus : ergot preparations synthetic estrogen pituitary extract strychnine quinine These are not always successful in low doses and in higher doses they may be dangerous

48. Emmenagogues –drugs which initiate or increase the menstrual flow e.g. estrogen , borax , saven .Genitourinary irritants : e.g. canthrides oil of terpentine oil of tansy Reflex uterine stimulants : some drugs primarily irritate GI tracts and reflexly stimulate uterus e.g. drastic purgatives like castor oil , croton oil , calomel , seena and rhubarb and saline purgatives like MgSO4.

49. Drugs which are primarily toxic to other systems like inorganic irritants : lead Arsenic Phosphorus Copper Mercury General violence :For example severe exercise , cycling , riding , jumping from heights , use of alternate hot and old bath , violent kneading of abdomen but all this usually fail because of tenacity of the ovum in healthy patient is remarkable .

50. Unskilled interference : Out of desperation , anything may be used by the patient e.g. : knitting needle pencil hair pin self syringing all are dangerous .

51. Use of abortion stick : practice by dais –thin , wooden or bamboo stick about 15-20 cm long or twig of irritant plant such as madar ( calatropis ) , chitra lal chitra , kaner ( nerium odorum ) at one end stick is equipped with cotton wool soaked in irritant such as juice of marking nut or a paste prepared from white arsenic or red lead . Abortion stick is introduced into the os of uterus . Abortion with or without rupture of membrane may occur . Sepsis is likely to be followed .

52. Enema syringe : Higginson syringe ..soap solution is introduced between placenta and uterine wall . Risk of air embolism vagal inhibition Skilled interference : laminaria tent – sea weed which draw fluid and swell and dilate the cervix . Takes 6-12 hours to dilate cervix . during first trimester ---D &C during second trimester ---prostaglandin amniocentesis passage of electric current –110 volts . Negative pole is connected to posterior vaginal cul-de –sac and positive pole to lumbosacral region leads to contraction of uterus and expulsion of contents . Such crime is difficult to detect .

53. Complications of criminal abortions :Vagal inhibition –rough handling of cervix and uterus in un anaesthetized patients .Insertion of syringe into cervix or rapid introduction of hot or cold fluid results in vagal inhibition .Air embolism is a common complication following use of enema syringe for injecting soap solution into uterus . About 100 ml of air is considered sufficient to cause air lock and death .Severe hemorrhage –vagina , uterine lacerations and perforations or pieces of retained placenta –uterus unable to contract and uterine vessels remain open

54. Amniotic fluid embolism : this fluid contain fetal squames ,lanugo hair , material from vernix cells from chorion and amnion , meconium and cellular debris . Possibly contents gain entry either through tears in myometrium and endocervix or amniotic fluid is forced into uterine sinusoids by vigorous uterine contractions . Death may result from :Anaphylactic reaction to amniotic fluid components Mechanical blockage of pulmonary circulation in extensive embolism .DIC due to liberation of thromboplastin by amniotic fluids

55. Delayed complicationsSepsis—infection from instruments or necrosis of tissues –E coli , staph , strept , C Welchii Renal failure following acute tubular necrosis Tetanus 3 days to 3 weeks

56. Examination of woman who have allegedly abortedIn living : authorization from concerned authority .Identification of female Written informed consent History of incident –means adopted material expelled Clothings Systemic examination : as irritants are used to induce abortions , there is GI tract disturbance and evidence of sepsis HCG serum and urine positive up to 7-10 days Local examination : perineum , external genitalia –injuries

57. Condition of os –injuries due to instrumentation, presence of recent tears , discharge In dead: same sequence When air embolism is suspected pre autopsy radiology of chest and abdomen must be performed for air bubbles in heart , great veins , thorax , peritoneal cavity and pelvic veins MRI or CT scan increase the chances of detecting air in vessels . Open the heart chambers under water

58. Internal examination : a small supra pubic incision – remove uterus ovary and adenexal tissues en –mass after cutting pubic symphysis. Note abdominal cavity for fluid or blood due to perforation of uterus due to instrumentations .Note injuries to intestines and bladder Findings in uterus : enlarged , soft , congested walls thick POCs in cavity , weights and measurements of uterus are more than normal . Non pregnant uterus weight is 40 gms , 7 cm length 5cm breadth and 2 cm thickness

59. Gestation Length of uterus3rd month 10 cm 4th month 12.5 cm 6th month 16 cm 8th month 20 cm 9th month 27 cm

60. Uterus may show perforations , if soap water used –froth in cavity there may be hair pins , abortion sticks in cavity Swabs of uterine walls for micro biology Tissues preserved in 10% formalin Ovaries examined for corpus luteum Toxicological examination of vagina , uterus and appendages if poisonous substance used locally

61. Examination of aborted material Microscopy --- chorionic villi – show sign of pregnancy If well developed fetus , apply hess’s rule

62. Dissolution of marriage contract Important issues which can be raised in court of law for dissolution of marriage are : Impotency of either party Sterility and virility Impotency and sterility may be important questions in cases of : disputed paternity Zina and claims for damages for loss of sexual functions due to criminal injury or accident at work

63. Puberty –13 in females and 14 in males Below these ages , law presumes presence of impotency in both sexes .Law further presumes that after attainment of puberty : Man is capable of begetting and woman is capable of bearing children .

64. Impotence : is defined as inability of either party to perform sexual intercourse from any cause whether temporary or permanent .Court can declare a marriage null when there is permanent incapacity to consume marriage by either spouse due to impotency .

65. Physical causes of impotency : Local causes : Male congenital or acquired absence of sex organs cancer of penis sarcoma of testis large hernia hydroceleelephantiasis

66. Female : congenital absence or atresia of vagina firm or imperforate hymen adhesions of labia prolapsed uterus vaginal tumors

67. General causes in both sexes: Diseases in CNS such as hemiplegia, dissiminated sclerosis , syringomylia Endocrine dysfunctions of pituitary and thyroid glandsAbuse of drugsObesity

68. Psychological impotency : In males : Fear of inability to complete sexual intercourseDisgust for the actDislike for the partner In females :Spasm of vagina –vaginismus Fear of act Dislike of partner

69. Sterility Is inability to impregnate by male or to conceive by female Causes of sterility :Congenital non production of germ cells i.e. sperms in males and ova in females Other causes in males are malformation of penis such as hypospadiasis , epispadiasis , surgical removal of testis , contraceptive operation , gonorrhea

70. Causes in females : Infection of reproductive operations Uterine displacement Diseases in ovaries Lesions in tubeswhen such cases are brought in court medical examination of males and females is ordered to confirm physical integrity besides psychological assessment .Sterility is not ground for dissolution of marriage , which may require microscopic examination to confirm absence of living spermatozoa or ova .

71. M/L importance of virginity Cases of nullity of marriage Cases of divorce Cases of defamation Virgin is a woman who has never had any sexual intercourse . Defloration means loss of virginity Signs of virginity :Intact hymen Normal condition of fourchette and posterior commisure Narrow vagina with rugous walls

72. Labia majora – firm , elastic , completely close by vaginal orifice Lower part fuse in middle –posterior commisure (intact ) Labia minora are two thin folds of skin within labia majora , lower portion fuse in midline to form a fold called fourchette (intact )Depression between fourchette and hymen is called fossa navicularis .Vestibule is the space between labia minora and narrow ..

73. Mucosa of vagina is rugous , reddish , sensitive to touch and walls are approximated .