how do hospitals test for rape?

[OwlMyste]

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I was reading a cnn article about a 9 year old that was raped. And it got me to thinking...how do doctors test for rape? also what procedures are done on the victim at the hospital that is used to collect any evidence of rape??? Just out of curiosity.

I tried looking it up on the internet with no luck............

 

[Apollyon]

How hard did you look? I went to Google and put in "rape physical examination" and got hundreds of hits.

I had written a comprehensive list of what's done, but you can find that easily elsewhere, or in textbooks and journals.

I could tell you what's included, but it is incredibly humiliating and traumatizing to the women (and some men) that have to go through it.

If it is SO interesting to you, PM me.

 

[womansurg]

Originally posted by Apollyon
How hard did you look? I went to Google and put in "rape physical examination" and got hundreds of hits.

I tried it and got hundreds of hits too. But none of them detailed what constitutes an appropriate physical examination for a rape victim. Do you comb the victim's pubic hair to collect loose hairs from the assailant? Semen swab? What do you put it in? What if it was anal or oral penetration? Can you collect DNA if there was no ejaculation?

In fact, one site said that - under no circumstances - should any attempt at a pelvic examination be made.

Makes it kinda hard to collect physical evidence, one would think.

 

[Apollyon]

On the first page of hits, there was a link for the Merck Manual online, and there was a checklist that had originally been published in the Western Journal of Medicine in 1975. It was pretty comprehensive.

I don't know how much forensic stuff you know (probably more than me), but I remember from EM and from paramedic school that there is wide variety (as you've stated); the pubic hair combing has been eliminated in some localities, but not in others, with clipping, and some communities use UV lighting, others don't. There are even more things that I am not up on right now, but, I think that, if you can think of a good reason, it's being collected already.

 

[ckent]

Originally posted by womansurg
I tried it and got hundreds of hits too. But none of them detailed what constitutes an appropriate physical examination for a rape victim. Do you comb the victim's pubic hair to collect loose hairs from the assailant? Semen swab? What do you put it in? What if it was anal or oral penetration? Can you collect DNA if there was no ejaculation?

In fact, one site said that - under no circumstances - should any attempt at a pelvic examination be made.

Makes it kinda hard to collect physical evidence, one would think.

I vaguely recall what a rape specialist and a pediatrician told my class a last year. It basically all depends on the history and what the police want you to do. As for doing pelvics, my pediatrician told us all that by doing a pelvic exam, particularly on a very young patient, you may actually be subjecting them to just as bad or worse psychological abuse as the perpetrator of the crime since they won't understand why it's "necessary". That's why some would advocate against it. Otherwise, I think that at least doing a pelvic would be standard as you can at least reveal the presence of trauma (don't know if you guys heard about the recent case in Maryland involving a school superintendent and a student, but that's what they found). You can always try to swab for DNA even if there was no ejaculation even though your yield will be lower. There is always pre-ejaculate and epithelial cells that got sloughed off that may be present. The police should have a crime lab that runs all of the necessary tests, the hospital does not need to run DNA tests unless it is being contracted by the police. Of course a main part of treating rape victims is just testing them for STD's and making sure that they follow up for continued testing in the future. DNA evidence is nice, but they were convicting people for rape long before DNA tests were available. One thing that kind of disturbs me is how all of these people are "getting off" because "DNA tests cleared them". I don't know the specifics of this case, and I know that eye witness testimony can be essentially useless or very misleading, but I worry about people using DNA as the "definitive" answer. It just seems to me that all it takes is the slightest bit of contamination to throw off their tests since they are PCRing out minute amounts of DNA. But I don't know the specifics of what's going on there.

 

[sweetfynesse]

Originally posted by ckent
I vaguely recall what a rape specialist and a pediatrician told my class a last year. It basically all depends on the history and what the police want you to do. As for doing pelvics, my pediatrician told us all that by doing a pelvic exam, particularly on a very young patient, you may actually be subjecting them to just as bad or worse psychological abuse as the perpetrator of the crime since they won't understand why it's "necessary". That's why some would advocate against it. Otherwise, I think that at least doing a pelvic would be standard as you can at least reveal the presence of trauma (don't know if you guys heard about the recent case in Maryland involving a school superintendent and a student, but that's what they found). You can always try to swab for DNA even if there was no ejaculation even though your yield will be lower. There is always pre-ejaculate and epithelial cells that got sloughed off that may be present. The police should have a crime lab that runs all of the necessary tests, the hospital does not need to run DNA tests unless it is being contracted by the police. Of course a main part of treating rape victims is just testing them for STD's and making sure that they follow up for continued testing in the future....

As far as testing for gonorrhea and chlamydia--its a no, no in the state of NY, and perhaps other places as well. this is the case because if someone tested positive, it essentially means that the victim had gonorrhea/chlamydia prior to the rape, and it gives defense attornies "reason" to demoralize and tarnish the victim's image to cast doubt on their testimony. But, definitely follow-up tests for HIV and hepatits B/C would be in order. I think they go ahead and treat for gonorrhea/chlamydia/syphilis, and give HIV prophylaxis if the patients wants it, as well as pregnancy prophylaxis.

Also, most cases of rape (in women of reproductive age ) show no signs of trauma to the vaginal walls, so a normal exam doesn't mean that a rape didn't occur.

 

[ERMudPhud]

As others have pointed out what is actually done or collected varies depending on what local law inforcement requests. A few general principals and practices apply.

1. look after the victim first , collect evidence second. Make sure the victim doesn't have significant physical trauma requiring repair/treatment before you get concerned about preserving evidence. Along with that dictum we don't test for STD's but do treat for them. We test for pregnancy and if it is negative we offer Lo-Ovral ("morning after pill"). Referrals for later HIV/Hep B/Hep C testing is also given. Prophylaxis for HIV is not routinely offered but that practice is under debate.

2. Evidence collection where I work consists of swabbing any area that might have DNA from the rapist - mouth, skin, anus, vagina, etc... We also comb for collected pubic hairs and then pluck samples of the victims head and pubic hair(this part is extra cruel in my opinion). Samples of the victims blood and saliva are taken for DNA as well. A pelvic exam is done to document any trauma and some but not all of the counties ask us to do a wet prep looking for sperm.

3. Peds is a different story. We collect much of the above evidence if applicable and do an external exam looking for trauma. If we dont see any trauma than some swabs at the introitus should be good enough for DNA without doing a speculum exam. If there is evidence of vaginal trauma than a speculum exam is probably indicated to make sure the extent of internal trauma and any need for treatment or repair. A group at our local childrens hospital does these exams under sedation if necessary.

4. Perhaps most importantly we have a network of counselors on call 24/7 who come to the ER begin counseling the victim immediately, stay with them through the exam, and help with outpatient referrals/followup/counseling etc...

 

[Tazmaniac]

A clinic I worked at had a standardized 'rape kit' with extremely precise and verbose instructions on gathering evidence. "Place X specimen in Z canister, label it with A, B, C, and D, sign and date it, cap it with W and place it in bag Q..."

I haven't seen its contents since all of the pts requiring the kit were examined by female practioners...

-Todd MSIV

 

[iwakuni_doc]

The sexual assualt evidence kit that's currently being used at our facility is from Tri-Tech, Inc. It's web-site, www.tritechusa.com, unfortunately does not go into the detail of the kits. The kits for the victims & the attackers are different. The best thing for you to do is go to your hospital's ED & inquire - most places have training kits that you can look through, cause it's never good to see a kit like this for the 1st time when you're doing it for real.