Autopsy – Death in Sexual Violence

Suspicious deaths of females should be examined methodically to assist in the investigation of sexual violence. These deaths result from sexual assault and are commonly associated with other forms of violence.

BACKGROUND INFORMATION

The case information provides valuable insight into the death process, comprising of details of the incident, including the date, time, location, nature, and associated information of the scene of death. Background information should also include the deed of preliminary investigation (घट्नास्थल प्रकृति मुचुल्का) as well as the deed of examination of dead body (लाश जाँच मुचुल्का) which should describe the perceived events that led to the incident of death.

Personal history of the deceased should be collected with as much details as possible, including information regarding recent and past medical and surgical conditions and procedures, obstetric and sexual history, history of substance abuse etc.

PRELIMINARIES

Scene of death
The scene of death should be visited, as required or requested by Nepal Police, to help collect information to assist in the investigation of the death. The information that is vital include – position in which body was recovered, clothing and any associated stains, presence of items near the body. Including drugs, alcohol, contraceptives, as well as disturbance in the scene.

Transport of the Body
Before the body is transported, trace evidence that could possibly be present on the hands and feet should be preserved by placing paper or plastic bags over the hands.

The body should be wrapped in a clean sheet or placed in a clean body bag to prevent trace evidence that might get lost while transporting the body and to prevent the body from picking up debris that might be confused with valid trace evidence.

Photography
Photographs should be taken, and should ideally include documentation of body and genital injuries, bite marks as well as stains.

Clothing
Clothing are an integral part of the examination of any victim of sexual offence. The clothing are the outermost layer that come into contact with the perpetrator and could possibly have evidence. Clothing typically have fibers, plant and animal matter, as well as other evidence that could assist in deducing the identity of the location of crime or the identity of the perpetrators.

Any significant evidences should be properly documented, including by photography, and material evidences should be secured before transporting the body.

Collection of swabs
As required, swabs should be collected to preserve evidence for further analysis. The collection of swabs should be performed before the area is manipulated.

EXAMINATION OF THE BODY

At the start of the examination of the body, all available evidences should be collected. Hands should be examined for presence of any foreign material. If indicated, nail clippings may be collected to examine for trace evidence. A fresh pair of scissors or nail clippers should be used to prevent contamination. Any material thus collected should be placed in labeled containers or envelopes. Swabs of bite marks as well as of the genitalia should be taken before the body is washed or manipulated. Relevant control samples should also be taken from corresponding areas of the body.

EXTERNAL FINDINGS IN FATAL SEXUAL ASSAULTS

External examination is extremely important in cases of sexual assault, perhaps even more so than internal dissection. Examination follows the same principles irrespective of if the victim is alive or deceased.

A meticulous and systematic examination is required. The examination proper is divided into two parts, general examination and examination of genitalia and any specific parts of the body.

Oral cavity
Contusions in mouth and lips could possibly indicate injures of a sexual nature from rough kissing. Abrasions present over the inner aspect of the lips indicate pressure against the teeth. Lacerations of the buccal surface as well frenulum could indicate forceful manipulation of the oral cavity. Oral penetration may leave traces of seminal fluid in the oral cavity, and swabs from mouth should be collected.

Bites marks
Bite-marks in a death due to sexual offences are predominantly seen over the neck, breasts, inner thighs as well as genitalia. Bite marks consist of an amalgam of injuries including contusions from suction, abrasions from friction with the teeth as well as lacerations due to penetration of the skin by the teeth. These marks should be swabbed with a sterile cotton swab that has been dabbed in normal saline. They should also be documented by photography.

General bruising and abrasion
Linear abrasions may be present over the back and limbs, in addition to the breasts and genitalia, usually representing injuries from fingernails. Bruises may be present over the wrist and knees as well as over the inner thighs in additional to the breast and genitalia. Discoid bruises, around 1-2 cm in diameter usually represent finger pressure. In addition, abrasions and contusions may be seen on the back, following friction against uneven or hard surface. They may also be seen over the knees and palms.

Other general injuries
Other general injuries could be present anywhere on the body. Deaths associated with sexual violence tend to have injuries over the limbs, in addition to injuries of a purely sexual nature. These tend to be from restraint applied in confining the victim. In addition, fingernails may be broken during struggle. In deaths with extreme violence associated with revenge and sadistic nature of the assailant, multiple cuts and stab injuries may be found over multiple parts of the body.

GENITAL INJURIES

The genital region should be examined, in detail, following general examination and should follow a methodical and systematic protocol to avoid loss of valuable evidence.

The vulva and anus should be inspected externally and documented for laceration, swelling, bruising, bleeding and discharge. Lacerations may be present over the perineum, as well as over the orifices. The coning and dilatation of anal and vaginal orifice should be interpreted with caution, following death; sphincters become patulous, and may open wide.

The pubic hair should be examined for external hair, vegetation and other external material as well as dried seminal stains. All evidence should be collected, along with control samples of hair and combings. A fine comb may be used for combing hair, dried stained hair may be cut and placed in an envelope.

Following completion of external examination, samples should be collected. This could include samples for biological testing, for the presence of semen and venereal infection, as well as samples for DNA profiling. A sterile cotton-wool swab should be used to take samples from

  • Interior of vulval labia and around vaginal orifice
  • Margins and interior of anus
  • Mid-vagina, without contamination from lower vagina
  • Upper vagina, cervix and posterior fornix.

The swabs should be smeared on glass slides and air-dried. A piece of cloth, moistened with saline, should be used to obtain any seminal stains on the skin. Oral and rectal smears and swabs should also be retained, if indicated. Injuries to the genitalia should be examined and documented after all samples have been collected. Genital Examination should include examination of the hymen, with documentation of any injuries as well as scars.

INTERNAL EXAMINATION

The cranial, thoracic and abdominal cavities are opened routinely to examine for cause of death. In deaths associated with with sexual violence, special pelvic dissection may need to be performed. The bladder should be emptied and urine samples collected, if indicated.

The pelvic dissection involves removing the pelvic organs en bloc. The skin and underlying soft tissue is dissected along the superior ramii. The pubic bones are sawed a few centimeters lateral on each side to pubic symphysis, continued through the inferior ramii. The pubic symphysis is then removed and the perineum deeply dissected to remove the vagina, rectum, anus, uterus, tubes and ovaries for detailed dissection.

The vagina should be opened with large scissors along the anterior midline and exposed to the posterior fornix. All injuries and findings should be carefully photographed and documented. The ovaries and fallopian tubes as well as pelvic soft tissue, including ligaments should be examined for injuries, hemorrhage or any other findings. Vaginal instrumentation may penetrate into the abdominal cavity, either via the posterior fornix or lateral vaginal walls.

The cervix and uterus are examined next. The uterus is examined by first dissecting along the vault. The cut is then opened along the anterior midline, to expose the entire uterine cavity as well as the cervix. All injuries and discharge should be documented.

Investigations to detect spermatozoa could include tests for sperms, prostatic acid phosphates, and prostate specific antigens. Blood grouping and DNA profiling can be performed, if indicated. Screening for HIV and Sexually Transmitted Diseases may also assist in the investigation. Lubricants present on the genitalia or perineum can be collected and the analysis of the chemical composition may help identify the offending material.

Any foreign body found should be retained for further analysis.