• Sexual jurisprudence is a subject subdivision in forensic medicine wherein medical knowledge is applied to derive justice in cases of sexual offenses.

• It deals with the medicolegal aspects of virginity, impotency, sterility, artificial insemination, pregnancy, abortion, delivery, etc. on one hand, and various types of sexual offenses and sexual perversions, on the other hand.

26.1: Virginity

• A female is called a virgin (Virgo intacta) if she has never experienced any sexual intercourse.

Signs of Virginity

1. Genital Signs

   • Labia majora is firm, elastic, rounded and lie in close contact with each other even on full abduction of the thighs.

   • Labia minora is soft, elastic, small, pinkish in color, and lie in close contact being completely covered by the labia majora.

   • Vestibule is narrow.

   • Posterior commissure and fourchette is intact and crescent-shaped.

   • Vagina is narrow and tight with rugosed pinkish wall; slit-like orifice due to the opposition of its walls and presence of hymen.

   • Hymen is intact and may admit hardly one finger in an adult.

2. Extragenital Signs

   • Breasts are hemispherical, firm, plump and elastic.

   • Nipples are small and usually surrounded by a small areola, pinkish in fair-skinned, while dark brownish in dark-skinned girls.

Hymen

• Hymen, a membranous diaphragm at the vaginal introitus, is a thin fold (about 1 mm) of mucous membrane derived from the posterior vaginal wall, with an anterior opening.

• Based on the shape of its opening, hymen may be classified into five types:

  1. Annular Hymen — with an oval central opening.

  2. Crescentic Hymen — with a semilunar central opening.

  3. Vertical Hymen — with a vertical slit-like opening.

  4. Septate Hymen — with two lateral openings partitioned by a bridge of hymenal tissue.

  5. Cribriform Hymen — with multiple small openings.

• Other Variants of Hymen:

  1. Absence of hymen is observed as a congenital deformity.

  2. Infantile with a small central linear opening.

  3. Imperforate without any opening.

  4. Fimbriated the free margin of the hymenal opening shows symmetrical indentations or notches placed anteriorly.

  5. Ring or fringe-like or marginal type with a narrow ring or fringe or band of thick membrane all around the vaginal orifice.

• The hymen usually gets ruptured with the first act of sexual intercourse. Such a condition where the hymen remains intact in spite of sexual intercourse is called False Virgin.

  • It can occur under the following conditions:

    • Hymen is fleshy and elastic

    • Hymen is thick, tough and with annular or big central opening.

    • Hymen is situated higher up in the vagina.

• Changes in the Hymen after Rupture

  • The ruptured hymen appears like triangular projections varying from 3 to 6 in number.

  • The tear usually reaches up to the base. It heals up from edges in 4 to 6 days, but torn segments will never reunite.

  • Carunculae Hymnales: The torn segments gradually become thicker and smaller in size and appear as small fleshy pyramidal projections

• Hymen examination is an essential step in the examination of a rape victim.

  • It is done with a special kit called ‘hymen examination kit’ that comprises of a set of glass rods of varying sizes with a spherical bulbous expansion at one end.

• Defloration signifies loss of virginity.

  • The genital and extragenital signs in a deflorated female are as follows:

    • Hymen is ruptured.

    • Labia majora is not apposed and gaping

    • Labia minora is not covered and protruding between labia majora.

    • Vaginal canal is dilated with loss of rugosity.

    • Posterior commissure is usually ruptured

    • Breast is enlarged and flabby

    • Nipple is large and surrounded by wider areola.

26.2: Erectile Dysfunction and Sterility

• Impotence (erectile dysfunction) — may be defined as inability to perform sexual intercourse.

• Sterility — means inability to procreate.

• Frigidity — refers to a woman who fails to respond to sexual stimulation.

Causes of Impotence in males

• Congenital or acquired malformations such as:

  • Bilateral hydrocoele

  • Bilateral inguinal hernia

  • Micropenis

  • Severe forms of hypospadias or epispadias

• Before puberty, boys are considered to be impotent though there is no age limit for it. It depends more on the physical development of the individual.

Causes of Sterility in Males

• Congenital or acquired malformations

  • Loss or absence of both testicles.

  • Cryptorchidism

  • Severe forms of urethral fistula.

• Before puberty, boys are considered to be sterile though there is no age limit for it. It depends more on the physical development of the individual.

• Diseases

  • Local diseases

    • Elephantiasis of scrotum and penis.

    • Stricture of urethra.

    • Large size hydrocoele and hernia

    • Diseases of testis and epididymis

    • Partial amputation of penis

  • General diseases

    • Exhausting constitutional diseases

    • Hormonal imbalance and chromosomal abnormalities

    • Certain diseases of the brain and spinal cord

    • Prolong or habitual use of certain drugs

    • Mental or psychic causes

Causes of Impotence in Females

1. Congenital or acquired malformations of genital organs such as absence or atresia of vagina, absence or underdeveloped ovary or uterus, tough and imperforate hymen.

2. Adhesion of the vaginal wall due to diphtheria or ulcers may render sexual act impossible. Kraurosis vulva in elderly females will produce vaginismus.

3. Local diseases such as vaginitis, gonorrhea, leucorrhoea, the displaced position of the uterus, rectovaginal fistula, tumors of labia and vaginal canal, obstruction of fallopian tubes, diseases of the ovaries, etc.

4. Mental or psychological causes:

   • Hysterical fits — in this condition, any attempt to perform sexual intercourse will result in severe fits. This may be because of hatred of the male sex, fear, or excessive passion.

   • Vaginismus — in this condition any attempt to perform sexual intercourse results in severe spasmodic contraction

     • Primary vaginismus — refers to the experience of vaginismus with first time sexual intercourse is attempted.

     • Secondary vaginismus — refers to the experience of vaginismus a little later in life, after a period of pain-free normal sexual intercourse and typically following temporary pelvic problems.

26.3: Artificial Insemination

• Artificial Insemination (AI): Artificial introduction of semen into vagina, cervix or uterus to bring about pregnancy.

• Artificial insemination homologous (AIH) — when the semen of the husband is used.

• Artificial insemination donor (AID) — where the semen of some other person is used.

Indications

1. When the husband is impotent but fertile.

2. When the husband’s sperm count is not up to the optimum level of fertility.

3. When the husband is suffering from congenital anomalies like epispadias or hypospadias and is unable to deposit semen in the vagina.

4. Rh-incompatibility between husband and wife.

5. To avoid transmission of hereditary diseases.

6. Nullity of marriage — marriage may be nullified under the following conditions:

   1. When either party is under-age for marriage contract.

   2. When either party is already married.

   3. When one party is of unsound mind or mentally defective or suffering from the incurable disease at the time of marriage.

   4. Where the marriage was not consummated due to impotence or willful refusal.

   5. Where the woman was pregnant by another man at the time of marriage.

Though special precautions need not be taken for AIH, the following precautions are required to be adopted in the case of AID:

• The knowledge and full consent of the donor is mandatory.

• The identity of the donor must remain secret to the recipient and her husband.

• The results of insemination and the names of the recipient and her husband should remain secret from the donor.

• The donor must be mentally and physically healthy and should not have any hereditary or familial diseases.

• The donor must not be a relative of either spouse.

• He should be fertile and his age should not exceed 40 years.

• The race and morphological appearance of the donor should resemble the husband of the recipient as far as possible.

• The donor should give a written declaration that he will not claim parenthood for the child.

• Rh compatibility between the donor and the recipient should be tested.

26.4: Test Tube Baby

• In this process, the ovum of the wife is removed from the ovary through the abdominal wall and is fertilized by the sperm of her own husband in a laboratory.

• At the stage of the blastocyst, the developing embryo is implanted into the uterus through the uterine cervix and develops there till a full-term fetus.

• It was Dr. Steptoe who pioneered the birth of the first test tube baby in Bolton, England in the mid-1970s.

26.5: Surrogate Mother

• Surrogate Mother — a woman who bears a child either by artificial insemination from the husband of a sterile woman or by implantation of in vitro fertilized ovum at the blastocyst stage.

• She bears the child and on delivery, she hands over the child to its biological father and his wife.

• A mother by substitute.

26.6: Sterilization

• Sterilization — a procedure to render a person sterile but without any interference to potency or sexual function.

Types of Sterilization

• Compulsory: This is performed by an order of the State on eugenic grounds for those who are mentally defective and as a punishment for those sexual criminals.

• Voluntary: Voluntary sterilization may be done on the following grounds:

  • As a family planning measure.

  • For therapeutic purposes.

Sterilization could be permanent or temporary:

• Permanent methods are vasectomy in males and tubectomy in females, and exposure to deep X-rays of gonads in both.

• Temporary methods are the use of oral hormonal pills, condoms, diaphragm, spermicidal jellies, and intrauterine contraceptive devices including loops, copper T, etc.

The following precautions should be observed before undertaking the surgery:

• Written consent of both couples should be taken.

• When performed for family planning purposes, the age of the husband should not be below 25 and the wife below 20 years and they must have at least two children one of whom should be a male child.

• When performed for eugenic or therapeutic purposes, a senior colleague should be consulted.

• It is preferable to have a seminal check-up after vasectomy.

  • The couple should be advised to abstain from sexual intercourse for at least 3 months or till the semen examination shows the absence of spermatozoa.

26.7: Pregnancy

• Pregnancy — a phase in the reproductive period of a woman which results as a consequence of fertilization of an ovum by a sperm.

• Pregnancy can be diagnosed from subjective and objective signs.

Subjective Signs

• Amenorrhea

• Morning sickness: nausea and vomiting on getting up from bed in the morning

• Perverted appetite

• Increased frequency of micturition

• Progressive enlargement of abdomen

• Quickening — a peculiar sensation of fetal movement felt by the mother.

• Excessive salivation

• Constipation

Objective Signs

• Probable Signs

  • Changes in the Vagina

    • The normal pink color of vaginal mucosa changes into violet and ultimately into blue coloration.

    • Flattening of the anterior vaginal wall by the upwardly tilted cervix.

    • Thickening of hypertrophied mucosal folds.

  • Changes in the Cervix

    • Increased vascularity imparts certain changes to the cervix such as softening (Goodell’s sign), fullness, and roundedness with circular external os.

  • Changes in the Uterus

    • Increase in size

    • Hegar’s sign — the characteristic softening of the isthmus of the uterus, detectable by manual examination, from the sixth week.

    • Braxton Hick’s sign — an intermittent uterine contraction, seen only after the fourth month.

    • Uterine souffle — a blowing sound synchronous with a maternal pulse, due to the blood circulation through the enlarged tortuous uterine arteries heard by auscultation of the abdomen from the sixth month onwards.

    • Ballottement — a technique of feeling for a movable object in the body, esp confirmation of pregnancy by feeling the rebound of the fetus following a quick digital tap on the wall of the uterus.

    • The fetal part can be palpated through the abdominal wall. This is appreciated only after the sixth month.

  • Changes in the Breast

    • Enlarges in size, and becomes firm, tense, and tender.

    • Nipples become prominent, with 10-12 small pigmented nodules around called Montgomery’s tubercles.

    • Pigmentation of the areola, making it darker.

    • Secondary areola formation

    • Superficial veins may become more distinct.

    • Secretion of colostrums (witch’s milk) from the fourth month.

  • Laboratory tests

    • Biological tests: These tests are based on reactions of chorionic gonadotropins in pregnant woman’s blood or urine on test animals.

    • Immunological tests: These tests are based on antigen-antibody reaction upon human chorionic gonadotropin hormone (HCG) passed by the pregnant mother in her urine.

Positive Signs of Pregnancy

• Fetal movements: These are felt by keeping the palpating hand on the abdomen from the fourth month and also seen by naked eye examination from the fifth month.

• Fetal heart sound: Forms an important and definite sign of pregnancy, heard from 18 to 20 weeks. Normal heart rate is 160 per minute at the fifth month and 120 per minute in the ninth month.

• Radiological diagnosis: Shadow of the fetal skeleton in the radiograph and ultrasound scanning of the abdomen is diagnostic of pregnancy, which is usually seen from the 15th to 16th weeks.

Medicolegal Importance

• When a woman is condemned to death or sentenced to undergo rigorous imprisonment, she might submit a petition to the court, stating that she is pregnant.

• When a woman after her husband’s death may feign to be pregnant so that she might be entitled to the estate left by her deceased husband on behalf of the prospective heir.

• When a woman after claiming to be pregnant, brings an accusation in the court for breach of marriage or seduction against a certain person.

• When an unmarried woman, a widow or a woman living separately from her husband, wants to get rid of charges of adultery brought against her on grounds of her pregnancy.

• When a woman alleged to be pregnant asks for compensation from a person.

• When the pregnancy of a widow or an unmarried girl is suspected to be the motive of her suicide or murder.

• A woman who is pregnant can claim greater compensation in case of the death of her husband in a railway or airplane accident.

• Pseudocyesis — a condition wherein a woman who has no issues nearing menopause and intensely desiring an offspring, presents with all subjective signs of pregnancy including abdominal distension which may be due to deposition of fat, ascites, or tumor.

• An accepted average period of pregnancy is 280 days from the first day of the last menstrual period (LMP).

• A child born at or after 210 days of pregnancy is considered a viable child, as it is capable of independent survival outside the mother’s uterus.

26.8: Delivery

• Delivery — refers to the birth of the child, on completion of 280 days of pregnancy (full term).

• If delivery occurs earlier than 280 days, it is called premature delivery, while if it occurs after 280 days, it is called postmature delivery.

Signs of Recent Delivery in the Dead

1. Size of the uterus depends on how long the victim lived after delivery.

2. Peritoneal covering is wrinkled.

3. Cut section shows are dark colored, irregular area of placental attachment covered with blood clots.

4. Fallopian tubes are congested.

5. Ovaries are both are congested and one of them shows a large corpus luteum.

Medicolegal Importance

• Blackmail – a woman may feign pregnancy for sometime and then produce some child, alleging that, it is her child. The motive here is to extract money by blackmailing. Such a child is called a “fictitious child” or “suppositious child”

• Affiliation cases – these are cases wherein a woman having illicit sexual intimacy with a man may become pregnant, and deliver a child and then sue him for maintenance of the child.

26.9: Paternity

• Paternity is the ‘fatherhood’ of a child.

Diagnosis of Paternity

1. Parental likeness – a child may resemble the parents in features, figures, complexion, gestures, gait, the color of iris and hair, mannerisms, etc. and with this, we infer that the child is of such a parent.

2. Atavism – at times the child may not resemble the parents but grandparents.

3. Blood group tests – the blood group of an individual is of a hereditary transmission origin from a parent to the offspring.

4. Determination of nonpaternity is also established if the alleged/putative father is:

   • Impotent or sterile

   • Had no access to his wife

   • Blood groups of the child and father are inconsistent

   • Racially not similar to that of the child.

Medicolegal Importance

• In case of legitimacy and disputed paternity.

• In the case of a fictitious child.

• Superfecundation: This is a condition wherein fertilization of two ova, discharged in the same ovulatory period, occurs by different acts of coitus resulting in the birth of twins.

• Superfetation: This is a condition wherein fertilization of two ova, discharged in two different ovulatory periods, occurs by two different acts of coitus, resulting in twins at birth, one of which will be always older than the other.

26.10: Legitimacy

• A child born during the continuance of a legal marriage is considered a legitimate child.

• A child born to a couple who is not married legally is considered to be illegitimate.

Presumption in Favour of Legitimacy

• A child born to a woman who is living with her legally wedded husband, but the offspring is, in reality, a product of her illicit intimacy with a paramour, is still considered a legitimate child, till the contrary is proved in the court.

• A child born to a woman within 270 days of divorce is considered a legitimate child until the contrary is proved.

• A couple indulges in sexual intimacy prior to marriage and consummation takes place.

Legitimacy may have to be decided in cases of:

• Affiliations – according to the law, father of an illegitimate child, must arrange to maintain it.

• Inheritance – a legitimate child alone can inherit the property

• Fictitious child: These arose when an heir was required and so a suitable baby might be procured and passed off as genuine.

26.11: Sexual Offenses

• Sexual offenses are almost of the infinite variety of physical acts by a person with another person or animal, either executed or attempted in the furtherance of sexual gratification.

Classification of SO

1. Natural Sexual Offences: All such physical acts executed within the order of nature’s accordance in furtherance of sexual gratification are considered natural sexual offenses.

   • Rape

   • Incest

2. Unnatural Sexual Offences: All such physical acts executed against the order of nature’s accordance in furtherance of sexual gratification are considered as unnatural sexual offenses.

   • Sodomy

   • Lesbianism

   • Buccal Coitus

   • Bestiality]

3. Sexual Deviations: All such physical acts executed which are not only against the order of nature’s accordance but also against human biology in furtherance of sexual gratification are considered sexual deviations.

   • Eoneism, Exhibitionism, Fetishism, Masochism, Masturbation, Nymphomania, Necrophagia, Necrophilia, Satyriasis, Sadism, Transvestism, Troilism, Undinism, Voyeurism, etc.

26.12: Rape

• A man is said to commit “rape” if he has sexual intercourse with a woman under circumstances falling under any of the six following descriptions:

  1. Against her will.

  2. Without her consent.

  3. With her consent, when her consent has been obtained by putting her or any person in whom she is interested in fear of death or of hurt.

  4. With her consent, when the man knows that he is not her husband and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married.

  5. With her consent, when, at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration by him personally or through another of any stupefying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent.

  6. With or without her consent, when she is under sixteen years of age.

• Penetration is sufficient to constitute the sexual intercourse necessary to the offense of rape.

  • Exception: Sexual intercourse by a man with his own wife, the wife not being under fifteen years of age, is not rape.

• Feigned Rape — a condition wherein a woman pretends to have been raped.

Dangers of Rape

• Shock due to fear may turn fatal or when the victim survives, may make her mentally deranged temporarily or permanently.

• Hemorrhage, due to genital injuries, may be fatal when severe.

• Accidental death.

• Homicidal death.

• Psychological trauma; parasuicide/suicide – out of frustration of being raped, the victim may end her life.

26.13: Detection of Semen

Process of Collecting Biological Samples

• Dried Stains: Application of absorbent swabs moistened in distilled water or normal saline.

• Wet Stains: Under direct visualization any liquid secretions in the body cavities can be collected by aspiration or insertion of dry absorbent swabs.

Screening Tests

1. Ultraviolet Light Scanning: Helps in identifying occult semen stains. Dried seminal stains fluoresce under UV illumination.

2. Chemical Tests:

   • Barberios’ test: Detects the presence of spermine, one of the constituents of semen.

   • Fluorescent test: Detects the presence of choline, one of the constituents of semen.

   • Seminal Acid Phosphatase (SAP): It is an enzyme present in varying amounts in different body fluids.

   • Other markers like creatinine phosphokinase, lactate dehydrogenase isoenzymes, etc. have also been employed for the detection of the presence of semen in the stain extract.

Confirmatory Tests

1. Microscopic Examination: Depending on the time elapsed since the crime, spermatozoa may be alive and motile or dead.

   • Motile sperm: It is best accomplished when the examination is done at the time of collection of the evidence.

   • Nonmotile sperm: Can be detected from the examination of stained smear preparation.

2. Noncellular semen markers: To detect the presence of specific and unique seminal plasma markers.

   • P30 (Prostate Specific Antigen/PSA): It is a glycoprotein derived from the prostate epithelial cells and is found in seminal fluid, male urine and blood, but not found in any female tissue or body fluids.

   • Monoclonal Antibody Mouse Antihuman Semen-5 (MHS-5): It is secreted by the seminal vesicle epithelium and is not found in any other body fluid besides semen and has no cross-reactivity with other body fluids.

26.14: Blood Group Typing

ABO group typing can be done only among secretors.

• Secretors are those individuals who secret soluble ABO agglutinogens in their body fluids.

• Seminal ABO group typing can be done by several methods: absorption-elution, absorption-inhibition, or mixed agglutination.

• Blood group isoagglutinin can be determined by the Lattes Crust method.

Enzyme Typing

• Enzyme markers commonly used in the genetic profiling of semen are phosphoglutamase (PGM) and peptidase (Pep A). These enzymes are found in semen and vaginal secretions regardless of ABO type or secretor status.

• PGM is polymorphic in all populations and can be subdivided into 10 distinct subgroups.

• Pep A is polymorphic in many racial groups and is commonly employed as a discriminator in cases where the perpetrator is suspected to be black.

DNA Profiling

• The primary advantage of DNA profiling in sexual assault investigation is its ability to accurately individualize semen that contains only minimal number of spermatozoa.

• Besides, it can also differentiate multiple donors in mixed stains.

• Postcoital Interval — the time lapsed since last act of sexual intercourse.

26.15: Unnatural Sexual Offences

Incest

• Incest — means an offense wherein sexual intercourse is practiced between a man and a woman who are within a restricted relationship in a family (blood relation) and society such as father and his daughter, mother and her son or brother and his sister, etc.

• It is prohibited and consent given by woman here is not a defense. This is not punishable in India, unless it amounts to rape.

Sodomy

• Sodomy — defined as anal intercourse performed by a male with another male/female who may be a child/adult, with or without consent and by force.

• Active agent — a sodomist male who performs anal intercourse actively.

• Passive agent — a sodomist male or female who offers the anus, and plays a passive role.

• Pederasty — an adult performing a sodomy act involving a male or a female child as his passive agent.

• Catamite — a child who plays a passive role in sodomy.

• Gerontophilia — an old male or female who acts as a passive agent.

Lesbianism

• Lesbianism — defined as a mode of deriving sexual gratification by two consenting females, by mutual genital manipulations manually with fingers, lips, or extragenital mechanical devices—sex toys.

• All steps of examination are the same as for examining the case of rape.

  • Bite marks (love bites), nail scratch marks, abrasions, etc. on mutual genitalia, perineum, breasts, etc.

  • Injury to vaginal canal (especially if dildos are used).

  • Women may be more masculine.

Buccal Coitus

• Buccal Coitus — sexual gratification of a male by performing the act of intercourse into the oral cavity of a sex partner with consent or by force (usually a female partner).

Bestiality

• Bestiality — defined as sexual gratification by having sexual intercourse with animals.

• Certain causes are:

  • Sexual excitement when left alone with animals (pet ones).

  • False belief among Indian villagers that it is a remedy for curing gonorrhea.

• Signs in Accused:

  • Penis/vulva will be found to be contaminated with animal discharges or secretions.

  • Marks of injury due to animal biting, scratching, kicks, etc. • Presence of animal hair on the garments worn.

• Signs in Animals:

  • Presence of human semen or sperms in animal passages, injuries on animal genitalia and other natural orifices.

  • Venereal discharges in animal passages.

26.16: Sexual Deviations

• Sexual deviations are certain physical acts or behavioral abnormalities performed without hesitation, to achieve sexual gratification without the actual sexual union.

Types of Sexual Perversions

1. Eonism/Transvestism — a a sexual perversion wherein sexual gratification is achieved by wearing the dress of the opposite sex.

2. Exhibitionism: The exhibitionist gets the pleasure by exposing private parts in public or in front of a opposite sex individual, sometimes performing masturbation.

3. Fetishism: Here the individual gets sexual excitement and gratification by merely seeing or feeling of female body parts, certain articles belonging to a woman, such as a sari, footwear, stockings, undergarments, hankies, hairpins, etc.

4. Masochism: Here the sexual gratification is obtained on being tortured by the sex partner. Virtually this is just the opposite of sadism.

5. Sadism — a sexual perversion wherein sexual gratification is achieved by inducing pain on the sex partner.

6. Lust Murder — the consequence of extreme sadist practice by a male. In this type of perversion, sexual arousal begins with torturing of the sex partner and with death of the partner full gratification is obtained.

7. Sadomasochism — commonly know as bondage. It is a combined form of sadism and masochism in the same individual.

8. Necrophagia — a person gets sexual gratification by tearing out the genitals or other parts like breasts, buttocks, etc. of his partner after her death by his teeth and may virtually eat them raw.

9. Necrophilia — a desire of obtaining sexual gratification by performing sexual intercourse with a dead person of opposite sex.

10. Voyeurism: It consists of achieving sexual gratification by secretly watching others getting undressed, taking bath, or performing sexual intercourse, etc.

11. Blue Film — a movie taken while a couple is performing sexual union and exhibited to the audience in a theatre or video parlour.

12. Troilism — an extreme degree of voyeurism wherein a perverted husband gets sexual gratification by watching his own wife performing, sexual intercourse with another man.

13. Masturbation — type of perversion comprises of an act of deliberate, manual handling or self-manipulation of genital organ by fingers or mechanical devices till ejaculation in a male and orgasm in a female.

14. Nymphomaniac — a type of perversion of excessive sexual desire in a woman, wherein the woman is in need of sex frequently, irrespective of whether it is by normal or abnormal sexual acts.

15. Satyriasis — an excessive sexual desire, arousal and drive in men. These subjects are liable to commit sexual offenses like rape or practice other abnormal sexual acts.

16. Frotteurism — a mischievous act usually practiced by a male sex-pervert in a crowded place to derive sexual gratification by pressing/rubbing his genital part through the dresses worn, against body parts of a female in front of him.

17. Undinism — a rare type of sexual perversion, common among men wherein the pervert achieves sexual gratification by watching the act of passing urine or defaecating by woman.

18. Indecent Assault — any offense committed on a female with an intent or knowledge to outrage her modesty. This is usually sexually motivated and obviously done without her consent. This includes:

    • Kissing of any part of female body

    • Touching, pressing the breasts or private parts, including thighs

    • Exposing a female’s genital parts, breasts, etc.

    • A medical practitioner can be accused of indecent assault if he examines a female patient by stripping her clothes without her consent.

26.17: Abortion

• Abortion — defined as the premature expulsion of the products of conception prior to completion of the total period of gestation.

• Fertilized ovum — from fertilization till implantation, which usually occurs within 1st to 2nd weeks of conception.

• Embryo — denotes the developing product of conception after its implantation in the uterus up to the end of second month, when usually the placenta develops.

• Fetus — the product of conception from the 3rd month till birth.

Classification of Abortion

1. Natural Abortion — an abortion that occurs spontaneously without any induction procedures and usually coincides with a menstrual flow.

2. Artificial or induced abortion which could be again of two types:

   1. Justifiable or therapeutic abortion

   2. Criminal or non-justifiable abortion

Medical Termination of Pregnancy/MTP

• Medical termination of pregnancy is an abortion induced by a medical man in good faith to save the life of the mother for proper therapeutic need.

• The following conditions must be fulfilled to perform a justifiable abortion:

  1. Written consent of both the woman and her husband or legal guardian.

  2. Consultation with another medical man, usually a specialist or one who is superior in qualification and experience.

  3. Proper indication of performing the abortion:

     • Systemic diseases – cardiac failure, severe hypertension, severe toxemia of pregnancy, advanced renal diseases, epilepsy, etc.

     • Gynecological indications.

     • Conditions causing fetal abnormality- infective conditions.

Cause of Death in Criminal Abortion

1. Immediate causes

   • Reflex vagal inhibition following instrumental evacuation or from sudden dilatation of vagina and cervical canal by the passage of instrument.

   • Air embolism from faulty syringing.

   • Soap embolism from improper introduction and absorption of soap solution.

   • Shock and hemorrhage from injury to vaginal, uterine or pelvic vessels.

2. Delayed causes (2-3 days):

   • Septicemia following infection.

   • Pyemia from pelvic abscess.

   • Generalized peritonitis following perforation of uterus of the bowel by the instrument.

   • Tetanus.

3. Remote causes (beyond 3 days):

   • Renal failure.

   • Pulmonary embolism from dislodged thrombus.

   • Systemic poisoning by absorption of abortifacient drugs.

   • Secondary infection — pneumonia, empyema, meningitis, etc.

Signs of Criminal Abortion

1. Profile of victim – usually unmarried girls or widows.

2. On examination the patient may show following:

   • Laceration of the vagina and cervix

   • Marks of violence on the abdomen of healthy women

   • Evidence of sepsis – like pelvic cellulitis, peritonitis, etc.

   • Injuries on the fetus.

   • Evidence of burns over the back may be found in a criminal abortion induced by electrocution

   • Presence of the parts of the abortion stick or foreign body in the uterus or vagina

   • Reddening and blistering of vaginal mucosa when irritants are used

   • Perforation of the uterus, when abortion stick is used.

3. Examination of a Case of Criminal Abortion

   • Procedural formalities

   • Examination of the alleged woman

   • Examination of the material alleged to have expelled out.

Examination of the Alleged Woman (Victim)

• In the living: This should be elicited as early as possible, otherwise many of the important signs will disappear within seven days.

• In the dead: In addition to above signs we may find following internal postmortem findings:

  • Foreign body inside the uterus.

  • Extravasated blood under the bruised portions.

  • Mucous membranes of stomach and intestines are congested if an irritant poison was swallowed to procure abortion.

  • Uterus is enlarged and its cavity contains portions of decidua.

Examination of Material Alleged to have been Expelled out

• This may be blood clot, shreds of membrane, a hydatidiform mole, fibroid tumor, polyp, an embryo or an immature fetus.

• Traces of ovum are searched for in the material after washing it in a basin of water. Abortion cannot be definitely established, unless the products of conception are found.

• If it is a fetus, its intrauterine age is determined. The viability of the child is also noted (210 days – viable age).

• Note the length, weight, and stage of development of the baby and whether it is stillborn or live born. Blood group test may determine its maternity.

• After the death of a pregnant woman, if body is highly decomposed, the contents will come out spontaneously due to the pressure of gases of putrefaction (postmortem delivery).

• Even the uterus may prolapse.