The second step in the examination of sexual assault cases is the anal examination. Anal Examination is required to detect medical evidence of acute or recurrent anal penetration.
Anal examinations are typically performed in the knee-elbow position, but also can be done in the lateral or gynecological position. During an anal examination, gluteal cheeks and perianal region are to be inspected while applying gentle gluteal retraction with both hands. At this point, it is also important to note sphincter tonus. The examiner’s fingers should then be used to retract the perianal area and check between the anal mucosal folds.
Possible findings in acute anal penetration include sensitivity, ecchymoses (focal or surrounding the anus), acute mucosal fissures, deep lacerations involving the submucosa or muscularis mucosa, and bleeding. Anal sphincter tone is commonly found to be normal. However, during examination, an increase in tonus may be seen due to irritation of a painful fissure, or a decrease in tonus due to sphincter injuries.
Chronic sodomy may be characterized by a decrease or loss in anal sphincter tone, resulting in gas and fecal incontinence, effacement and flattening of anal mucosal folds, scar tissues from healed deep lacerations, a perianal funnel appearance due to loss of external anal sphincter tone, hyperpigmentation, and a shiny appearance due to chronic irritation. To detect these findings related to acute and chronic sodomy, SAFE (Sexual Assault Forensic Examination) Imaging Systems’ various magnification features and filters, which can draw attention to different lesions, are extremely useful.
Findings discovered during an anal examination must be evaluated together with the medical history, and a differential diagnosis of poor hygiene, intertrigo, constipation, scratching, anal area infections, parasitic infestations, and other lesions caused by various medical conditions.
The type, severity and distribution of anogenital injuries are affected by many factors;
• Type and size of the inserted object,
• Erectile status and size of the inserted penis,
• Type of organ the inserted,
• Age and physical development of the victim,
• Whether or not a lubricant is used
• Whether the intercourse is consensual or not,
• Position of victim and attacker, angle of penetration, etc.
Obtaining a swab sample is an essential part of the anal examination since it offers biological evidence. Finding sperm in the sample is a crucial step towards identifying the offender. Samples collected under the naked eye are likely to contain no sperm, even if the offender’s sperm is present in the victim’s body. Through the various light filters of SAFE (Sexual Assault Forensic Examination) Imaging Systems, sperm emits flourescence. In order to identify the area that has to be sampled, this is very important. Holding the perpetrators for the crimes accountable will be considerably easier with the use of these samples as proof. Because of this, using SAFE (Sexual Assault Forensic Examination) Imaging Systems offers healthcare professionals a number of benefits, including the protection of victim rights, thorough examinations, and impartial and genuine contributions to the legal system.
Figure 1: Normal anal examination images captured by Forenscope SAFE systems with White light and Polarized light
Figure 2: Acute mucosal fissure images captured with Forenscope SAFE systems
Figure 3: High magnification images of acute mucosal fissure captured with Forenscope SAFE systems
Figure 4: Anal scars become clearly visible with Green filter and Polarized camera of Forenscope SAFE systems
