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Pink notes in Legal Medicine (Finals)

Medico Legal Aspects of Sexual Crimes


Virginity a condition of a female who has not experienced sexual intercourse and whose genital
organs have not been altered by carnal knowledge.
Kinds of Virginity
1. Moral Virginity state of not knowing the nature of sexual life and not having experienced
sexual relation. Refers to children whose sex organs and secondary sexual characteristics
are not yet developed.
2. Physical Virginity a woman conscious of the nature of sexual life but has not yet
experienced sexual intercourse. Refers to women who have reached sexual maturity.
a. True Physical Virginity hymen intact with the edges distinct and regular and the
opening are small to admit the tip of the smallest finger;
b. False Physical Virginity condition wherein the hymen is intact but the orifice is wide
and elastic to admit two or more fingers of the examiner with lesser degree of
resistance. Lax hymen.
3. Demi-Virginity a condition of a woman who permits all forms of sexual liberties as long as
they abstain from rupturing the hymen by sexual act. Inter-femora or inter-labia only.
4. Virgo-intacta literally the term refers to a truly virgin woman with no structural changes in
her organ and she is a virtuous woman; include women who had previous sexual act or
even habitually but not given birth.
Anatomy of a female organ
Classification of hymen
a. As to shape and size of opening
1. Annular or circular opening is oval or circular located at the center of hymen.
2. Infantile opening is small, usually linear, fleshy and resistant.
3. Semi lunar or crescentric concavity maybe facing either side or upwards or
downwards.
4. Linear
5. Cribriform hymen has multiple opening
6. Stellate
7. Septate a thin strip of tissue is present in between two lateral openings
8. Fimbriated opening of hymen is in the center but the margins are wavy or undulating
and shows multiple notches
9. Imperforate hymen with no opening
b. As to number of opening
1. Single
2. Septate - A septate hymen is when the thin hymenal membrane has a band of extra
tissue in the middle that causes two small vaginal openings instead of one. Teens with a
septate hymen may have trouble getting a tampon in or trouble getting a tampon out.
The treatment for a septate hymen is minor surgery to remove the extra band of tissue
and create a normal sized vaginal opening.
3. Multiple
4. Imperforate hymen with no opening
c. As to structure and consistency
1. Firm and with strong connective tissue and plenty of blood vessels
2. Thick yielding hymen with scarce blood vessels
3. Membrane hymen hymen is parchment, like, maybe transparent
Septate 2 openings
Crescentric crescent shaped

Anular circular hymen


Imperforate hymen closed, no opening
Defloration it is the laceration or rupture of hymen as a result of sexual intercourse.
Parts of female genital to be examined:
1. Condition of the vulva craptated or gaping labia majora or minora.
2. Fourchete V sgape or rounding of the base or blunted.
3. Vafinal anal sharpness or obliteration of the rugosities laxity of the walls.
4. Hymen intact or lacerated.
Other causes of hymenal laceration
1. Passage of clotted blood during menstruation
2. Ulceration due to disease
3. Jumping or running
4. Falling on hard or sharp object
5. Local medication
6. Self-scratching due to irritation
7. Masturbation
8. Insertion of foreign bodies
9. Previous operation
Myths
1. Sexually transmitted infections through sharing of same bed, toilet seat or towel;
2. Biking, horseback riding, dancing (split) can cause hymenal laceration
3. Masturbation can cause hymenal laceration.
- Normal masturbation in girls involves clitoral or labial stimulation
- Self injurious behavior
Degree of laceration; extent of damage
1. Incomplete laceration when it does not involved whole width of the hymen, it maybe:
a. Superficial laceration does not go beyond of the whole width of the hymen.
b. Deep involves more than of the width of the hymen but not reaching the base.
2. Complete involves the whole width, but not beyond the base.
3. Compound or complicated laceration involves the hymen and also the surrounding
tissues; it may involve the perineum, vaginal canal, urethra and rectum.
Notches indentation of the hymen simulating laceration; maybe mistaken for laceration.
Duration of laceration
1. Fresh laceration recent origin within 24 hrs
2. Fresh healing with fibrin formulation of edema of the surrounding tissues after 24 hrs to 3-4
days or 5 days
3. Healed laceration or completed edges and with sharp coaptible borders recently healed;
4-10 days
4. Healed laceration with sharp coaptible borders without congestion: 10 days or 2-3 weeks
5. Healed
Complications of laceration
1. Secondary infection gonorrheal infections
2. Hemorrhage severe compound laceration
3. Fistulae formation recto-vaginal or verico-vaginal fistulae may develop in case of
compound laceration
4. Structure scar formation (burns)
5. Sterility prolonged infection will result to sterility

Sexual crimes
1. Rape A. is committed by a man who shall have carnal knowledge of a woman under any
of the following circumstances:
a. Through force, threat, or intimidation;
b. When the offended party is deprived of reason or otherwise unconscious;
c. By means of fraudulent machination or grave abuse of authority; and
d. When the offended party is under twelve (12) years of age or is demented, even though
none of the circumstances mentioned above be present.
B. by any person who, under any of the circumstance in para 1 hereof, shall commit an
act of sexual assault by inserting his penis into another persons mouth or anal orifice, or
any instrument or object, into the genital or anal orifice of another person.
2. Seduction consented sexual intercourse by a virgin who must be over 12 years but not
over 18 years through abuse of authority or deceit
a. Qualified seduction committed in the excess of power or abuse of confidence
b. Incestuous qualified seduction abuse of relationship such as by brothers or
ascendants
c. Simple seduction committed by means of deceit
3. Acts of lasciviousness - (1) that the offender commits any act of lasciviousness or
lewdness; (2) that it is done: (a) by using force and intimidation or (b) when the offended
party is deprived of reason or otherwise unconscious, or (c) when the offended party is
under 12 years of age; and (3) that the offended party is another person of either sex.
[T]he intentional touching, either directly or through clothing, of the genitalia, anus, groin,
breast, inner thigh, or buttocks, or the introduction of any object into the genitalia, anus or
mouth, of any person, whether of the same or opposite sex, with an intent to abuse,
humiliate, harass, degrade, or arouse or gratify the sexual desire of any person, bestiality,
masturbation, lascivious exhibition of the genitals or pubic area of a person.
4. Abduction - The person kidnapped must be a woman; It must be against her will; The
abduction must be for lewd or unchaste designs.
a. Forcible abduction abduction of any woman against her will and with lewd design.
b. Consented abduction the abduction of a virgin over 12 and under 18 years of age,
carried out with consent and with lewd designs.
5. Adultery - the carnal relation between a married woman and a man who is not her husband,
the latter knowing her to be married, even if the marriage be subsequently declared void.
Each sexual intercourse constitutes a crime of adultery.
6. Concubinage - is committed by any husband who shall keep a mistress in the conjugal
dwelling, or, shall have sexual intercourse, under scandalous circumstances, with a woman
who is not his wife, or shall cohabit with her in any other place.
7. Prostitution - any act, transaction, scheme or design involving the use of a person by
another, for sexual intercourse or lascivious conduct in exchange for money, profit or any
other consideration.
8. Corruption of minors - Any person who shall promote or facilitate the prostitution or
corruption of persons underage to satisfy the lust of another, shall be punished by prision
mayor, and if the culprit is a public officer or employee, including those in governmentowned or controlled corporations, he shall also suffer the penalty of temporary absolute
disqualification.
9. White slave trade - any person who, in any manner, or under any pretext, shall engage in
the business or shall profit by prostitution or shall enlist the services of any other person for
the purpose of prostitution.
Sexual abnormalities
1. Heterosexual - sexually attracted to people of the opposite sex.
2. Homosexual - sexually attracted to people of one's own sex.
a. Overt - Homosexual tendencies that are consciously recognized and expressed through
behavior.

b. Latent homosexual arousal which the individual is either unaware of or denies.


3. Tribadism sexual practice among women with women
4. Infanto sexual use of an immature person as a sexual object.
5. Phidophile sexual desire with children
6. Besto sexual desire for animals; bestiality (zoophilia)
7. Cluto sexual
8. Gerentophilia sexual desire with elder person
9. Necrophilia sexual desire with corpse
10. Incest blood relation
11. Satyriasists uncontrollable or excessive desire in a man
12. Nymphomaniac - a woman who has abnormally excessive and uncontrollable sexual
desire.
13. Sexual anexthesia - the absence of normal sensations during sexual activity that can be
psychogenic.
14. Dyspareunia - difficult or painful sexual intercourse.
15. Vaginismus - painful spasmodic contraction of the vagina in response to physical contact or
pressure (especially in sexual intercourse).
16. Old age
17. Oralism obtaining sexual pleasure exclusively from the application of the mouth to the
sexual organs
18. Fellatio (irrumation) - Oral stimulation of the penis; a type of oral-genital sexual activity;
19. Cunnilingus - oral stimulation of the vulva or clitoris.
20. Analism (anillingus) use of the anus for sexual purposes
21. Sado-masochism - psychological tendency or sexual practice characterized by both sadism
and masochism.
22. Flagellation flogging or beating for sexual gratification.
23. Sadism (active algo lagnia) obtaining sexual pleasure from acts of cruelty.
24. Cannibalism one eats the other before, during or right after sex.
25. Love bites - a temporary red mark on a person's skin caused by a lover biting or sucking it
as a sexual act; a hickey.
26. Necro sadism or lust murder cutting and stabbing, biting the skin or drinking the blood.
27. Masochism (passive algo lagnia) obtaining sexual pleasure by being hurt, humiliated,
dominated, bound, or degraded.
Fetishism the real or fantasized presence of an object or bodily parts is necessary for sexual
gratification
Kinds of fetishes
1. Anatomic structure of organism
2. Clothing
3. Necrophilic use of dead body as sexual object
4. Osphesiophilia
a. Urolagnia tendency to derive sexual pleasure from the sight or thought of urination
b. Coprolagnia sexual excitement produced by contact with feces
c. Mysophilia abnormal attraction to filth
5. Pygmalionism sexual responsiveness directed toward a statue or other representation
especially when ones own making.
6. Manikinism use of manikin as sexual object
7. Narcissism excessive or erotic interest in oneself and ones physical appearance.
8. Negative fetish
9. Saboteur fetish
10. Incendiarism sexual pleasure in malicious burning to destroy property
11. Vampirism sexual pleasure obtained by drinking blood
12. Sodomy sexual intercourse involving anal or oral copulation.
13. Uranism the practice of homosexuality between males

14. Frottage sexual pleasure obtained by and seems to be due to persistence of the infantile
love of being cuddled and rubbed.
15. Partialism sexual interest with an exclusive focus on a specific part of the body other than
the genitals
16. Voyeurism practice of obtaining sexual gratification by looking at sexual objects or acts,
especially secretively
17. Mixoscopia (scotophilia) obtaining sexual pleasure by looking at other peoples genital
organs
18. Troilism (mnage a tois) three people having sexual relations with each other occupy the
same household.
19. Pluralism
20. Coprolalia utterance of obscene words for sexual pleasure.
21. Indecent exposure
22. Transvestism deriving sexual gratification from dressing in the clothes of the opposite sex.
23. Transexualism wish to change ones sex
24. Intersesuality a person is born with a reproductive or sexual anatomy that doesnt seem to
fit the typical definitions of female or male.
Medico-legal aspects of injuries:
Due to heat, cold, and electricity
Injury due to heat
- Any excess of temperature over 50 degrees centigrade can cause damage to living
tissue.
1. Dry heat burn
2. Moist heat scalding
3. Erythema and blistering is caused and there is fluid
Burns
1. Dry burns are classified by severity and extent:
a. First degree erythema and blistering (vesiculation)
b. Second degree burning of the whole thickness of the epidermis and exposure of the
dermis.
c. Third degree destruction down to the dermal tissues, sometimes with carbonization
and exposure of muscles and bones.
Estimating the extent of injury
- Rule of nine is used to calculate the approximate extent on the body surface.
- The area of burning may be more dangerous to life than depth.
- If the area exceeds 50% the prognosis is very poor.
- Old people may die only with 20% burns.
Causes of death in burns
1. Rapid death
- Actual destructive effects of heat
Asphyxia
Shock due to pain
Inhalation of hot gas burning the interior of air passage
Carbon monoxide toxicity and other noxious gas
2. Delayed death
- Dehydration
- Electrolyte imbalance
- Renal failure
- Toxemia from substances absorbed from the burned area
- Infection

Injury due to cold


1. Hypothermia exposure to low temperature
Signs:
28 degrees Celsius or less almost certain to die even with treatment
Below 32 degrees celcius shivering ceases
35 degrees shivering is constant
Body shows pink areas, sometimes slightly brown or pink with distinct
Frost bite
Hypothermia of the extremities frostbite, it is really the infraction of the peripheral digits with
edema redness and later necrosis of the tissue.
Electrical injury
- Current
- All electrocution, fatal or otherwise originates from the public power supply which is
delivered at either 110 or 240 volts; it is rare for death to occur at less than 100 volts.
- Usually the entry point is the hand and exit is to earth (or ground) it will cross the thorax
unexpected and sudden death from natural cause.
- Where natural death is very rapid, virtually instantaneous cause is cardio vascular;
- If a person collapses and is clinically dead when someone nearby runs to assist him,
cause is cardiac arrest.
Causes of sudden and unexpected death
a. Cardio vascular system
- Coronary artery disease
- Coronary insufficiency
- Complications of atheroma
- Coronary thrombos
- Myocardial infraction heart attack
- Lesions in the cardiac conducting system
- Ruptured myocardial infract
- Myocardial fibrosis
b. Hypertensive heart disease
- Aortic stenosis
- Senile myocardial
- Primary myocardial
- Diseases of the arteries
Atheromatous aneurysm
Dissecting aneurysm of the aorta
Syphilitic aneurysm
Intracranial vascular lesion
c. Respiratory system
- Pulmonary embolism
- Massive hemoptysis from cavitating pulmonary tuberculosis or from malignant tumor
- Chest infection
d. Gastro intestinal system
e. Gynecological conditions
- Abortion vagina shock
- Ruptures ectopic gestation
f. Asthma
-over use of adrenergic drugs
g. Epilepsy - Status epilepticus - a dangerous condition in which epileptic seizures follow one
another without recovery of consciousness between them.

Medico legal aspects of pregnancy and abortion


Pregnancy 270-280 days
- Product of conception
Legal importance
1. Claim for breach of promise or charge of seduction
2. Alleged criminal abortion
3. Civil disputes
4. Excused attendance in court
5. Charges of infanticide
Legal termination of pregnancy
1. Performed by medical practitioner
2. Carried out in health service hospital
3. Two doctors must examine the woman
4. Termination must be notified to medical officers of the appropriate government department
5. Circumstances/reason for termination of pregnancy
a. Endanger life of a woman
b. Endanger physical health
Abortion willful killing of the fetus or violent expulsion of the fetus from the natural womb and
which results to the death of the fetus. Maybe natural, therapeutic or clinical.
Methods:
-drugs and toxins
-instrumentation cauterization
-general violence
-local interference
-syringe aspiration
Causes of abortion
-death of fetus congenital abnormality, poisoning, diseases
-abnormality of the uterus
-emotional condition
-abortificient drugs
-trauma direct or indirect
-hormonal deficiency
-acute specific fever and high temperature
Fatal effects of illegal abortion
1. Hemorrhage from local genital trauma
2. Sepsis
3. Shock
4. Air embolism
5. Complications such as leg vein or pelvic vein thrombosis, pulmonary embolism,
disseminated intravascular coagulopathy, renal failure.
Death and injury in infants
Still births child is more than 28 weeks, gestational age, which after being completely expelled
from the mother did not breathe or show any signs of life.
Causes
1. Prematurity
2. Fetal hypoxia

3. Placental insufficiency
4. Intra urine infection
5. Congenital defects
Infanticide killing of a child less than 3 days old
Child abuse syndrome physical, mental, and sexual abuse of children by parents or guardian.
Child abuse is also called child or baby battering or non-accidental injury
Features:
- Infants can be of any age
- Most fatalities under 2 years
- Any social class
- Lower middle class most at risk
- Lesions are in the skin and skeleton
Child sexual abuse involvement of dependent develop mentally immature children and
adolescents in sexual activities they do not truly comprehend, to which they are unable to give
informed consent.
Sudden death of infant syndrome (SIDS) crib death or cot death
Features:
1. Takes place between 1-7 month with a peak at 2-3 months
2. Slight predominance in male
3. Incidence is markedly greater in one of a twin pair whether identical or not
4. Seasonal variation in zone, more on colder
5. Higher risk in disadvantageous families.
Physical abuse or human rights torture
1. Skin with redness, swelling, intradermal bruising, subcutaneous bruising
2. Double slavery line
3. Where skin is lacerated
4. Falanga (feet are beaten by a thin rod)
5. Burns from hot irons
6. Cutting and piercing
7. Electric torture
8. Damage to ears
9. Suffocation
Alcohol abuse
Effects:
30-50 % - impairment of driving and similar skills
50-100% - reduced inhibitions, talkativeness, laughter, slight sensory disturbance
100-150% - in coordination, unsteadiness, slurred speech
150-200% - obvious drunkenness, nausea and ataxia
200-300% - vomiting, stupor, possibly coma
300-350% - danger of apirating vomit, stupor or coma
Over 350% - progressive danger of death from respiratory paralysis
Symptomatic changes after ingestion of alcohol
-stage of excitement
-stage of confusion or in coordination
-stage of narcosis or coma

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