Perianal examination
The examination of the patient alleging sexual torture is not technically different from a general anogenital examination. The essential aspect, even more than for other medical purposes, is to gain the confidence of the individual. By this stage the health professional will have already completed an interview and general physical examination.
Following a more general history, questions should be asked about urinary function after the episode(s). Some survivors of torture described haematuria for a median of two days, mostly after beating or electric shocks to the genitals, although some could have had haemaglobinuria (haemoglobin in the urine) from beatings elsewhere in the body. Where an object has been inserted into the anus, including anal rape, there is normally bleeding and pain for a few days afterwards, but these symptoms do not normally last for more than about two weeks.
Generally, visual inspection of the anogenital region is sufficient to find scarring and other lesions of the skin. The focus of the examination will depend on the history.
Anal rape or objects pushed through the anus in either sex can sometimes lead to scarring. Scarring from haemorrhoids or anal fissures is seen in a proportion of the general population, but may also relate to constipation due to a poor prison diet. If a health professional sees scarring in an unusual part of the anus, or scarring that is bigger than commonly seen following anal fissures, this should be emphasised.
It is best to examine the anus with the patient lying on her or his left side. The buttocks can be separated gently to see if there is any perianal scarring. It is only necessary to check the tone of the anal sphincter if the survivor has been anally raped repeatedly. If the survivor had persistent bleeding after an object was pushed through the anus, there may be scarring of the rectal mucosa and this can be looked for by proctoscopy.
Following rape, the possibility of sexually transmitted diseases should be considered and local protocols followed. If there is any possibility of the perpetrator being prosecuted, air dried internal and external anal swabs can be taken up to five days after the rape, even if the survivor has defecated, and stored for DNA testing.
Comments