Forensic gynaecological examinations
in connection with sexual violence
H. Pallo
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Forensic gynaecological examinations constitute 4-5% of personal examinations performed in the North Estonian department and carried out on the basis of examination regulations in a gynaecology consultation room of the personal examinations office, where 2 doctors and a medical nurse take part in every gynaecological examination. Examinations include rapes, attempted rape, sexual harassment of children outside their family as well as incest. Two hundred documents of forensic gynaecological examinations were analysed.
I. Kinds of sexual violence
Sexual intercourse %
Vaginal 40
Oral 9
Orovaginal 10
Oroanal 5
Orovaginoanal 6
Anal 8,5
Molestation 7,5
Exhibition 2
Attempt of anal penetration 3
Attempt of vaginal penetration 5
Foreign body in vagina 3
Foreign body in anus 1
Sexual harassment in the form of violent vaginal intercourse was present in 40% of all sexual assault cases. Violent oral intercourse was in 38% of cases committed against girls aged 4-14 and in 11% the victims were boys under 14 years of age, violent anal intercourse with boys of similar age comprised 64% of all cases of anal assault. The most frequent combined form of violent intercourse was orovaginal, making it 10% of all cases. Orovaginoanal rape was committed by groups in 66,6% of these cases.
II. Victims by age
% of sexual 0-5 yrs 6-10 yrs 11-14 yrs 15-18 yrs 19-25 yrs over 25 yrs
crimes 5 11 19,5 31 18 19
III. Number of performed examinations by month
Months I II III IV V VI VII VIII IX X XI XII
Number 14 15 19 19 15 19 26 24 12 14 8 15
of victims
IV. Assaults grouped by time committed
Time Daytime 6p.m.-12 a.m. after 12 a.m.
% 24% 41% 35%
Our data suggest that the number of sexual crimes grows in March and April, reaching its maximum in July and August, with the smallest number of cases taking place in January and November. Seventy six per cent of victims were assaulted (raped or harassed) in the evening or at night, 24% of cases took place in the daytime. Inside the age group of 0-25 yrs, the greatest number of sexual crimes land upon those of 15-18 yrs (31%), followed by the group of 11-14 yrs - 19,5%. Sixty six point five per cent of all assaults are committed against those of age 0-18 yrs. Thus, sexual assault was aimed mainly at underage girls, over 50% of those cases pertaining to children aged 11-14 yrs.
V. Rape victims grouped by social status
Workers 8,5%
Attendants 9%
Civil servants, educated persons 3%
Students 56,5%
College students 4%
Unemployed 8%
Retired 4%
Pre-school aged 7%
The victims of sexual assault are mainly high school and other students, which explains the relatively high percentage (24) of assaults taking place in daytime. Four attackers were classmates of the victims and were 8, 11 and 12-year-old boys - insertion of a foreign body (stick) into the vagina, molestation; two of the attackers were female classmates who introduced a foreign body into the vagina with the aim of taunting. Incest or sexual harassment of a child by a family member occurred in 33% of cases pertaining to the age group of 11-14 yrs.
Sexual harassment of boys in the same age group (in family as well as outside of it) was present in 18,5% of cases.
Repeated and long-term abuse of a child by one person ranged from 2 days to 4 years, occurring mainly in a family, whereas 24,3% of the victims in the age group 0-14 yrs were boys.
VI. Time period after sexual abuse when the primary forensic gynaecological or andrological examination was performed
% of days
I II III IV over V
11 18 14 16,5 22,5
% of months
I II III IV V over VI
4 3,5 1,5 - - 1,5
% of years
I II III IV
5,5 2,5 - 1,0
Primary gynaecological and andrological examinations that were performed months and years after sexual abuse took place is a concern of permanent sexual violence, mainly in the family.
In 59,5% of cases the forensic-gynaecological examination was performed on days I-IV, whereas in 32% of those cases the victim was first brought to hospital by police immediately after the rape, in order to perform a gynaecological examination and to obtain samples of sperm and infection. Vaginal and anal sperm samples were obtained by a medical examiner no later than the days I-III after rape, oral samples were obtained only on day I.
VII. Number of rapists in group rapes
Number 2 3 4 5 6 and more
% 53,8 29,6 10,2 2,5 3,8
From all cases of observed rapes, group rape comprised 34%, the most frequent of those being the groups consisting of two or three people. There were relatively many groups consisting of four people - almost 1/3 of all group rapes.
VIII. Body injuries by severity in sexual crimes
Body injuries light severe extremely severe no damage
% 62,5 5 0,5 32
Severe body injuries observed were rib and zygomatic bone fractures, brain contusion and in one case fracture of spinal process in a lumbar vertebra, fracture of mandible.
One extremely severe bodily injury was present - fracture of the skull.
Most frequent light injuries were haematomas and excoriations, cuts, fractures of nasal and zygomatic bones without dislocation and light head trauma. Knife injuries were present in 7% of cases. Traces of strangling were observed in 16% of victims.
Twenty four point five per cent of cases with no body injury pertained to children who were the subjects of permanent sexual abuse; in the rest of the cases the cause was mainly a late call for help.
IX. Injuries of genitals and anal area
Injuries of fresh tears old tears perforated no injury -
hymen hymen virgo
% 13 56 8 15
hymenal isolated injuries injuries of
tear with of vaginal perineum anal area
vaginal tear tear
% 0,5 2 0,5 5
Thirty per cent of cases presented with scratches, excoriations, submucous haematomas and fissures in the anal region; slackness of outer sphincter muscle and an open anal orifice was present in 3%, whereas 50% of anal sexual abuse was committed against underage boys of 4-14 yrs.
No injuries of oral mucous membranes were found in cases of oral raping.
Hymenal tears were most frequently located in the lower segment with a tear in one of the lateral segments. Isolated tears of lateral segments were less frequent.
X. Relations between the rapist and the victim
Unknown rapist % 43
Acquaintance % 27,5
Previously acquainted in a bar etc. % 17,0
Father % 3,5
Stepfather % 4,0
Son % 0,5
Uncle % 2,0
Brother % 1,5
In most cases the attacker was unknown to the victim, relatively frequent was a previous acquaintance made in a bar, night-club or in company. In one case the acquaintance was made on a train, in two cases it was on the beach and in nine cases on the street or in a hotel.
Alcohol was consumed by both the attacker and victim in 32% of cases. Two cases presented with violent administration of drugs to the victim.
XI. Locations of assault by percent
Location %
Home 18
Other apartment 15
Hotel, bar, campsite 7
Car 9
Street 18
Apartment or cottage of an acquaintance 13
Woods, garden etc. 20
In cases of a street assault a victim was pulled into a car in 20 cases and thereafter raped in a car, woods or some apartment.
Six point five per cent of cases witnessed an assault in a park or garden, 3,5% took place in an abandoned building or a construction site. Two assaults were made in a schoolhouse by fellow students, in 17 cases the location was either a workplace, ship, vestibule, elevator or beach.
Summary
Sexual assault was directed mainly against underage children and young females up to 18 years of age, the main social status of the victims was student.
Raping or an attempt of it was almost always accompanied with brutal physical violence, even if a victim surrendered completely; only solitary cases were presented with threats only.
Previous acquaintance between young people in some public place or in private company was quite frequently present and in 1/3 of cases alcohol was consumed by both the attacker and the victim.
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