SAT, Oct 9 \ 9.00-11.00 \ Victims of Sexual Abuse, II

112
THE FORENSIC MEDICAL EVALUATION OF THE SEXUALLY ABUSED CHILD

Chaido Spiliopoulou, Stavroula Papadodima, Nikos Kotakidis
Dept. Forensic Medicine and Toxicology, Medical School, University of Athens, Athens, Greece
cspiliop@cc.uoa.gr

Child sexual abuse is being recognized as a serious problem which affects children regardless of their age, sex, socio-economic class, or geographic location. It is also well accepted that the incidents of child sexual abuse are underreported. The role of a comprehensive forensic medical examination is of major importance in the full investigation of the case and the building of an effective prosecution in the court. The protection of the sexually abused child from any additional emotional trauma during the physical examination is of great importance for the forensic doctor. A supportive adult, not involved in the case, should be present. The physical examination includes inspection of the whole body with special attention to the mouth, breasts, genitals, perineal region, buttocks and anus. The next concern of the forensic doctor is the collection of biologic evidence such as epithelial cells, semen and blood, under the term that the alleged sexual abuse has occurred within the last 72 hours. A brief assessment of the developmental, behavioral, mental and emotional status should also be obtained. The cooperation with a pediatrician and/or a pediatric psychiatrist could be helpful or even necessary. Cultures and serologic tests for sexually transmitted diseases are decided by the forensic doctor according to the special circumstances of each case. Pregnancy test should also be performed in each case of a girl in reproductive age. Photographic documentation may be useful. A detailed presentation of the different aspects of the examination is attempted and guidelines and protocols are suggested. The current situation and legislation in Greece are also discussed.

113
TOXICOLOGICAL INVESTIGATION OF DRUG-FACILITATED SEXUAL ASSAULTS

Stavroula Papadodima, Sotiris Athanaselis, Chaido Spiliopoulou
Dept. Forensic Medicine and Toxicology, Medical School, University of Athens, Athens, Greece
stpapd@med.uoa.gr

Sexual assault perpetrated on both women and men, while incapacitated by the so-called date-rape drugs, has drawn considerable attention during the last decade. In the typical scenario, the sexual predator surreptitiously spikes the drink of an unsuspecting person with a sedative drug. In some cases the victim consumes voluntarily recreational drugs, or mixes prescribed drugs with alcohol, which lead to impairment and loss of consciousness. If an individual takes advantage of such situations and has unconsensual sexual intercourse with an incapacitated individual is considered to commit a drug-facilitated sexual assault. Theoretically, any substance that is administrated to lower sexual inhibition and enhance the possibility of unwanted sexual intercourse is a potentially a date-rape drug. Flunitrazepam and γ-hydroxybutyrate have been considered as the most commonly used date-rape drugs in these cases, although a quite broad list of such drugs have been reported. A great number of difficulties surround the forensic and toxicological investigation of drug-facilitated sexual assaults. The vast number of drugs makes the toxicological analysis a really time-consuming procedure. The delays in reporting due to the psychological burden of the rape in combination with the amnesic effects of the drugs enhance the problem. At the same time, the administration of a single dose makes even more difficult the toxicological investigation as it requires extremely sensitive analytical methods. Obtaining information about the time and the circumstances of the event, and about the symptoms appeared, prior the analysis is essential for the full investigation of the case. The most useful biological specimens, the time that they should be collected, the toxicological methods and assays that could be used, are discussed thoroughly. The Greek experience on the subject will also be presented.

114
CASES OF VICTIMS OF SEXUAL ABUSE IN A GREEK ISLAND REGION

Monti Catherine1, Varnava Despoina2
1: Pediatric Dept of Ikaria island Hospital
2: Social Services Dept of Ikaria island Hospital
monthcon@ika.forthnet.gr

Our experience has been acquired during a five years service to the Paediatric and Social Services Departments of the Ikaria Hospital. Ikaria is a Greek island with about 10000 permanent inhabitants.
We shall be referring to four individual cases. The first was that of a seven-year-old girl from an immigrant family;on examination for dysuria it was found that the girl had a perforated hymen and was suffering from vaginitis. The second case was that of a thirteen-year-old mentally retarted girl who was reported by many residents to have been the victim of sexual abuse and exploitation. The third case was a girl of fourteen who had herself accused her own father of sexual abuse, and the fourth was a female visitor of the island who had been raped.
General observations:
1) Neither the doctors (of all grades) nor the other staff of the hospital have any formal protocol for dealing with cases of this kind, however sensitive and genuinely anxious to help they may be.
2)The other authorities involved (police,, judicial authorities, etc) generally react with confusion and embarrassment to cases of this kind and often seem unaware of what they sould do.
3) The geographical isolation of the island prevents easy access to-and cooperation with- services specializing in cases of this kind, making it almost impossible to treat the case properly, despite the best endeavours of the local doctors and services.
It is significant that the four above mentioned cases only one has received satisfactory attention in legal terms.