Incest: blood-related

• Rarely reported b/c happens at home (detected: social workers, doctors, schools)
• Leaves LT emotional + psychological problems for Pt
• Man + Granddaughter, daughter, sister or mother (willingly) (unwillingly = rape) (onus: must know that you are related to that person)
• Woman (>16) + Grandfather, father, brother or son
• Moral stance: inbreeding unacceptable
• Not applicable: step-siblings, adoption, step-parents

• More common in agricultural communities, human + animals

• Male vs. male, has to be someone under 21 yo/ without consent/ in public place (therefore, legal = both over 21 yo, with consent, in private place)

• A man commits rape if:
• He has unlawful sexual intercourse with a woman who at the time of the intercourse does not consent to it; and
• At that time he knows that she does not consent to the intercourse or he is reckless as to whether she consents to it
• Eg. Rape conviction after safe-sex vow broken

• Get to a place of safety ASAP (attacker many want to kill victim after rape)
• Do not wash or clean (need to gather evidence)
• Seek medical and psychological help ASAP
• Decision to report to Police must be an informed choice of the victim (if Pt doesn't consent, Dr cannot release information)
• Note: sprays and stun-guns are illegal in HK; martial arts may not work

• Rape in HK: an overview of current knowledge - Journal of Clinical Forensic Medicine (1998), 5, 124

• NGO (Non-Govt Organisation): Association Concerning Violence Against
• Rain Lily Hotline
• Women Hotline - 2375 5322
• The Family Planning Association of HK - 2572 2733
• SafeTalk - 2603 7815
• Hospitals
• Police

• To re-establish a sense of control over her own life

• Respecting her decisions and allowing her to re-establish her control (eg. She may not want her family to be told)
• Non-judgmental support
• Examination and documentation of injuries (potential to go to Court)
• Collection and preservation of contact evidence
• Screening and treatment for pregnancy, STD's (HK: HIV not included in. Other countries: routinely tested, prophylaxis given)
• Psychological counselling and support: most doctors not equipped to counsel, therefore refer. Hospitals do not routinely offer this

1. Who attacked Pt?
2. Location of attack?

• Fibres/Clothing
• Fluids: blood, saliva, semen, vaginal secretions, pus, bacteria (eg. If attacker has STD)
• Hair samples
• Fingernail scrapings (not cuttings: woman already traumatised enough)

DIAG: Ground sheet

• Clean, white plastic/ paper sheet
• Pt stand on top as she undresses
• Acute case
• Eg. Pollen, soil samples, grass, trees (unique to location)

DIAG: Loose hair/fibres in hair

• Different coloured hair, ask Pt to comb her hair

DIAG: Fibres

• Synthetic very smooth
• Natural fibres rough
• Forensic scientists can compare substances

DIAG: Spermatozoa

• DNA

1. Pt may not be struggling: her or her family threatened with knife/ gun during rape
2. Most people raped by someone they know

Injuries when present should be properly documented:

• Photographed with scale and/or drawing/ sketch
• Measured and described
• Description of type, pattern, appearance, size and location on body

DIAG: Photographic documentation

• Using scale to measure injury
• Even if you forget to measure, have photo of scale, therefore can work it out

DIAG: Petechial haemorrhages in eyes

• Eg. Attacker tries to strangle victim

DIAG: Other bodily injuries

• Neck bruises
• Injuries to inside of thighs as attacker tries to spread victim's legs
• Bites
• Palate injuries: forced oral sex
• Anal penetration
• Note: if no vaginal penetration involved, not defined as rape in HK (indecent assault causing bodily harm)

DIAG: Injuries to lips

• Forced kissing against victim's will

DIAG: Hymenal variants & injuries

• Fleshy hymen
• Semilunar shape
• Septic hymen
• Membranous hymen
• Before you call something a hymenal injury, you must know appearance of normal hymen
• Colour of hymen: due to thickness of tissue (dependent on amount of oestrogen in body - eg. Newborn baby's hymen very red and fleshy due to mother's oestrogenic effect)
• Injuries: bruises, tearing, fourchette, extend to anus (babies, forceful penetration with objects)

DIAG: Vaginal speculum

• Use plastic, transparent (can see vaginal wall)
• Try not to use speculum (esp. when injuries): already painful
• Clinical indications for using speculum: injury extending into vagina may need to use GA for examination)

Samples from victim or someone else?

• Hair
• Blood
• Saliva
• Blood of spouse/ sexual partner

• Rape is perpetrated by strangers: false; more likely by someone you know
• Rape is most likely to occur in lonely dark alleys: false; in HK more likely in your own or your acquaintance's home
• The victim will always have extensive injuries
• Victims are most likely to be under the influence of alcohol and/or drugs: false; only 10% of victims used alcohol and/or drugs (even so, these levels not enough to cause incapacitation, also if under the influence cannot give consent)
• Note: rape in peace-time - "She was asking for it"; rape in war-time different
• Men, not women, are responsible for rape: 1/3 believe otherwise
• Women do not provoke rape by their appearance or behaviour: 50% believe women do provoke rape
• Women who wear short skirts or tight blouses are not inviting rape
• The extant of a woman's resistance should be the major factor in determining if a rape has occurred (wrt injuries) - 30% agree
• Note: attitudes of men and women quite similar

• Marital rape: sexual intercourse with wife against her consent is not rape (rape under common law but written law has yet to be amended.)
• Penetration with anything other than the penis is not rape
• Penetration of anything other than the vagina is not rape (eg. Forced oral sex, anal sex)
• These are included rape laws in USA, Canada, Australia, UK, some European countries
• SLIDE: Marital abuse law 'must be made clearer'