ABSTRACT

Objective:

It was aimed to reveal the limitations of different structural features of hymen in determining whether there is a sexual intercourse or vaginal sexualassault/abuse and the importance of the other physical examination findings of the genital region, general physical examination and psychological examination findings on creating idea about whether the incident has happened or not, while evaluating this issue.

Methods:

Between January 1, 2016 and December 31, 2018, 121 cases of sexual abuse and sexual assaul twhich were genitally examined in the Forensic Medicine Department of Süleyman Demirel University Faculty of Medicine were analyzed retrospectively. For statistical analysis, the SPSS version 22.0 program was used.

Results:

In the first examination, the rate of detecting physical findings in the genital area, physical findings other than genital areas were determined as 8.3%, 28.9%, respectively, and also a psychiatric finding was observed in 47.1% of thecases. In regressional analysis; the risk of developing psychiatric symptoms is 3.8 times higher in the group with the claim compared to the group without penetration claim, and according to the results of the genital examination, it was found 8.2 times higher in the group with acute rupture (p<0.05). According to the degree of victim-perpetratorcloseness, taking into account the group where the victim does not know the perpetrator, the risk of developing psychiatric symptoms is 2 times higher in cases of incest, 2.5 times higher in cases where the attack occurs against the partner, alcohol, drugs-narcotic substances under the influence of alcohol, 1.7 times higher than not to increase the development of psychiatric symptoms. A statistically significant correlation was found between being exposed to physical violence/threat/forced and the development of psychiatric symptoms (p<0.05). A significant correlation was found between the claim of penetration and the development of psychiatric symptoms (p<0.05). A statistically significant correlation was found between revealing evidence of penetration by detecting signs of acute penetration in genital examination and the development of psychiatric symptoms (p<0.05).

Conclusion:

In most of the victims of sexual crimes, noobvious physical traumatic changes occur. Therefore, detailed psychiatric evaluations should be made in each case, and the psychological evidence of sexual assault/abuse should be investigated and this evidence should be included as a result of the report.

Keywords: Sexual abuse, sexual assault, hymen, psychiatric evaluation

References

İbiloğlu AO, Atlı A, Oto R, Özkan M. Multifaceted Glance on Childhood Sexual

Abuse and Incest. Current Approaches in Psychiatry. 2018;10(1):84-98. https://doi.org/10.18863/pgy.336520

Taner Y, Gökler B. Çocuk İstismarı ve İhmali: Psikiyatrik Yönleri. Hacettepe Tıp Dergisi. 2004;35(2):82-86. https://actamedica.org/index.php/actamedica/article/view/188/166

Berber G, Korkut S. Father Incest Against a 4,5 MonthOldBaby: Case Report. Adli Tıp Dergisi. 2009;23(3):28-32.

Eskin M, Kaynak-Demir H, Demir S. Same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in university students in Turkey. Arch Sex Behav. 2005;34(2):185-195. https://doi.org/10.1007/s10508-005-1796-8

Cantürk G, Cantürk N. Cinsel Saldırı Mağdurlarının Muayene Prosedürü. Türkiye Klinikleri Acil Tıp Dergisi. 2006;2(50):49-55.

Demirci Ş, Doğan HK, Deniz İ, Doğan NÜ, Günaydın İG. Sağlam Himen Morfolojilerinin Değerlendirilmesi. Türkiye Klinikleri J Foren Med. 2008;5(3):93-100.

Mishori R, Ferdowsian H, Naimer K, Volpellier M, McHale T. The little tissue that couldn't - dispelling myths about the Hymen's role in determining sexual history and assault. Reprod Health. 2019;16(1):74. https://doi.org/10.1186/s12978-019-0731-8.

Ergun E. Social, Medical, and Legal Control of FemaleSexuality Through Construction of Virginity in Turkey. Master tezi, Towson University, MD, USA, 2006. Erişim tarihi: 10.03.2008. https://www.academia.edu/582639/Social_Medical_and_Legal_Control_of_Female_Sexuality_Through_Construction_of_Virginity_in_Turkey

Frank MW, Bauer HM, Arican N, Fincanci SK, Iacopino V. Virginity examinations in Turkey: role of forensic physicians in controlling female sexuality. JAMA. 1999;282(5):485-490. https://doi.org/10.1001/jama.282.5.485

Soysal Z, Eke M. Cinsel suçlar. Soysal Z, Çakalır C, editörler. Adli Tıp Cilt 3. İstanbul: İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Yayınları; 1999. p.1167-244.

Gümüşburun E, Katkıcı U, Soysal Z, Kolusayın Ö. Hymen’in anatomik tiplemesi ve anatomik özelliklerinin adli tıp açısından değerlendirilmesi. I. Adli Bilimler Kongresi, 12-15 Nisan 1994. p.391-393.

Gürpınar SS, Gündüz M, Özoran Y. Hymen incelemesi (195 olgulukretrospektif çalışma). I. Adli Bilimler Kongresi, 12-15 Nisan 1994, Adana. p.399-401.

Salaçin S, Alper B, Uçkan H. Seksüel saldırılarda mağdurun muayenesinde karşılaşılan sorunlar. Adli Tıp Dergisi. 1991;7:133-139.

Karanfil R, Zeren C. Kahramanmaraş Ağır Ceza Mahkemesinde görülen ve sonuçlandırılan cinsel suçların analizi. Adli Tıp Dergisi. 2012;26(1):1-7.

Gölge ZB, Yavuz MF, Yüksel Ş. Cinsel Saldırgan Profili. Adli Tıp Dergisi. 2006;20(1):1-17.

Çaylı E. 2006 – 2010 Yılları Arasında Süleyman Demirel Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı’na Başvuran Vakalarda ve Ülke Genelinde Cinsel Saldırı ve İstismar Olgularının Ruh Sağlığı Açısından Değerlendirilmesinde Karşılaşılan Sorunlar ve Çözüm Önerileri. SDÜ, (Uzmanlık Tezi), 2011. https://acikbilim.yok.gov.tr/bitstream/handle/20.500.12812/271948/yokAcikBilim_415969.pdf?sequence=-1&isAllowed=y

Aydın B, Çolak B. Sexual crime cases those reflected penalty courts in Samsun. Adli Tıp Bülteni. 2004;9(1):109- 116. https://www.readcube.com/articles/10.17986%2Fblm.200491532

Çekin N, Hilal A, Bilgin N, Alper B, Gülmen KM, Savran B, Sarıca AD. Adana'da Ağır Ceza Mahkemelerine yansıyan cinsel suçların incelenmesi. Adli Tıp Bülteni. 1998;3(3): 81-85.

Saint-Martin P, Bouyssy M, O'Byrne P. Analysis of 756 cases of sexual assault in Tours (France): medico-legal findings and judicial outcomes. Med Sci Law. 2007;47(4):315–324. https://doi.org/10.1258/rsmmsl.47.4.315

Balcı Y, Erbaş M, Işık Ş, Karbeyaz K. Evaluation of the Sexual Assault Crimes in Muğla Forensic Medicine Department. Adli Tıp Bülteni. 2014;19(2):87-95. https://doi.org/10.17986/blm.2014192795

Karbeyaz K, Gündüz T, Balcı Y, Akkaya H. Yeni Türk Ceza Kanunu Sonrası Değerlendirilen Cinsel Suç Olguları; Eskişehir Deneyimi. Türkiye Klinikleri J Foren Med. 2009;6(1):1-8.

Yazar ME, Boz B. Evaluation of Sexual Abuse and Sexual Assault Cases Which were Referred to Pamukkale University Faculty of Medicine Department Between 2010 and 2016. Adli Tıp Bülteni. 2019;24(1):43-50. https://doi.org/10.17986/blm.2019149818

Şahingöz S. Erişkinlere Yönelik Cinsel Saldırılarda Ruh Sağlığının Bozulup Bozulmadığının Değerlendirilmesinde Atatürk Üniversitesi Tıp Fakültesi Adli Tıp Anabilim Dalı Deneyimi (Tıpta Uzmanlık Tezi). Erzurum, Atatürk Üniversitesi, 2015. https://silo.tips/download/tc-atatrk-nverstes-tip-fakltes-adl-tip-anablm-dali-bakanlii

Tahiroğlu AY, Avcı A, Çekin N. Çocuk istismarı, ruh sağlığı ve adli bildirim zorunluluğu. Anadolu Psikiyatri Dergisi. 2008;9(1):1-7. https://www.proquest.com/openview/5132b3b2e5d3cbe3d01be42b1b485dd9/1?pq-origsite=gscholar&cbl=136214

Uğur Ç, Şireli Ö, Esenkaya Z, Yaylalı H, Duman NS, Gül B, et al. Psychıatrıc assessment and follow-up of chıld abuse vıctıms: experıen-ce from the last four-years. Çocuk ve Gençlik Ruh Sağlığı Dergisi. 2012;19(2):81-86. https://cms.galenos.com.tr/Uploads/Article_27639/cogepderg-19-81.pdf

Holmes MM, Resnick HS, Frampton D. Follow-up of sexual assault victims. Am J Obstet Gynecol. 1998;179(2):336–342. https://doi.org/10.1016/s0002-9378(98)70361-8

Evaluation of Physical, Genital and Psychiatric Examination Findings in Female Sexual Assault and Sexual Abuse Victims

ABSTRACT

References