The forensic aspects of sexual violence

The initial report and early evidence considerations

The first appropriately trained person to encounter the complainant may need to
collect certain types of early evidence. These samples may include sanitary wear,
urine for toxicology, samples from the oral cavity where oral sex may have been
alleged, hand and fingernail samples and non-intimate skin samples. The decision
to collect these samples is based on immediate medical needs, the welfare of the
patient, availability of a Forensic Medical Practitioner (FMP), or delays in
reaching a dedicated forensic examination facility.
One of the first dedicated early evidence kits was developed by the Forensic
Science Service_ together with the Metropolitan Police in 2001. The practical
nature of the kit was highlighted as good practice by a Her Majestys Inspector of
Constabulary and Crown Prosecution Service report on the joint inspection
into the investigation and prosecution of cases involving allegations of rape,
published in April 2002.1 Evidence indicates that the concept of early evidence
kits is now more readily available to front-line officers and Accident and
Emergency Departments in many jurisdictions.2 As a backup to having kits
readily available at exam sites or with examiner programmers, jurisdictions may
also want to consider the feasibility of storing a few kits in police patrol cars.
Variations in temperature, however, even within one jurisdiction must be born in
mind, as heat exposure could affect kit contents before use. It is important that,
before an encounter with the woman, an FMP establishes whether any of these
samples have already been collected and by whom.

Evidence-based sampling time frames

A number of practical guidelines are available to assist the FMP in deciding
whether a forensic medical examination of complainant or suspect should be
conducted immediately or deferred.4 This is particularly important, as many
complainants of sexual assault will report during out-of-office hours. The FMP
should speak directly with a police officer investigating the allegation about time
frames and points to prove. Further considerations include post-offence activity of
the woman. Local advice may be to speak directly with the FSP about what
should be seized according to the crime report.

Contamination issues
Contamination is a crucial issue for everybody involved in the collection of
forensic evidence during a sexual assault investigation to be aware of. It is
particularly important where the FSP is concerned with the analysis and
interpretation of trace DNA. From a theoretical perspective, the forensic scientist
considers any DNA deposit identified that is not immediately relevant to the crime
being investigated as potential contamination. Reported evidence shows that
contamination has occurred in a number of different ways: (1) before the sexual
assault being committed5; (2) in the interval between the crime and a forensic
medical examination taking place; (3) during the forensic medical examination6;
and (4) within the forensic science provider (FSP) laboratory.7,8,9 Although
points (2) and (3) are considered as adventitious transfer and cannot be strictly
controlled, the FMP should apply methods to minimise the effect of such
contamination occurring. One example of good practice includes the provision of
dedicated forensic medical examination kits containing disposable equipment and
unopened controls. It is crucial that the consumables within the kits do not
compromise the integrity of the samples collected or adversely affect the forensic
analytical process in any way, and several studies have looked at this
problem.8,10,11 The FMPs use of disposable hospital scrubs when conducting an
examination, changing gloves between examination of different body areas,
logging all persons in the room at the time of the medical taking place, and staff
providing elimination DNA samples can all minimise the occurrence of
contamination.
Unsolved sexual assault investigations of today may well become the cold-case
investigations of the future; as such, potential forensic evidence must be correctly
collected, stored and examined with trace DNA detection sensitivities in mind.
Any deviations from locally recommended protocols12 must be documented, with
clear justifications recorded (Table 1).
The forensic medical examination facility
Many jurisdictions now have specially designed dedicated examination facilities
for the examination of complainants of sexual offenses. These have fixtures and
fittings that are durable with washable surfaces, and can be cleaned between
forensic examinations. Practically, it is important to monitor equipment and
examination areas to identify if any significant levels of DNA are present, and
subsequently whether cross-contamination between cases could be considered a
possibility.9,11 Evidence has shown that the provision of an environmental
monitoring process helps focus how successfully the cleaning procedures are
implemented within the facility and identifies any problem areas. Comparison of
DNA results obtained from the environmental samples with all relevant staff
profiles could also identify any gross contamination seen.
Unfortunately, the examination of potential suspects in sexual assault
investigations is much more ad hoc, and little information has been recorded on
this. Often detainees are forensically examined in cramped medical rooms that are
not for dedicated forensic use. Few jurisdictions have dedicated forensic cells. The
use of dry cells with no provision of toilet or hand-washing facilities within the
cell for the detainee to use to remove potential forensic evidence are the
defaultable option in many jurisdictions. No studies were found for the
recommended standards for forensic facilities available for the examination of
suspects in sexual assault investigations.
Other issues to consider in reducing cross-contamination include the importance
of having examination facilities with a suitable area or at least a non-clutteredwall
surface if record photography is required. This includes the ability for total black
out where ultraviolet photography is used.

The role of the forensic science provider

Forensic evidence is essential in any sexual assault investigation because it can
identify a suspect or a crime scene, or provide corroborative evidence about what
sexual acts have occurred. It may also identify possible series links or demonstrate
repeat offending by the same suspect. Semen found on intimate swabs may have a
more probative value than semen found on clothing or bedding, because it only
has a finite time for survival compared with dried drainage on fabrics. If a sexual
assault involves oral, digital or foreign object penetration, then it is useful for the
FSP to be provided with as much detail as possible about the alleged offence to
process the evidence most effectively. Therefore, in order to maximise all forensic
opportunities and to plan the order of analysis, it is important that the police
investigator discusses a forensic strategy with the FMP to ensure relevant forensic
evidence is secured at an early stage. Good evidence shows that this occurs when
dealing with complainants but is less likely for nominated suspects.
Given that the accused suspect will often allege that the complainant has
consented to the sexual act, forensic evidence in such cases is more problematic
and often requires examination of a large number of exhibits looking at
discrepancies between the accounts of those involved. In cases where the
complainant is known to the suspect, forensic results have to be interpreted
carefully, as legitimate contact could account for some of the findings.
In recent years, in many jurisdictions, victims of sexual assault often report an
unclear recollection of what has happened to them. These reports are usually
associated with alcohol drug consumption, or both. In many cases, the
complainant alleges interference with their drink. The FSP has a dual role here to
establish whether sexual activity took place and to conduct toxicology analysis to
check for drug or alcohol consumption.

Forensic sample site identification

Trace DNA analysis has become an integral part of an FSPs workload in relation
to sexual assault investigation. DNA methodologies based on polymerase chain
reaction have allowed the generation of profiles in sexual assault cases in recent
years that were not previously examined. This, in turn, has lead to the success of
many national offender DNA databases.12,13,14,15,16,17,18,19
When dealing with trace samples from complainants or suspects of sexual assault,
it is important to identify which areas to target. By their very nature, such trace
samples are not readily obvious. Swabbing an assumed trace sample area that is
smaller than the actual deposition area could mean that some of the relevant
sample goes uncollected. Alternatively, sampling a much larger area than that of
the actual deposit may mean that the sample is spread over a larger surface area
and that overall less sample is collected or becomes diluted. Both practical
approaches have the potential to give an inaccurate view of where the actual
sample was located. The uses of non-invasive detection systems are helpful here
and, as such, the Polilight is used to initially examine the patient in a number of
jurisdictions.
Numerous studies have shown the value of speculative searching scene items and
articles of clothing with a Polilight equivalent.20,21,22,23,24,25 Forensic
odontologists use ultraviolet photography to document bite marks on skin as the
light penetrates the epidermis or upper levels of the skin down to a few hundred
microns in depth, which helps to focus on the surface damage while minimising
the appearance of visible bruising. Studies looking at traditional photography have
shown that these standard methods may interfere with the viewing and
characteristics of the injury.26,27

Some studies indicate that ultraviolet light may cause semen and saliva to
fluoresce.28,29 Other studies contradict this. For example, Santucci et al.30
identified many creams and ointments that fluoresced on exposure to aWoods
lamp (wavelength 360 nm), which is used in a number of countries when
examining women who have been sexually assaulted; however, none of the semen
samples examined by Santucci et al.30 fluoresced. Other research has shown that
ultlraviolet light provides nonideal results in the examination of women, as many
traces accounted in day-to-day situations also fluoresce (i.e. detergents and
lubricants that contain petroleum jelly and milk).31 It is possible at higher
intensity light sources using goggles to detect semen even when the background
surface is also fluorescent, but the perceived impracticality of this method does
not make it ideal.32 Nelson and Santucci33 in their study asked FMPs in training
to use an alternate light source, the Bluemaxx BM 500, as it gives 100%
sensitivity, and to differentiate it from other trace substances. It must be
remembered that some fibres may also be visible under ultraviolet light, which
enables the FMP to visualise these for collection on skin and within hair. If the
FMP is not a regular user of light sources as a means to identify potential contact
traces, this does create a practical problem in identifying relevant areas of
luminescence, This, however, may be overcome by conducting controlled
photographic trials that show different body fluid deposits (including mixtures),
commonly applied skin products, and lubricants (e.g. on different skin types), and
creating a reference book of standards available for review in the medical
examination facility (Miller A, Product Manager at Forensics Source,
Jacksonville, Florida, USA, April 2012, personal communication).34

In general terms, forensic photography using normal lighting conditions is an

important element of a forensic medical examination. Internationally, variation
exists on the extent of forensic photography necessary, including when
colposcopy of intimate areas is used. Some jurisdictions routinely take
photographs of both detected injuries on patients and normal (apparently
uninjured) anatomy, whereas others limit photography to detected injuries. It must
be born in mind that the photographs may also help the forensic scientist with
their interpretation of findings and, as such, should be made available to them
where appropriate. A photographic record of a woman who presents soon after a
sexual assault still wearing the same clothing is considered useful if the woman
agrees. Pre-printed body diagrams and maps are also useful for recording any
injuries and should be used by the FMPs in their assessment of a patient, in
addition to the use of photography. It may be beneficial for these records to be
forwarded to the FSP to assist in their forensic assessment of any contact traces on
the clothing worn at the time of the assault. This is particularly useful when there
has been a long delay between the sexual assault and the medical examination
taking place, particularly when the complainant has washed in the intervening
time.
The forensic medical examination kit
Sexual assault evidence collection kits vary between countries and even between
jurisdictions of the same country, so it is not possible within the scope of this
chapter to discuss the variations. What is important is that the kit, or its modules,
are periodically reviewed for efficiency and usefulness on the basis of evidence-
based findings obtained from the FSPs, and any changes are made as needed. In
the UK, the Faculty of Forensic and Legal Medicine have a scientific committee
that includes FMPs, FSPs, police investigators and forensic kit manufacturers that
meet biannually to discuss the content of forensic kits used to sample
complainants and suspects of sexual assault. A sampling recommendation
document is produced for faculty members after the meetings have taken place
with any changes highlighted within it.4 In addition to kit content reviews, it is
important to establish mechanisms to ensure that kits at exam facilities are kept up
to date (e.g. if a new evidence collection procedure is added, facilities need to
know what additional supplies should be readily available to FMPs).
Variation also exists in who covers the cost of a forensic medical examination; in
some jurisdictions, it can be down to the individual themselves, particularly where
the complainant does not wish to involve the criminal justice agency at the outset
and as such provide anomalised samples. Elsewhere, the cost of the medical
examination and the forensic analysis of the samples is paid for by the local
criminal justice agency regardless of whether the police are involved or not. It is
not uncommon for a restricted forensic budget to be made available where
anomalised reporting applies. Training and policies should actively discourage
decision making about evidence collection that is based on extraneous factors,
such as reluctance of a criminal justice agency to pay for sexual assault evidence
collection or subsequent forensic analysis.

Collection of forensic samples

For forensic sampling from a patient, complainant or suspect of sexual assault,
most trace samples are collected using swabs. Some jurisdictions use the medical
forensic history, the examination, and patients consent to determine whether and
where to collect swabs, whereas others collect swabs from all orifices and from
the surface of the body (with patients consent). In particular, some do not collect
anal swabs unless indicated.
The swabs and containers differ from those used for clinical purposes. Other
methods have also been used practically to recover evidence. These have included
the use of surgical gauze pads.35 The swabs should be made of fibres that readily
release the collected absorbed material during extraction. In recent years,
considerable research has been undertaken into fibre compositions and whether
this makes a difference to the amount of collected material subsequently
released.36,37,38 Recently, other swab types, such as foam, flock and Dacron,
have been introduced.39,40,41 The collection device used for recovery of trace
DNA is often a matter of convenience i.e what has always traditionally been used,
often based on old research in relation to evidence recovery and the price of the
device, rather than what is fit for purpose given more recent research on recovery
and findings.

Swabbing of a non-genital skin area that is dry has always required moistening of
the swab to traverse the sampling area a number of times. Limited pressure is
applied to prevent exfoliation of the patients own epithelial cells, while rotating
the swab so that the whole surface area can be included in maximising the
collection process. Research has shown that use of a single moist cotton swab may
not pick up all the available material from the surface, and it has been shown that
this technique may only remove half of the available material from the sample
site.42,43 Few FSPs have undertaken research studies to check the composition of
the swab head and whether the swabs being used in forensic medical examination
kits are better or worse than alternatives now available on the market. Further
research into optimal collection methods and swab types would be beneficial
given the tiny amounts of trace evidence recovered in sexual assault
investigations.
Skin sampling
Trace DNA is a term used by many to describe minute quantities of DNA
transferred thorough skin contact. The small numbers of cells and the nature of the
type of transfer make identification of the cellular source of origin (e.g. buccal and
epithelial) impractical or impossible as discussed by Wickenheiser. 43 The nature
and the extent of the contact from licking, kissing or biting may result in salivary
amylase also being transferred, which is the only means for the forensic scientist
to identify the presence of the fluid as potentially being saliva. The traditional test
used by many FSPs is still the Phadebas_ amylase test. Specificity, however, is a
problem, as amylase can be present in body fluids other than saliva.

Fingernail sampling
Numerous different techniques have described how to sample fingernails where
trace evidence may be present. These include clipping nails, and scraping or
swabbing with fine-tipped swabs beneath the surface. The fingernail
hyponychium is logically an isolated area where biological material may
accumulate and can provide a valuable source of evidential material in police
investigations. During the course of a sexual assault, trace amounts of skin, body
fluids, hairs, fibres and vegetation may collect under the nails of either the
complainant or the assailant. It is not uncommon these days for complainants to
have well-manicured nails. Artificial nails such as acrylics and gel nails having
been popular with women worldwide since the late 20th Century. The FMP,
therefore, needs to be mindful that cutting of false nails is very difficult and
cutting of real or false nails may cause a complainant additional stress. It is not
clear from the research which is the optimal sample type for collection.
Considerable research has been undertaken into DNA typing of debris from
fingernail samples and the significance of the results. Wiegand et al.55 reported
33% of fingernail samples from casework analysis contained a foreign source of
DNA and persistence of foreign DNA tended not to last beyond 6 h. Cook and
Dixon,56 on the other hand, conducted a study looking at fingernail swabs from
100 volunteers where foreign DNAwas detected in 13% of samples, with only 6%
of these giving reportable mixed DNA profiles, suggesting the incidence of
foreign DNA under the fingernails was low. A significant proportion of the mixed
DNA profiles obtained came from male donors who had given information to
indicate some form of physical contact within the 24-h period before sampling. A
study by Dowlman et al.57 showed fingernail swabs from donors showed high
level DNA profiles with recent intimate contact, but also from samples from
individuals who shared accommodation with their partner.
The study showed that low-level DNA profiles were associated with all levels of
contact. Results have been reported from two homicide cases in New Zealand
where the deceased females had been submerged in water. The first in bath water
and the second in seawater for 2 and 3 h, respectively, showed that valuable
forensic evidence can be obtained from samples that may be considered unlikely
given the circumstances.

Hair sampling
Hair from a sexual assault complainant or suspect is most likely to be sampled for
the FSP to check for body fluids, foreign hairs, fibres or other particulates. Some
jurisdictions collect pubic and head hair combings, others collect only pubic
combings. Pubic hair combings are typically collected if the assault involved the
womans genital area. Complainants of sexual assault find the sampling of their
pubic hair degrading and, as such, the FMP needs to understand the relevance of
collecting the sample. Pubic hair transfer between people that have had sex in the
missionary position is minimal even when samples are collected a short time
afterwards, as demonstrated by research conducted by Exline et al.61 Mann62 and
Stone.63 A survey of sexual offence cases examined by FSPs throughout the USA
did, however, find pubic hair association between complainants and nominated
suspects in 15% of cases.64 Therefore, pubic hair sampling may be of relevance at
the time of the medical examination. Although shaving of pubic hair is more
widely spread through jurisdictions by the general population for hygiene regions,
if pubic hair is present on a patient, it must be borne in mind that the hairs are not
subject to as much change as head hairs over time. Because of this, a sample can
be taken at a later date for purposes of meaningful comparison. If fibres or
particulates are relevant, then the sample should be taken at the time of the
forensic medical. An improved method over combing hair samples if fibre
exchange is considered relevant is the use of low-tack adhesive tape as mentioned
in the study of Salter and Cook.65 They found fibres can remain in hair for up to 7
days if the hair has not been washed.

Toxicology sampling
The FMP needs to be clear about the circumstances in which toxicology testing
may be indicated in a sexual assault case for optimal care or when there is a
suspicion of drug-facilitated sexual assault (DFSA). Toxicology screening in
DFSA cases can help the investigator identifying whether drink spiking may have
occurred and whether abuse of legal drugs had occurred and whether illegal drugs
were used. Routine toxicology testing in all sexual assault cases is not
recommended in some jurisdictions, considerations being around the distress to
some patients particularly in collecting blood. Other jurisdictions collect
toxicology samples from every patient (with permission) and analyse these
samples as case facts and jurisdictional policy dictate. In addition to cases of
suspected DFSA, however, some jurisdictions may request toxicology samples if
patients indicate voluntarily that they have used drugs, alcohol, or both, before the
assault or that they did not consume any form of alcohol or drugs.
One rationale for such a policy is that prosecutors will want all information on
drug and alcohol use to prepare for the case. If samples are not collected at the
time of the medical, then critical evidence may be missed. it varies between
jurisdictions whether specific drug tests are conducted or whether general screens
for all potential ingested drugs and alcohol are undertaken, and where the samples
are analysed. It is evident that hospital laboratories do not always have the
capability to detect drugs in small quantities, which the FSPs do. Also sensitivity
of detection methods may allow for drug metabolites to be detected for longer
time frames. The list of drugs that have the potential to facilitate sexual assault are
continually growing, which makes the identification of the drug and their effects,
particularly with the increase in the number of legal highs coming on the market, a
challenge for the FSPs to identify. A legal high is a description given to the influx
of designer drugs that have been reported in recent years, including artificial
chemicals such as synthetic cannabisand semi-synthetic substances, such as
methylhexaneamine. These drugs are primarily developed to avoid being
controlled by laws against illegal drugs, thus giving them the label of legal
highs.

Semen identification
The persistence of semen is something that is used as a bench mark for whether
intimate samples are routinely collected in sexual assault cases. In Hong Kong, for
example, routine collection occurs if the woman presents within 24 h of the
alleged offence, but samples may be considered beyond these depending on case
circumstances (Bah P, Hong Kong, April 2012, personal communication).79 In
Romania, vaginal swabs are routinely taken within 48 h and occasionally up to 72
h (Barbu C, Head of Forensic Science of Covasna County, Romania, April 2012,
personal communication).80 In several American jurisdictions, 72 h is the
standard cut off time frame for collecting evidence, but again the medical forensic
history governs whether samples are considered beyond this.81 Modern forensic
techniques allow DNA to be extracted from ever decreasing amounts of cellular
material. In sexual assault cases, it is often trace amounts that are only ever
detected. Also, the DNA derived from haploid cells (semen) contain only half the
DNA complement of diploid cells (3 pg compared with 6 pg). Indeed, the smaller
the number of cells sampled, the smaller the probability that there is a full
representation of the alleles comprising the donor profile. The technique of low
copy number profiling enables the production of short tandem repeat DNA
profiles from small numbers of cells. It has been reported that it is possible to
obtain a DNA profile from as a few as 10 haploid cells. Moreover, a method such
as laser micro-dissection, enables forensic scientists to potentially isolate fewer
individual cells for olymerase chain reaction (Gill P, Professor of Forensic
Genetics Oslo University, April 2012, personal communication).82
Conclusion
Many challenges are faced by the FMP and the forensic scientists working for the
FSP when dealing with the forensic aspects of sexual violence. A sound
examination strategy noted by the FMP, taking into account pre and post-offence
activity by the complainant and suspect, coupled with evidencebased sampling
persistence data provided by the local FSP, is important in identifying and
maintaining best practice in forensic sampling. vances in sensitivity and, as such,
less material is now required to obtain a DNA result. This necessitates a practical
appreciation by the FMP of the sampling methods that can be applied, coupled
with the FSPs expertise to estimate the probability that a body fluid or DNA
would be transferred, persist and be detectable.8588 The other major problem
faced by the practitioners is the lack of information in cases where alcohol or
drugs by one or both parties is involved which, as a result of the accuracy of
events, may limit the sample types collected. It is evident from the research for
this chapter that an increase in the collection and analyses of relevant transfer and
persistence data from cases received by the FSPs is continually needed.

Practice points
_ Evidence indicates that the concept of early evidence kits is accepted as best
practice, and kits are now more readily available to relevant agencies.
_ Use of dedicated forensic medical examination kits containing disposable
equipment and unopened controls reduce the opportunity for DNA contamination
occurring with the forensic collection process.
_ Double swabbing is an effective method for recovering body fluid traces from
skin
_ Low adhesive tape is a more effective method of recovering fibres from hair
than combing or swabbing.
Use of cut-hair sampling in late reporting of DFSA cases if drugs are detected,
even at single dose levels, are a consideration.
Research agenda
_ Effectiveness of the use of early evidence kits to detect drugs and alcohol in
potential DFSA cases.
_ Effectiveness of environmental monitoring in preventing DNA contamination at
sexual assault examination facilities.
_ Comparison across jurisdictions of forensic facilities available for the
examination of suspects in sexual assault investigations,
_ Further comparison of optimal collection methods compared with swab types
and storage conditions.
_ Effectiveness of evidence retrieval from false nails compared with human
fingernails.
_ Reporting of relevant transfer and persistence data from cases received by FSPs,
together with data collected from mock trials, known research sources, or both.
_ Further reporting on low-level detection limits in DFSA cases.