The survivor should undress while standing on clean examination table paper to catch any hair or fibers falling from her clothing. All of her clothing should be placed by the survivor (to avoid DNA contamination from the examiner) in individually labeled paper bags, sealed, and given to the proper authorities. Wet or damp clothing should be air dried before packaging in paper bags because DNA evidence degrades quickly if it is moist (139). During the physical examination, the degree of injury to the survivor should be assessed, and any injuries should be documented for use as evidence. The nature, size, and location of all injuries should be carefully documented, using photographs or body charts (traumagram) if possible. Ultraviolet photography may enable the examiner to record injuries not seen with standard photographic equipment, such as bite marks, stains, blood, or weapon imprints. Nongenital injuries occur in 20% to 50% of all rapes, so it important to carefully examine the entire body (152,153).
The most common injuries are bruises and abrasions of the head, neck, and arms, and genital injuries accompanied by bleeding and pain (150). Hair and skin should be examined for dirt, foreign material, dried blood, and dried semen (152). Ruptured blood vessels in the retina may be the result of trauma from choking. If oral penetration has taken place, injuries of the mouth and pharynx may occur (154). Injury to the oral cavity, including a torn frenulum, broken teeth, trauma to the uvula, and injuries of the hard and soft palate, are related to forced fellatio. Evidence of trauma is more likely when the assault has occurred out of doors or is perpetrated by a stranger (155). The most common genital findings are erythema and small tears of the vulva, perineum, and introitus. Genital trauma is more common in postmenopausal women. A Foley catheter, placed in the distal vaginal vault and then inﬂated, allows for full visualization of hymenal injuries (138). There may be bleeding, mucosal tears, erythema, or a hematoma noted around the rectum if penetration occurred. Identification of small lacerations of the genitalia or rectum may be aided by colposcopy or by staining with toluidine blue, which has an affinity for the nuclei of exposed submucosal cells and will make the injuries stand out (153,154,156). Toluidine blue should be applied before the speculum examination, as insertion of the speculum itself can cause small lacerations and false-positive results. Toluidine blue is spermicidal and should not be applied until all forensic evidence is collected (156). Bite marks are not uncommon and frequently are found on the breasts or genitalia. Impressions and photographs of bite marks can be made and used to help identify the assailant. Foreign bodies may be found in the vagina, rectum, or urethra.
Samples should be obtained from any sites of contact (vagina, rectum, or mouth) and tested for gonorrhea and chlamydia. A vaginal wet prep examination should be performed for evidence of trichomonas. A urine or serum pregnancy test should be performed, and baseline testing for syphilis, hepatitis B (surface antigen and immunoglobulin M antibodies to hepatitis B core antigen), and HIV. Urine and blood samples should be collected to screen for the presence of any date rape drugs.
Evidence must be properly collected for legal purposes according to the following procedures: 1.