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SURGICAL

MANAGEMENT OF
SODOMY CASES
Kumar
Department of General Surgery
Hospital Raja Permaisuri Bainun
Ipoh
Sodomy
Anal or oral copulation with a member of the
same or opposite sex;also:copulation with
an animal
Merriam-Webster dictionary

crime against nature

Anal intercourse committed by a man with a


man or woman
Webster dictionary
The law of the land
Penal code Act 574 (revised 1997)
The law of the land 377A
Carnal intercourse against the order of
nature. Any person who has sexual
connection with another person by the
introduction of the penis into the anus or
mouth of the other person is said to commit
carnal intercourse against the order of nature.

ExplanationPenetration is sufficient to
constitute the sexual connection necessary to
the offence described in this section.
The law of the land 377B
Punishment for committing carnal
intercourse against the order of nature.
Whoever voluntarily commits carnal
intercourse against the order of nature shall
be punished with imprisonment for a term
which may extend to twenty years, and
shall also be liable to whipping.
The law of the land 377C
Whoever voluntarily commits carnal
intercourse against the order of nature on
another person without the consent, or
against the will, of the other person, or by
putting the other person in fear of death or
hurt to the person or any other person, shall
be punished with imprisonment for a term of
not less than five years and not more
than twenty years, and shall also be
liable to whipping.
Multidisciplinary
Approach

Emergency Team

Forensic Department

Surgical Department

Police Investigating officer

Psychologist / Psychiatrist
Preparation
Explanation

Consent

Equipment

Personnel

Chaperone
History
Medical history

Medical problems

Medications

Allergies

Bowel symptoms- chronic constipation, anal


fissures
History
Events leading to assault

Perpetrator

Location, date & time

Drugs
History
Timing to presentation
Less than 72 hours
More than 72 hours

Objects used

Penetration

Injuries
Examination
Appropriate environment

Head to toe

Left lateral decubitus position


Examination
External signs or injuries - TEARS

Anal fissures

Haemorrhage
Examination
Scars
Examination- Acute
fissure
Chronic anal fissure
Examination
First offender
Tenderness
Oedema
Laceration and bruising around the anus
Examination

Signs of habitual sodomy


Orifice is becomes dilated and smooth
Sphincter is lax with loss of elasticity
+/- old lacerations
Perianal inspection

Faecal / Semen
Laceration, fissures
External Haemorrhoids
Swab form anorectal (around anal verge)
Spermatozoa/DNA
Examination
Proctoscopy

Disposable

Transparent

Warm water as lubricant

Rectal swab (High/Low)


Disposable proctoscope
Digital Rectal
Examination
Gentle
Feel the contractility of the sphincter
Painful/Painless
Report
Documentation of findings

Detail descriptions

Detail drawings
Surgical treatment
Depends on the extent of injury
In most cases, minor abrasions/lacerations
Oral laxatives
Topical anaesthetic/steroids
Suppositories
Surgical treatment
Major injuries
Often with the use of foreign objects
Large tears may involve urethra or vagina
Requires Examination under anaesthesia
If extraperitoneal, will need defunctioning
colostomy
Definitive repair is often delayed
If intraperitoneal, will need laparotomy with
repair, often a colostomy is required
Follow Up
Outpatient

Social Rehabilitation

Psychological Counseling
Examination of Male
Genitalia
Inspection
Congenital Abnormalities
Circumcised
Testis
Presence of dried/moist secretions,
faeces,lubricants foreign materials, venereal
lesions should be documented
Collect any foreign material particularly
on the glans or in the sulcus and placed in
the appropriate envelope, which is then
labeled and sealed.

Dried secretions are collected with the


two-swab technique and moist secretions
with the one-swab technique.

The patient's pubic hair should be


combed, and the comb should then be
placed on the paper sheets under the
patient's buttocks for collection later.
Two swab technique
First swab is moistened with sterile distilled
water, Second swab is dry
Dry area ; moisture present in the first swab
rehydrates and loosens the cells
Both swabs are placed into the same
container/envelope
Allows the cells to adhere to the cotton fibre
Permits larger amount of DNA collection
Penile swabs must also be collected.
One swab from the urethral meatus
One from the glans.
One from the penile shaft

The swabs are moistened before evidence is


collected. (If a condom was worn during the assault,
the examiner will also want to collect swabs from the
base of the penis.)

The presence of fecal matter is noted. The swabs are


air-dried and then labeled as to location.

If indicated, a specimen is obtained for N. gonorrhea


and Chlamydia culture from the urethra as a
baseline and prophylactic medication is offered to
the patient. Other soft tissue culture cultures are
Final Report
Should be professional and independent
Unbiased
It is the duty of the court to determine
whether sodomy/rape had occurred. The
medical practitioner job is to collect evidence
There is evidence of penetration.
Evidence of penetration not necessarily means
sodomy
Normal examination
Normal examination not necessarily means no
sodomy
Swabs

Detection of semen
Acid phosphate test non confirmatory
PSA
Sperm isolation test
Timing ; G.M.Willot J.E.Allard : Spermatozoas
Their presence after sexual intercourse (2410)
Internal/External vaginal 120h
Rectal swabs 65 h
Anal swabs -46h
Oral swabs 6 h
Thank you