I've heard it said so many times, "We don't test for sexually transmitted infections (STI's) in a sexual assault case." or "We don't do wet preps or look for motile or non-motile sperm." When I hear words like this, I have to catch myself before I make an excited utterance. (Seriously?)
Even given that there is an incubation period for STI organisms, the examiner needs to realize that the presence of an infection during a sexual assault exam can confound what an examiner sees on inspection. Therefore if redness, irritation or bleeding are present on a body in a criminal case, then other causes of those findings need to be investigated. The alleged victim or suspect should be tested any time it is possible. Why?
If there is redness or a discharge in the genital region (cervix, vagina, labia, penis or anus) then STI's should be ruled out as a possible contributor to that redness. When redness/irritation is seen in a photograph (or video) during a sexual assault exam, the assumption by the jury, the judge and the Prosecution is that the redness is due to some form of assault. However, when questioned by the Defense, the FNE must concede, under oath on the witness stand, that redness, bleeding or tissue injury could have originated from the presence of something else other than assault. In the absence of testing for infection, it can be assumed that some sort of infection was possibly there at the time and contributed to the findings.
Redness and/or irritation could be due to infection such as a yeast infection or bacterial vaginosis. It could be due to the presence of an STI. It could also result from consensual sexual intercourse (vigorous or not vigorous depending on the person and his/her nutritional status or overall health status) or it could result from non-consensual sex or non-consensual/consensual use of some other object (finger, fist, vibrator, coke bottle...etc.).
The point being, that it is important to investigate every causative possibility for redness, injury or bleeding in order to provide the courtroom with the best evidence available to make a sound decision. It is imperative for Forensic Nurse Examiners to learn to see beyond what is traditionally expected, to think ahead concerning what the 'recommendations for care are' vs 'what the guidelines for forensic evidence collection suggest," and then their goal should be to exceed them if need be.
If what we do is 'evidence based' then we know there are alternative reasons for redness, bleeding and various injuries. When collecting evidence it's also important to rule out those reasons so the courtroom can be more informed when it makes its decision. Some nurses are uncomfortable with doing that because they lack the skills or because of cost of time, equipment or other factors. Microscopy, or the use of lab and other expert professionals (consulting urologist, Family Practice or ER MD, etc.) should be considered when examining those reporting a crime and those suspected of one.
It is by questioning the status quo that we move ahead. It is by understanding the right thing to do versus the easier thing to do, that we can bravely take steps that just might make a difference in a case. If we contribute knowledge that helps the jury and the judge make the right decision, then we not only obtain professional and ethical excellence, but we also preserve our own peace of mind.
*****
*Disclaimer: This blog is solely the opinions and experiences expressed by the author and in no way reflects the opinions, policies or beliefs of the U.S. Government, the DoD or United States Navy.
