Browsing by Author "Wijewardena, H.P."

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Analysis of medicolegal examination in alleged sexual abuse presented to a tertiary care hospital in Sri Lanka
(Wolters Kluwer - Medknow, 2023) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.
Forensic experts are often expected to provide an opinion on alleged physical or sexual contact between individuals following medicolegal examination of a case of sexual abuse (SA). There are many factors influencing the opinion. A retrospective descriptive study was performed to study the factors influencing the medicolegal opinion in SA forensic examination using medical and medicolegal records of alleged SA victims to extract data. Records of 441 victims were studied. A majority, 180 (40%), presented due to the guardian’s concerns – 302 (68%) presented for medicolegal examination 72 h after the incident. Recent injuries were observed in only 15% of the victims. Genital injuries were observed in 74% of the victims brought due to concerns of the guardians, with 12 victims having recent injuries. Of the 172 victims who complained of vaginal intercourse, 21% had recent injuries. A firm positive medicolegal opinion could be given in 63% of all cases. In 124 individuals, a firm positive or negative opinion could not be given. A majority (n = 90, 73%) of these individuals did not have any injuries, while 23% had healed injuries. According to the nature of the complaint, in a significant number of victims (53%), no scientific evidence was present to make a firm opinion. The nature of the sexual act and the absence of injuries influence the medicolegal opinion on SA, making it a challenging task for forensic experts.
Forensic Medical Examination in Female Children Alleged to be Sexually Abused
(Research Evolution Technology Press (Revotech Press), 2015) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.
INTRODUCTION: Child sexual abuse is a global public health problem and the medico legal examination is directed to provide an objective, unbiased opinion on alleged sexual contact. There are many factors influencing such opinion. Objective: The aim was to study the factors influencing the medico legal opinion in female children who alleges sexual abuse. METHODOLOGY: A retrospective descriptive study was done based on medico-legal case records of female children who had been referred for medico legal examination following alleged sexual abuse during past 3 years to the Teaching Hospital Ragama, Sri Lanka. Data analysis was done with Statistical Package for Social Sciences (SPSS). RESULTS: We studied the records of 353 child victims for this research. The main presenting complaint was concerns of the guardian 168 (48%). Majority, 261 (74%) presented for medico legal examination 72 hours after the incident. The perpetrator was known to the victim in 339 (96%) cases. Recent injuries were observed only in 40(11%) victims while there were 184(52%) victims with old injuries. 122 (73%) out of 168 victims who were brought due to concerns of the guardians had genital injuries and of them only 11 (9%) had recent injuries. Psychological impacts were observed among 149 (42%) children. Out of the 74 victims who had experienced physical threats, only 12 (16%) had supportive injuries. Firm positive medico legal opinion as per the complaint was given in 218 (62%). CONCLUSIONS: Paucity of medical evidence is well observed in child sexual abuse and is a challenge to the medical expert. The mere absence of physical findings does not necessarily exclude the allegations of sexual abuse. Proper insight in to the presentation, pattern and factors influencing medical opinion is needed for proper administration of justice.
A study on factors influencing medico legal opinion in alleged sexual abuse
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kitulwatte, I.D.G.; Wijewardena, H.P.; Edirisinghe, P.A.S.; Senarathne, U.D.
BACKGROUND: Aim of medico-legal examination in alleged sexual abuse is providing an opinion on physical/sexual contact between individuals. Supportive scientific evidence is often absent and experts are in a dilemma. OBJECTIVES: To identify the limitations of medico legal opinion in alleged sexual abuse and the factors influencing these limitations. METHODS: A retrospective descriptive study based on medico-legal case records of females who had been referred to a Teaching Hospital in the Western province of Sri Lanka following an allegation of sexual abuse during a period of 3 years (2012-2015). Data analysis was done with Statistical Package for Social Sciences (SPSS). RESULTS: Out of 441 medical records perused, the main complaint (n=180, 40%) was related to concerns of the guardians. Majority (n=302, 68%) had presented for medico-legal examination 72-hours after the incident. Giving a firm positive medico legal opinion as per the complaint had been possible in 280(63%). A firm opinion could not be given in 19 (86%) out of 22 victims reporting intracrural intercourse and for 22 (79%) out of 28 victims complaining of fingering. Out of 376 victims with no recent injuries, 276 (73%) presented late. Out of the 128 victims who had experienced physical threats, only 35 (27%) had supportive injuries. CONCLUSIONS: Many factors including late presentation and type of complaint influence the medico legal opinion in a case of sexual abuse and therefore it is a challenge to the forensic expert. Thus, proper administration of justice needs an insight into these factors, challenges and the limitations.