Introduction

Home Office figures show that in 2005/06 there were 13 331 recorded offences of rape of a female. This represented an increase of 3% on the previous year. In the same 12-month period there were 23 026 recorded offences of ‘sexual assault on a female’ and 25 724 recorded offences in the ‘other sexual assault’ category. The latter includes rape and other sexual offences on males. It is suggested that between 75% and 95% of rape crimes are never reported to the police [1].

Traditionally, the examination of complainants of sexual offences has focused on the collection of forensic evidence. However, it is now recognized that the medical and psychological needs of the complainant have equal importance. Thus the forensic physician has a duty to ensure that all relevant needs are addressed, either at the time of the examination or by appropriate referral. Sexual assault referral centres [2] that provide for forensic, medical and psychological needs of complainants are accessible both to patients who report to the police and those who choose not to.

The forensic, medical and psychological needs of a complainant or suspect of a sexual assault will depend on the nature and timing of the assault. The first, and major, part of this chapter is designed to guide forensic physicians through the potential components of a sexual assault examination and to help them with the interpretation of the findings. The remainder of the chapter deals with the medico-legal aspects of pregnancy and sexual variations.