Forensic Medicine

1. IMPOTENCY & STERLITY
• It is inability of either sex to perform sexual
act or to deliver gratification to other.
• Whereas sterility is inability to impregnate and
in the case of females to conceive.
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2. Impotency
• “Male sexual dysfunction involving inadequacy of
erection or problems with emission, ejaculation
or orgasm”.
• On psychological basis “as persistent or recurrent
partial or complete failure in a male to attain or
maintain erection until completion of sexual
activity”.
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3. Frigidity
It is sexual unresponsiveness, analogue to
impotency. It refers to difficulty or inability to
take part in sexual activity and sexual
intercourse by a female. It can be permanent
or temporary just like impotency.
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4. MEDICOLEGAL IMPORTANCE
CIVIL
• Divorce and dissolution of marriage.
• Paternity and legitimacy.
• Filing suit for adoption when alleged father pleads impotence in
his defense.
• Woman seeks absolute control over her money given to by
pleading that she has passed the age of child bearing.
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5. CRIMINAL
• Alleged adultery.
• Rape: Where impotence has pleaded in defense.
• Un-natural sexual offences.
• Claims of loss of sexual power.
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6. Causes of Impotency
• Physiological:
– Age
• Psychological:
– Stress and tension
– Excessive love or hate
– Fear e.g. vagina dentate.
– Nervous virgin
– vaginismis
• Pathological
– Malformation
– Acquired conditions
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7. Examination
• Male
– History
– General physical examination
– Genital examination
– Prostatic massage without and under light
anesthesia.
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8. – Sex offenders by ‘blood
meter’ or sleep erection
or for ‘morning wood’.
– Penile plethysmography
to detect sleep erection.
Normal individual has 4-5
times a night in deep
sleep in a night.
Opinion in the negative
form “that there is
nothing to suggest that
the person is impotent”.
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9. Artificial Insemination
• AIH
• AID
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10. VIRGINITY
• “Virgin intacta” is a woman who has never had
any sexual intercourse. Defloration means loss of
virginity.
Medicolegal Importance
• Cases of divorce
• Defamation of woman
• rape
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11. Signs of Virginity
Breasts
– Hemispherical
– Firm and rounded
– Small underdeveloped nipples
– Areola is pink or dark according complexion.
– Later they tends to be large, flabby without sexual
intercourse and pregnancy by frequent handling, sucking,
masturbation and coitus.
– Sometimes mulltipare have breasts like virgins.
– Occasionally milk can be squeezed out from breasts of
virgins.
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12. Genitals
– Labia majora are firm, elastic, rounded and in
close contact with each other and completely
close vaginal orifice and cover completely labia
minora and clitoris
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13. • Labia Minora (Nymphae) are
pink in colour irrespective of
the complexion of lady, soft,
smooth small and sensitive.
• Clitoris is small.
• Vestibule, a narrow space
between nymphae and clitoris
up to hymen.
• Fourchette: it is intact and
crescent in shape.
• Posterior commissure is intact
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14. 14

15. • Vagina is narrow and tight, walls are approximate,
mucosa is rugouse*, reddish in colour and
sensitive to touch. Rugousity* is not destroyed
by one or few acts. It is removed by many acts
and by first child birth.
– It may be absent in even virgins.
– When the legs are held wide apart in lithotomy
position, the vagina remains closed in virgins.
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16. Hymen
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17. FIMBRIATE TORN
1 Notches are symmetrical Irregular
2 Notches occur anteriorly and
are intact
Usually posteriorly and are not intact
3 They do not extend to the
vaginal wall
Extend to the vaginal wall
4 Mucous membrane intact Damaged
5 No signs of inflammation Inflamed
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18. • Hymen can be ruptured besides coitus in
– Masturbation.
– Introduction of thumb or any foreign body.
– Instrumentation by doctors.
– Artificial dilation of vagina to prepare the young girls for
intercourse (Prostitution).
– Disease
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19. • Hymen is the most reliable sign of virginity, and
usually ruptured by first coitus. If it is loose, elastic
and flashy, it may remain intact.
• Virgina intacta
• True virgin
• False virgin
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20. Major signs of virginity
• Intact hymen: barely admits tip of the little finger.
• Normal forchette and posterior commissure.
• Narrow vagina with rugose walls.
• Condition of labia majora.
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21. Pregnancy
MEDICOLEGAL ASPECTS
• Condemned prisoner pleads for relaxation. to avoid
court attendance.
• To produce false pregnancy soon after the death of
her husband to get more money or estate.
• File a suit against a man to breach of promise.
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22. • In divorce to receive more alimony.
• Blackmail.
• To retrieve the honor of a woman.
• To get a compensation from an alleged murderer of her husband.
• A dead body has to be examined for pregnancy.
• In cases of alleged concealment of birth or pregnancy or infanticide.
• To determine the identity.
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23. SIGNS OF PREGNENCY
SUBJECTIVE SIGNS/SYMPTOMS
• Cessation of menstruation.
• Morning sickness.
• Sympathetic disturbance.
• Quickening (quick with the child).
• Urinary disturbance.
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24. OBJECTIVE S/S
• Mammary changes.
• Pigmentation of skin abdomen, axillae, pubes
and vulva. (Linea nigra).
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25. • Change in vagina:
– Jacquemier’s sign (Chadwick’s sign): Due to
increased vascularity and pressure of gravid uterus
after 4th week. The normal pink color of vaginal
mucous membrane and vulva changes to bluish
then purplish.
– Cervix is blocked by thick mucous plug:
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26. CERVIX
• Goodell’s sign: by 4th month cervix is soft
instead of hard (just like nose).
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27. • Hegar’ sign: Softening and compressibility of
lower segment 4th to 5th months.
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28. • Progressive enlargement of abdomen:
– At the end of 4th month is just above symphysis.
– At the end of 5th month midway between symphysis
and umbilicus.
– At the end of 7th month midway between umbilicus
and xyphisternum. At the end of 8th month and early
9th month up to xyphisternum.
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29. • Braxton Hick’s sign: After 4th month there is
alternate contraction and relaxation of uterus
for 4-5 minutes.
• Uterine soufflé: Soft blowing murmur on
either side of uterus above the pubis due to
increased blood flow.
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30. • Ballottement: movement of fetus felt in
amniotic fluid between 4th to 7th month.
• Fetal movements after 7th month can be seen
more prominently.
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31. SURE S/S
• Fetal movements: After 5 months.
• Recognition of the fetal parts.
• Fetal heart sounds.
• Radiograph of the fetus.
• Ultra sound.
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32. • Biological test:
– Aschheim-Zondek Test.
– Friedman’s Test.
– Xenopus Test or Hogben’ or female frog test.
– Galli-Mainani Test or male toad or frog test.
– Prepurex Test or rapid Slide Test or Immunological Test or
Agglutination inhibition Test..
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33. SUMMERY
PRESUMPTIVE SIGNS
1. Suppression of menstruation.
2. Morning sickness.
3. Sympathetic disturbance.
4. Changes in breasts.
5. Pigmentation of skin.
6. Quickening.
7. Changes in vagina.
8. Urinary disturbance.
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34. PROBABLE SIGNS
1. Changes in abdomen.
2. Softening of lower segment of uterus.
3. Softening of ‘os’.
4. Presence of cervical mucous plug.
5. Intermittent uterine contractions and relaxations.
6. Ballottement.
7. Uterine soufflé.
8. Biological tests.
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35. CERTAIN OR POSITIVE S/S
• Feeling if fetal parts and movements.
• Hearing of fetal heart sounds.
• Radiograph.
• Ultrasound.
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36. SIGNS OF PREGNENCY IN DEAD
1. Presence of ovum or fetus.
2. Uterine changes.
3. Corpus luteum in one of the ovaries
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37. DELIVERY
• Required in following conditions:
1. Abortion
2. Infanticide
3. Concealment of birth
4. In connection with the legitimacy of “supposed
child”.
5. In libel action (For defamation of a woman).
6. In attempted blackmail or compulsory marriage.
7. In cases of feigned delivery.
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38. SIGNS OF RECENT DELIVERY
1. General appearance.
2. Breasts.
3. Flaccid abdomen.
4. Fourchette is usually ruptured.
5. Vulva is bruised.
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39. 1. Vagina is lax capacious, rugea absent and walls are
relaxed.
2. Cervix.
3. Lochia:
– First 3 days it is red and called lochia rubera.
– Next 3 days it is pale and serous called lochia serosa.
– Next 3-4 days it is greenish and then turns to whitish called
lochia alba.
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40. SIGNS OF RECENT DELIVERY IN DEAD
1. Breasts: when cut open may show milk.
2. Uterus when cut open may show enlarged
and flabby.
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41. TIME AFTER DELIVERY LENGTH OF
UTERUS
BREADTH OF
UTERUS
WEIGHT OF
UTERUS
1 Soon afer delivery 22-30 cm 20-23 cm 28 ounces
2 2-3 days after delivery
18 cm
18 cm 10 cm 20 ounces
3 At the end of a week 12-15 cm 8 cm 12 onuces
4 At the end of 2 weeks 10-12 cm 6 cm 5 ounces
5 At the end of 6 weeks 7 cm 5 cm 1and ½
ounce
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42. 3. Placental site can be identified shortly after
full term pregnancy.
4. Ovaries and fallopian tubes are congested an
become normal in few days.
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43. SIGNS OF REMOTE DELIVERY IN LIVING
1. Abdomen
2. Breasts
3. Linea nigra
4. Vagina
5. Hymen
6. Fourchette and posterior commissure
7. Cervix is slit like
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44. SIGNS OF REMOTE DELIVERY IN DEAD
1. Uterus is larger, thicker and heavier.
2. Cervix and uterus length is of same in virgins and in
nulliparous, whereas in parous uterus is twice the
length of cervix.
3. External os is enlarged and admits tip of finger. Internal
os is not well defined as in nulliparous.
4. Placental site is tinged with blood pigment and
elevated.
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45. LEGITIMACY AND PETERNITY
It is presumed by English law to the child of
the husband unless, it is proved that it was
impossible for the husband to be the father by
reason of non access or immorality on the part of
the mother or that the husband was suffering
from physical incapacity, which made intercourse
impossible.
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46. Father in determining legitimacy, the law
of England has regards to the date of birth and
not the date of conception. Whence a child
conceived before wedlock but born during
that state will be presumed to be legitimate.
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47. LEGITIMACY UNDER PAKISTAN EVIDENCE ACT
Section 112 of the evidence Act enacts the
rule that “a child born of a married woman
during the continuance of the marriage, or
within the period of gestation after its
termination, is presumed to be legitimate”.
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48. Under our law, therefore, the mare
circumstances of the birth of a child during the
continuance of a marriage or during 280 days
after its dissolution, will raise a conclusive
presumption of the legitimacy of the child, unless
it is shown that the husband and wife have had
no access to each other at time when the child
could have been begotten.
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49. MEDICOLEGAL
1. Nullity of marriage.
2. Divorce.
3. Suppositious child.
4. Inheritance.
1. Age in regard to pregnancy
2. Duration of pregnancy
3. Unusual form of pregnancy
4. paternity
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50. Pregnancy
• Age of conception:
• Age is 13 years.
• Period of gestation: 10 lunar months or 40 weeks.
• Confirmation of pregnancy
• Twin pregnancy:
– Identical twins.
– Fraternity
– Super-fetation: Fertilization of two ova, each liberated at different
ovulation. Though there is sufficient mendial proof but law does not
recognise.
– Super-fecundation: fertilization of two ova, both liberated during the
same period of ovulation but impregnated by two different coitus.
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51. Proof of Still Birth
• Condition of chest.
• Lungs.
• Digestive tract.
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52. Breathed and unbreathed lungs
• Vagitus uterinus: cry of a child after inspiration
in the birth canal.
• Age of the fetus.
• Age of the new born: caput succedanum and
ossification centers etc.
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53. • Abortion:
– Spontanous or criminal.
– Fetal causes.
– Meternal causes.
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54. • Stages of pregnancy
– Ovum stage up to 10 days.
– Embryo stage up to 09 months.
– Fetal stage uptill delivery.
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55. Criminal Abortion
• According to the stage of gastation it is of two
types:
– Isqat-e-Hamal.
– Isqat-e-Jenin.
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56. Techniques of therapeutic abortion
• D & C.
• Hysterrotomy
• Amniocentesis
• Vacume suction
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57. Death of pregnant woman
• Vagal shock
• Air embolism
• Rapid haemorrhage
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58. Medicolegal examination of a sexual
offender
• Protocol: consent
• Bio data
• Establishment of identity
• General history
• Obstratric history
• Genral impression
• Examiantion of cloths
• Examination of body
– General
– Systemic
– genital
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59. • Collection of specimens
• Vaginal examination
• Digital examiantion: to check
– Size
– Tone
– Any tenderness in vagina
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60. • Spacular examinatiion
– Not recomendedin virgins
Anal examination
– inspection
– Bilateral traction
– Digital examinationspacular examination
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61. • Sexual assault:
• Laws of marriage:
– Child marriage restraint Act 1929: It prhibits the
marriage before the attainement of majority.
– Dissolution of Muslim Marriage Act 1939: it narrates
the grounds on which mmarriage can be dissolved
– Muslim Family Laws ordinence 1961
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62. List of grounds for dissolution of
marriage
1. Husbands whereabiouts unknown for four years.
2. Husbands failure to provide maintenance for two years.
3. Husband imprisonment for 7 years.
4. Husbands failure to perform marital obligations for three years.
5. Husbands impotance since marriage.
6. Husbands suffering from insanity, leprosy or virulent diseases
for two years.
7. Repudiation of marriage by wife after attainment of majority
(18 years).
8. Husbands crulity towards wife by way of:
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