T ORTURE Volume 19, Number 2, 2009 157 Torture is used to discourage Torture 1 Primum non nocere: firstPrimum do not harm. non nocere: to do harmThe principle (non of avoiding maleficence) is one of the principal pre- nothing It is better to do cepts of medicine. risksthan to do something that causing forensic Physical more harm than good. tortured of sexually examination children should be conducted with extreme care by experienced health care professionals in of the child. retraumatization order to avoid medical personnel not specialized However, their due to in forensic medicine could, be expected to carry work, on examinations and tortured on sexually abused children. This article is intended to be a guideline to carry in this situation out examinations . dissent and to demonstrate power. This is This is power. dissent and to demonstrate The pur- particularly true of sexual torture. pose of sexual torture the is to humiliate Sexual torture others. victim and intimidate sexual activity as unwanted encompasses any Torture, in the context of human rights law, in the context of human rights law, Torture, or infliction of physical is the deliberate psychological pain in custody or under the or by a non state agent, control of a state agent acting in an organized group (such as including organized violence a rebel group), is either unwilling or unable which the state to control. sexual torture, forensic examination, forensic examination, sexual torture, The words used to describe the anatomy and used to describe The words the anatomy The child should be examined from head to digital of the va- or object penetration Penile, digital of the anus or object penetration Penile, Sexual torture by the ab- cannot be disproved *) IRCT [email protected] Keywords: Keywords: the forensic findings have to be precisely defined. to be precisely defined. the forensic findings have toe and should be left partially clothed. lead to injuriesif the gina even not always does Genital child is seen very soon after the abuse. no scars. injuries heal rapidly and can leave lead to injuries if the child is even does not always seen very soon after the abuse. sence of injuries or scars. anal injuries injuries, hymen children, Abstract of sexual tortureProper forensic documentation Informedin children is crucial. consent for ex- must be sought and documentation amination personfrom the child/accompanying and the ex- and respectful in a sensitive conducted amination Time should be given to the child to re- manner. the historylate of tortureand the examiner should The history of start with open ended questions. torture as much as should be recorded verbatim possible. Muriel Volpellier, MD* Muriel Volpellier, of sexual torture in children children in torture of sexual specialized medical examiners A guideline for non Physical forensic signs signs forensic Physical EDUCATIONAL EDUCATIONAL 158 T ORTURE Volume 19, Number 2, 2009 like Abu Graib.like Abu sexual humiliations ofdetaineesinplaces ing. anddirectedat heal- someone withexpertise should becarefullyplanned, conductedby outinasensitive way.carried The process tion ontheRightsofChild. is attained earlier” accordingtotheConven- der thelaw applicabletothechild, majority human beingbelow theageof18unlessun- In thisarticle erly. essential tobeabledocumentthemprop- arerareinchildrenandadults,torture itis are crucial. Even ifphysical signsofsexual assault andproperforensicdocumentation can beexpectedinchildvictimsofsexual prove theircaseinonlyafewinstances. Unfortunately, thechildren were ableto communityinthepastdecade.international allovertries theworld, have reachedthe ofsexualtorture, fromcoun- many reports beforecomingforward withcomplaints,face ample inGuantanamo, alsoassexualtorture, forex- been described towards maledetaineeshaveinterrogators to thegenitals. Sexualtacticsusedbyfemale well asdeliberate inflictionofphysical pain of examination is very difficultandsensi- of examination isvery who is consciousthat thiskind interpreter necessary, itshouldideallybeanauthorized atpanying ease. person is Ifan interpreter do hisbesttoputthechildand theaccom- andshould felt asextremelyembarrassing keep inmindthat theexamination mightbe times withempathy. The examinershould child (ifthereisany) mustbetreated at all accompanying the The childandtheperson Respect/confidentiality/consent It isessentialthat theexamination is The knowledge ofwhat physical signs Despite allthecomplications children 6

achildwillbedefinedas “every 3

2 aswell asthesevere 5 4 ceive abouttheexamination and information panying needstobecompetentre- person informed. appropriately The child/accom- given, withoutfear, duress, orfraudandis ation. consenttothe examin- give his/herinformed on hisage)and/ortheaccompanying person theexamination. takenduring photographs notes, or oroftheeventual bodydiagrams ofwhat usemight bemadeofthe informed and thechild(dependingonitsage)are that theaccompanying person is important case, later ontoacourt might contribute it ofaninvestigationexamination ispart or also beexplainedclearly. As aforensic ation. The issueofconfidentialityshould the possibledisadvantages oftheexamin- what couldbe the possibleadvantages and oftheexamination,what isthepurpose and andexplainclearly duce himselforherself be forcedtoundergoanexamination. should berespected. The childshouldnever of thechildand/oraccompanying person person, whichmeansalsothat thedecisions onstrated tothe childandaccompanying the child. totheageof do soinalanguageappropriate people andwhenaddressingthechildshould bylay inalanguageunderstandable herself oftheexaminer.without thepermission conducted inaplacewherenoonecanenter andshould be shouldn’t bedoneinarush sexual abuse thanyours. The examination ent culturalattitudes towards sexualityand andthevictimcouldhaveinterpreter differ- role. Take that the intoaccountthefact thesituation andhis/her he/she understands beforetheexamination tomakesure briefed tive. Inany case, shouldbe theinterpreter Valid consentisathat isfreely It isessentialthat thechild(depending intro- The forensicexaminermustfirst The utmostrespectshouldbedem- The examinershouldexpresshimself/ EDUCATIONAL T ORTURE Volume 19, Number 2, 2009 159 9 Obtain menstrual history, obstetric his- Obtain menstrual history, identify body parts: hair, eyes, nose, pri- nose, eyes, hair, parts: identify body anus … parts, vate body parts can be (for example by a child). “pee pee” named as you? something happen to in the question. or no. yes parts? private did someone touch your record also the emotional feeling of the ashamed …”) “dirty, for instance: child, important about bleeding, to know soreness …). signs of sexually possible constipation, warts, transmitted infections (ulcers, discharge ...). where did it go? penis of the assailant: Who cleaned it came out of it? Anything the the taste of was How With what? up? semen? a condom Was the same assailant? always gel …)? cream, lubricant any (saliva, used, an object used? Was • for the used by the child Use the words • did Start with open ended questions: • the answer contain questions that Avoid • by answered can be questions that Avoid • more focused questions if needed: Use • you? Where were • Who did it? • anything? Did the assailant say • (it is important feel? did you How to • partsprivate did your How feel? (it is • ask about dysuria, did it feel after: How • ask about the Depending on assault: • it Was times did it happen? many How witness? • Any • wearing? you were What the child understandsMake sure that each to question and can give consistent answers similar questions posed in different ways. older children ask if they are sex- For tory. if they use tampons. ually active, Time must be given to the child 8

7 It is important if the to remember that Children can feel guilty or ashamed A historychild should be taken from the Note that acquiescence in circumstances acquiescence Note that in a safe environment, comfortable for in a safe environment, the child. name of siblings …). age, name, Important interviewing points for children. • Interview the child alone (if age permits) • rapport Establish with the child (ask • a diagram Show to the child and ask to child is questioned repeatedly the examin- child is questioned repeatedly deteriorates. validity ation’s about the abuse, it is important it is the that about the abuse, other children too examiner stresses that happened difficulties to talk about what have to them. to express what has happened to him/her. has happened to him/her. to express what children might not know Remember that especially the genitalia. their body well, Most prepubertal or know children don’t is a sexual no clear idea about what have they can for instance mistake touching act; with penetration. penetration or attempted children often describe ejaculate Younger It can be very difficult for a child to as pee. Sexually in- describe happened. exactly what experienced teenagers might also be unsure happened. if penetration through free recall without prompts or dir- ect questions and with a non judgmental approach. Taking the history Taking Interview of children about sexual assault profession- is a task for highly specialized in developed als and is usually videotaped countries. where the person does not know what the where the person what does not know intervention entails is not the same as con- sent. able to weigh that information that and come to able to weigh decision. a rational EDUCATIONAL EDUCATIONAL 160 T ORTURE Volume 19, Number 2, 2009 ever possible. etc.burning isessentialwhen- Photography etration but isalsoaboutviolence, kicking, skin. isnotonlyaboutpen- Sexualtorture tion andlevel inrelation tothesurrounding crusty, ulcerating) aswell astheirdemarca- shape, size, (e.g. colorandsurface scaly, bytheirlocalization,described symmetry, clearly recordedonabodydiagram, and in girls). in boys, andthedevelopment ofthebreasts both sexes, thedevelopment ofthegenitalia ofpubichairin basedonthegrowth berty child usingthe Tanner scale(astageofpu- below”. to makesurethat he/sheisalright “down oftheexamination is tell him/herthat part body. the examin ined, thechildcanputitstopbackonand then oncetheupperbodyhasbeenexam- age ofthechild)toundressupperbody, (dependingontheaccompanying person to toeprogressively. Ask thechildor The childshouldbeexaminedfromhead Examination volved, them interview speaker) asmuchpossible. tim (i.e. inpreciselythesamewords thanthe uses. he/she about thedefinitionofterms talia. geni- take picturesorvideosofthe external the useofacolposcope, itcanbeusedto available andtheexamineriscompetentin remember touseascale. Ifacolposcopeis All injuries (recentorold)shouldbe All injuries Record thestageofdevelopment ofthe toreassurethechildand It isimportant If anotherchildorotherchildrenarein- Document thoroughlythehistory, verba- It is important that theexaminerisclear It isimportant

ation canproceed withthelower 10 If photographs aretaken, Ifphotographs separately. – – – – – Definition ofterms without adequate publishedevidence. sessment withthenakedeye isdoingso inachildbyas- of theageabruise adefinitive estimateclinician whooffers assessment orfromaphotograph. Any fromclinical not accurately ageabruise entific evidenceconcludesthat we can- To benoted: Ageing ofthebruises: sci- tissues. extravasation ofbloodintotheunderlying Bruise: overlying base. afirm cur following application offorcetoskin below). Ingeneral, lacerations willoc- objects(see that arecausedbysharp blunt impactinoppositiontoincisions as a “tear”. A laceration iscausedby ness oftheskinispenetrated. Itisknown Laceration: “scratch” ora “graze”. anabrasionisknown asa In lay terms totheskinormucousmembranes.jury Abrasion: the wound. Skinflapsmay alsohave thenhairmay bepresentwithin hairy not beentransected). Where theskinis orbloodvessels thatsion (nerves have aswell assomeabra- to theskinmargins withinthewound bruising tissue bridges andabradedwound margins,bruised and tion areraggedwound edges, irregular, features of alacera- The characteristic laceration. and analskin/mucosamay alsoproducea may tear. Overstretchingofthegenital height, fromagreat a fall thenany skin force isgreat, suchasmay occurfrom serous cavities. fluidincells,lation ofwatery tissues, or Oedema: orinflammation). (as insunburn resulting fromdilation ofbloodvessels Erythema: discoloration of theskinduetoan swelling fromexcessive accumu- anabrasionisasuperficialin-

inalaceration thefullthick- abnormal rednessoftheskin abnormal 11

13 EDUCATIONAL However, ifthe 12 T ORTURE Volume 19, Number 2, 2009 161

Adult/sexually active external genetialia. Access to a good light source is essential. genital organs. It includes majora, It includes , genital organs. urethral clitoris, vestibule, labia minora, fossa navicula- vaginal opening, opening, ris and fourchette. tion until the vestibule and hymen are and hymen the vestibule tion until exposed. cannot be seen if the edge of the hymen technique. in the supine separation well the technique, In the supine traction portionexaminer grasps the lower of the thumb and the labia majora between firmly but index finger and gently pulls and slightly upward. outward her abdo- arms, her head on her folded and her knees men is sagging downward, are bent 15 to 20 cm apartbut- with her It could be described as tocks in the air. The exam- to children. “doing the rabbit” on the iner then presses a thumb outward leading edge of the gluteus maximus.15 Figure 1. Figure – technique is useful The supine traction – child rests the The knee chest position: termsProper anatomical must be used to record the findings See sexually active genitalia, Figure 1. genitalia, See adult sexually active • – the external portion of the female Vulva

the These are caused by sharp – this is defined as an incised – this is defined as an incised

14 Abnormalmore likely if are examinations cutting instruments such as knives, glass cutting instruments as knives, such They differ from lacerations and scissors. divided and the edges are cleanly in that The skin mar- bleeding is often profuse. gins unbruised are usually and free of There Cut hairs be visible. may damage. types of incised wound: are two Slash wound It is longer than it is deep. that wound its entry be deeper at may point and the gape. edges may wound Stab wound It is deeper than it is wide. that wound for the exam- be extremely difficult may iner to determine deep a stab wound how is. been formed. It should be noted that that It should be noted been formed. caused by genital and anal lacerations these usually do not have overstretching characteristic features. Incised wounds: on her back with her knees bent, it could on her back with her knees bent, to chil- “frog” be described as doing the dren. with the tips of the labia are separated posi- fingers and downward in a lateral It is important to exclude other causes of bleeding like . The clinician should remember that The clinician should remember that bleeding or pain occurred during the assault. examination of most children with substantial examination is normal. sexual abuse

– – the technique, In the supine separation 1. Hymenal and other female genital injuries The positions used for examining a girl are: tech- the supine position with separation nique and traction technique and the knee chest position. – In the supine position the child is lying EDUCATIONAL EDUCATIONAL 162 T ORTURE Volume 19, Number 2, 2009 Monspubis: tissuelyingabove thefatty • Urethra–theconnectingtubeto • Hymen: collaroftissuearoundthevagi- • Fourchette (Posterior) –theareabeneath • Fossa –theshallow Navicularis depres- • Vestibule –thecleftbetween thelabia • enclosed –thesmallprotrusion Clitoris • LabiaMinorae –thetwo thinnernon- • LabiaMajorae –thetwo large, hairbear- • precise in the description of thehymen,precise inthedescription this hymenal remnants(seeFigure1). hymen. hymen, hymen, microperfortae imperforate Less frequentconfigurations are sleeve like – redundant = annularhymen, seeFigure3 fimbriated – hymen, crescentichymen, seeFigure2 – are (seeFigures): The 3mostcommonhymen configurations Hymenal injuries to thesymphysis pubis. the pubicboneofadultwomen, anterior bladder. nal orifice norae meet. openingwherethelabiami- the vaginal chette. four- vaginal andtheposterior orifice sion inthevestibule between thevaginal andtheurethra. vagina minora that containstheopeningof and sensitive tostimulation. by thelabiaminorae, whichiserectile round thevestibule. that lieinsidethe labiamajoraeandsur- foldsofskinorsmalllips hair bearing ofthevulva. the outerboundaries ing, fleshy lipsorfoldsofskinthat form see Figure4. Again, it is very important to be very tobevery Again, important itisvery Adult sexuallyactive women willhave

Figure 2. Figure 4. Figure 3. Crescentic hymen. Fimbriated (redundant) hymen. Annular hymen. EDUCATIONAL T ORTURE Volume 19, Number 2, 2009 163 linear

17 see Figure 1 for anat- ior fourchette have been reported ior fourchette have fossa navicularis lacerations are seen in are seen in fossa navicularis lacerations a large proportion of girls alleging pe- if examined within 72 nile penetration of the Laceration hours after the abuse. poster to the more frequently than laceration hymen. fossa navicularis ( been reported have in prepuber- erations tal girls with a history of vaginal penetra- not been reported they have in girls tion, selected for non-abuse. orifice marker of sexual is not a reliable in prepubertalabuse pubertal and girls. omy). Scars lacerations Scars transection, from hymenal and tears to the posterior fourchette can Be to detect. be difficult persist may but for careful not to mistake linea vestibularis is a white scar tissue (linea vestibularis – In pubertal posterior girls, fourchette/ to the the absence of laceration be noted: To posterior fourchette/fossa navicularis is not did not take the alleged abuse a proof that place. Lacerations to the posterior fourchette/ Lacerations to the posterior fossa navicularis – to the posterior Laceration fourchette or – fourchette/fossa navicularis lac- Posterior To be noted: hymenal injuries hymenal and heal rapidly be noted: To injuries no trace. extensive except for can leave structure and in the mid-posterior vestibule is a normal variant). anatomic Genital abrasions and bruising been re- Genital abrasions and bruising have ported girls in sexually abused soon after the other causes or be many can have but event soon after the event. absent even Measurement Where deep an absent or “nar- an absent or are seen in a small 16 Hymenal transection proportion of prepubertal and pubertal girls with alleged vaginal penetration. tran- the absence of hymenal be noted: To is not a soon after the event, even section, (includ- abuse penetrative that proof that did not happen. ing penile penetration) Notches on the hymen. pene- notches can be clearly visualized, injuries should be considered. trative superficial notches are seen in Bumps, newborns suggest- girls, and non abused they are normaling that variants. rim:Posterior hymenal posterior rim hymenal should be row” confirmed in the knee chest position in abuse the prepubertal Penetrative girl. must be considered in a prepubertal girl if there is complete absence or almost complete abscence of posterior hymenal tissue. orifice. of the hymenal Size orificeof the hymenal is not recom- The diameter of the hymenal mended. complete to the base of the hymen) is of the hymen) complete to the base acute and a notch if if called a laceration non acute. called a lac- is the base of the hymen) if non if acute and a transection eration acute. – – – – – A complete disruption (to of the hymen It is usual to refer to an imaginary clock face when describing on the hymen. the findings located clock position is always The 12 o’ under the and the immediately the coccyx 6 o’clock position is towards her regardless whether the child is lying on back or on her front. – A partial disruption (not of the hymen is why using clearly defined terms using clearly is why very is Definition of terms: helpful. EDUCATIONAL EDUCATIONAL 164 T ORTURE Volume 19, Number 2, 2009 conditions oftheskin. in thegenitalarea. to vitiligo. Cyst, canalsobepresent tumors ulcerations. Genitaldiscoloration canbedue hcet diseasecouldberesponsibleforgenital ing orsuperficialbreakdown oftheskin. Be- oid creamscanbethecauseofslightbleed- Lichen sclerosus, vulvitisandtheuseofster- Medical conditions girls. orpubertal sexual abuse inprepubertal doesn’t disprovebruising theallegation of ring. and oftenwithoutleaving any traceorscar- children, but onlyinthemidline. Anal skintagshave beenseeninnonabused Anal skintags acute analassault. the analmargin. from further than 1cminlengthmigrating Definition ofanallaceration: fissuremore Anal lacerations stool orconstipation. anal fissuressuchaspassageofalargehard toexcludeothercausesof but itisimportant Anal fissurecanbetheseeninanalassault, Anal fissures record thepositionofinjuries. (seeabove) clockface willbeusedto ary knees totheabdomen/chest). thigh andkneedrawn up)orsupine(holding (child lyingontheleftsidewithright eral recumbentposition/leftlateral position The anusisexaminedwiththechildinlat- 2. Analinjuries Clinicians shouldnoteany predisposing The absenceofgenitalabrasionsand quickly tendtohealvery Genital injuries Anal skintagsboth inthemidlineand Anal lacerations areassociated with

18 The imagin- The examination. examination positionandtheduration ofthe ence ofstoolornot, andrecordsalsothe records iftherectumisvisible, istherepres- plan,imum diameterinthetransverse should bemaintainedfor30seconds. of several seconds. oftheanus Observation then opens, thenclosesagainover aperiod ways beconsidered. cance ofthefindingRAD. rectum isnotknown toaffectthesignifi- tion. with theapplication ofminimalbuttock trac- sphinctermuscles andinternal the external opening oftheanusduetorelaxation of tothedynamicactionof RAD refers ofanaldilation. thedegree and determine The examinergentlyseparate thebuttocks Reflex AnalDilation(RAD) associated withanalabuse. are Good evidencesuggestthat analscars Anal scars Anal gapingis different fromRAD. The anus Anal gaping in othercircumstances. abused childrenbut hasalsobeenreported myotonic dystrophy. include neuropathic bowel problemsand inspection.change during Possible causes tock tractionandstays dilated. dilates withtheapplication ofminimalbut- Anal laxityisdifferentfromRAD. The anus Anal laxityorreducedanaltone cases ofanalabuse. in outside themidlinehave beenreported The examinerapproximates themax- If RADisseen, sexualabuse shouldal- The presenceorabsenceofstoolinthe Anal laxity has been described inanally Anal laxityhasbeendescribed The diameteroftheopeningdoesn’t 20 The anusisusuallyclosedinitially 18 EDUCATIONAL 19 T ORTURE Volume 19, Number 2, 2009 165 (vulval, vaginal, vaginal, (vulval, Candida, bacte- Candida, Chlamydia trachomatis Chlamydia vaginalis, Trichomonas Treponema pallidum Treponema Court, articleCourt, 7.2. 2005. 8 May Observer, Torture psychological torture by US Forces. 2005;15(1):66-70. Torture – an ignored and concealed crime. 2002;12(2):37. The absence of genital or anal signs does The absence of genital or anal signs does for pharyngeal or urine sample rectal, swabs depending on case). – for herpes simplex virus swab culture PCR or for rial vaginosis syphilis. The drawings are published with courtesyThe drawings of the UK in London, Paddington Haven Conclusion examin- and considerate patient Thorough, is a requirement for proper forensic ation of sexual torturedocumentation in chil- disappear Acute signs of trauma may dren. quickly. not exclude the possibility that penile, digital penile, not exclude the possibility that did occur. or object penetration • or blister: In case of genital ulcer – dark ground microscopy for • and C, B hepatitis Blood testing for HIV, If the STI testing is done as a part of there should be a medico-legal proceedings, chain of evidence for the samples taken. Notes 1. of the International Rome Statute Criminal The 2. Soldiers lifts lid on Camp Delta. Harris P. 3. use of Systematic Pross C. Borchelt GJD, 4. Sexual torture of children Blaauw M. • tests (NAATs) amplification Nucleid acid – for bacterial culture. swab • microscopy/culture If vaginal discharge: (vulval, (vulval, Neissera gonorrhoeaeNeissera 19 The persistence other cel- of semen or The absence of anal injuries is no proof The anus can be open to a variableThe anus can be open de- vaginal, meatal, urethral, rectal, pharyn- rectal, urethral, meatal, vaginal, depending on case). geal swabs bertal girl. • Culture for • Culture Sexually Transmitted Infections (STI) testing Sexually Transmitted consider testing for sexually trans- Always long after the how no matter mitted diseases, Depending on the cases: alleged assault. • Up to 48 hours on the skin or hair. • Up to 48 hours in the mouth. • Up to 72 hours in the vagina of a prepu- • in a pubertal to 7 days Up girl. • to 72 hours Up in the anal canal. lular material is: The collection of forensic samples to search The collection of forensic samples to search for cellular material or semen from which the DNA of the perpetrator(s) can be ex- tracted should be considered if such facil- ities exist. that anal assault (even penile penetrative as- penile penetrative assault (even anal that sault) did not take place. 3. Testing Forensic samples Anal/perianal bruising Anal/perianal bruising has been reported other There are many anal abuse. following causes of bruising which should also be con- sidered. gree due to severe or chronic constipation. gree or chronic constipation. severe due to is open on separation of the buttocks such of the buttocks separation is open on canal or rectum is a view into the anal that of so for the duration possible and remains or constant way. fixed in a the examination be seen in general anesthe- Anal gaping may with the use of relaxant drugs a and is sia, post mortem finding. EDUCATIONAL EDUCATIONAL 166 T ORTURE Volume 19, Number 2, 2009 20. Glossary of terms and the interpretations offind- andtheinterpretations 20. ofterms Glossary 19. The physical signsofchildsexualabuse. An 18. Heger A, EmansSJ, MuramD. Evaluation ofthe 17. The physical signsofchildsexualabuse. An 16. DaltonM, ed. Forensic gynaecology. Towards bet- 15. Heger A, EmansSJ, MuramD. Evaluation ofthe 14. StarkM, D, Rogers NorfolkG, ed. Goodmedi- 13. KnightB, E.Arnold Forensic pathology. 12. http://core-info.cf.ac.uk/bruising/key_messages 11. wordnet.princeton.edu/perl/webwn 10. Istanbul ProtocolManualontheeffective in- Heger A, EmansSJ, MuramD. Evaluation 9. ofthe DaltonM, ed. Forensic gynaecology. 8. Towards www.dh.gov.uk/en/Publicationsandstatistics/Pub- 7. DaltonM, ed. Forensic gynaecology. 6. Towards HumanRights1945-1995. Bluebookseries. 5. Abuse ofChildren, 1998. nations. Professional Societyonthe American exami- ings forchildsexualabuse evidentiary Health, 2008:73-88. practice. Royal CollegeofPaediatrics andChild evidence-based reviewandguidanceforbest Press, 2000:67. atlas.photographic 2nded. OxfordUniversity sexually abused child. A medicaltextbookand Health, 2008:32-63. practice. Royal CollegeofPaediatrics andChild evidence-based reviewandguidanceforbest RCOG Press, 2004:137. ter careforthefemalevictimofsexualassault. Press, 2000:60-62. atlas.photographic 2nded. OxfordUniversity sexually abused child. A medicaltextbookand ed. 2007. cal practiceforforensicmedicalexaminers. 2nd 2001:125-38. 2004:135, para176. 8/Rev.1. New York andGeneva:United Nations, number punishment professionaltrainingseries other cruel, inhuman, treatment or ordegrading vestigation and anddocumentation oftorture Press, 2000:44-9. atlas.photographic 2nded. OxfordUniversity sexually abused child. A medicaltextbookand RCOG Press, 2004:243. better careforthefemalevictimofsexualassault. 4006757. lications/PublicationsPolicyAndGuidance/DH_ RCOG Press, 2004:243. better careforthefemalevictimofsexualassault. 1995:334-44. Vol. VII: Documents. Geneva: UnitedNations,

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