Valutazione ed inquadramento diagnostico-terapeutico delle violenze sessuali su adulto e minore. Validazione di linee guida e protocolli d'intesa interdisciplinari

Victims of sexual violence require a high index of suspicion and familiarity with the historical, physical and behavioural indicators of abuse and specific skills and abilities to collect all possible information (physical lesions and biological samples) useful as proof of this crime. This is particularly crucial when the victims are children. Many studies emphasize the extreme importance of medical examination using standardized protocol and multidisciplinary guide-lines to obtain physical and genital exam in a very short time (24-72 hours) after the assault, because after this time any biological sampling is completely useless. We got extremely important methods to obtain valid biological-forensic proves of a sexual assault and did many tests to validate this techniques. Furthermore, we tried to optimize the forensic management of child abuse cases (acute, sub-acute and chronic) providing all necessary services in one place and in a sensitive, safe and forensically secure environment. A colposcope equipped with a camera is always used since January 2007. When the physical-genital exam was suspect or when the information were dubious, we collect various samples from the body, from clothes or from other evidences (sheet, underpants). For all of them we investigate the origin and the real nature. Confirmatory test for human spermatozoa was the microscopic identification of spermatozoa. In cases where no spermatozoa are detected, other methods as seminal vesicle specific antigen, known as Semenogelin (Sg), was employed to detect the presence of semen using membrane strip device provided in RSID-Semen Test. Sg I/II are the major seminal vesicle secreted proteins in human semen. Identification of Sg for semen detection was done in ELISA for years while detection of Sg in dot-blot-immunoassay and one-step immunochromatographic assay was described relatively recently. The test could be performed without consuming the DNA present in the samples since aliquots can be taken during DNA extraction procedures. Results of the Sg detection were obtained in 10 min. The RSID-semen test give excellent results; so in this way, we demonstrated that detection of Sg in seminal stain is an effective approach and it allows an alternative approach to the forensic identification of seminal plasma. A forensic pathologist qualified by the state to perform clinical forensic medicine and who generally has specialized in pathology and legal medicine, has spent more years of training performing examinations of victims of violence, especially children suspected of sexual abuse. All cases, including the colposcopic findings, are reviewed by a qualified senior; the forensic pathologist are then qualified to appear in Court. The medical examination takes about one hour. Only few findings can be considered as proof. Among these are the presence of spermatozoa or pregnancy, non-accidental genital injuries especially at the posterior part of the vagina, hymen and vestibulum, recent tears and/or scars of the hymen, non-accidental anal injuries, positive tests for venereal diseases (syphilis, gonorrhoea, HIV) if an infection during pregnancy or perinatally is excluded. The local findings, the overall findings and the search for and/or results from trace evidence are to be evaluated. It is obvious that such search and examination must be as soon as possible; in order to document all injuries before or during treatment it must include all relevant body parts and orifices, also hidden ones (intraoral). Swabbing of relevant body surfaces has to avoid contamination. Last, but not least, also clothes, especially underpants, have to be included in these accurate evaluation. The possibilities of physical examination in cases of suspected sexual abuse are often grossly ignored in Italy. This leads to either lacking physical evidence or a low level in this procedure with either none or very poor documentation. There is therefore an urgent need for a higher level of professionalism in the institutions involved, i.e. medicine, law enforcement agencies etc. In these three years we set up a specialized Service that, in collaboration with Pediatric and Gynecologist Divisions of the local Hospitals, Social Services and Crown Attorneys, provide medical and legal assistance to victims of violence. We are still strengthen the cooperation between all these different services planning a medical and technical procedure in agreement with Italian Legal System