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Dr Muriel Volpellier

Dr Muriel Volpellier. 1/per police force London 3 SARCs: The Havens St Mary’s, Kings College, Royal London Men, women, children Saturn centre – Crawley Hospital From age 14. Vaginal rape: pubertal: 7 days prepubertal: 3 days Anal Rape: 3 days (72 hours)

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Dr Muriel Volpellier

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  1. Dr Muriel Volpellier

  2. 1/per police force • London 3 SARCs: The Havens St Mary’s, Kings College, Royal London Men, women, children • Saturn centre – Crawley Hospital From age 14

  3. Vaginal rape: pubertal: 7 days • prepubertal: 3 days • Anal Rape: 3 days (72 hours) • Oral Rape: 2 days ( keep the toothbrush) • Digital penetration (12 hours) • Keep the clothes in a paper bag • Keep tampon, condom, everything you can think of

  4. Bruises • Abrasions = grazes/ scratches • Lacerations = tears • Incisions = cuts • Burns • Bite marks

  5. A bruise cannot accurately be aged from clinical assessment in vivo or on a photograph Maguire, 2005 • Different colours in same bruise at the same time • Same age bruises may undergo colour change at different rate • Not all bruises go through every colour change • Some people detect colour yellow less well than others

  6. Factors affecting the appearance of bruises • Laxity of skin • Location of bruise (highly vascular/ over bones) • Person’s age; skin pigmentation • Force of impact • Co-morbidities • Drugs

  7. THE LAW

  8. Sexual Offences Act 2003 • Rape (section1) a man (A) intentionally penetrates the vagina, anus or mouth of person(B) with his penis (B) Does not consent to penetration (A) Does not reasonably believe that (B) consent Whether belief is reasonable is to be determined with regards to all the circumstances

  9. Sexual Offences Act 2003 • Assault by penetration Person (A)penetrates intentionally person’s (B) vagina or anus using anything other than penis (B) Does not consent to penetration (A) Does not reasonably believe that (B) consent

  10. Medical definition of vagina is different from the legal definition Medical: muscular tube from cervix to hymen/ hymenal remnant Legal: outer end of the vagina starting with the vulva ie between the labia Vaginal penetration legally does not have to involve hymen penetration

  11. In past year • 2.5% women & 0.5% men experienced sexual assault • 0.6% women & 0.1% men experienced serious sexual assault • ‘lifetime prevalence’ since age of 16 • Any sexual assault: 1 in 5 females & 1 in 40 males • Serious sexual assault: 1 in 20 females & 1 in 200 males • Only 11 % victims serious sexual assault told police * all statistics are including attempts

  12. Impacts & considerations • Direct impact on physical and emotional health with long term consequences • Wide & sustained ripple effects • Significant economic impact for country (overall costs to society of sexual offences in 2003 – 2004 estimated at £8.5 billion) • Conviction rates historically not good but have been increasing • Specially trained officers & legal teams • Need to change societal misperceptions • Always consider domestic abuse

  13. Physical • Psychological Putting her down, making her believe she is mad, playing mind games, … • Sexual Rape, forcing to watch pornography, forced prostitution, … • Financial Witholding money, making her pay for drugs/alcohol • Social isolation Always accompanied • Stalking/harassment

  14. Acceptable • Uncovers significant numbers of previously hidden cases of DV • Repeated enquiry at a number of consultations increases the likelihood of disclosure • Give examples of abuse instead of using jargon

  15. A. Person experiences, witnesses or is confronted with an event that involves actual or threatened death or serious injury or a threat to physical integrity of self or others and person’s response involved intense fear, helplessness and horror B. Persistent re-experiencing C. Persistent avoidance of stimuli associated with trauma and numbing of general responsiveness D. Persistent symptoms of increased arousal E. Duration >1month F. Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

  16. People who have been sexually assaulted much more susceptible to developing PTSD than any other trauma • Rothbaum et al (1992): 65% met criteria at 1 month and 47% at 3 months • Capuzzo, Heke & Petrak (2007): 64% within 1 month in the Havens • 9/11 in USA: 7.5% at 1-2 months • 3% following natural disasters • Some natural recovery, hence NICE (2005) guidelines recommend ‘watchful waiting’ for one month

  17. Fight, flight and ‘freeze’ • Autonomic physiological response to threat • Adrenaline released via hypothalamus as need to ‘run’ or ‘fight’ • Anxiety-related symptoms (incl. heart racing, sweating, over-breathing, shaking, butterflies in stomach) • In certain situations more ‘protective’ to freeze, e.g. rabbits in headlights

  18. muriel.volpellier@imperial.nhs.uk • Haven Paddington: 0203 312 1101

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