Neobook — clinical reference

A copy of the medical report and test results should be kept in the Rainbow Clinic or by the attending doctor so that the details of the case are readily available and can be reviewed before appearance in court.
Make contact with the Prosecutor of the case ahead of time and confirm the date and time you will be required in court. The summons always states 9am, but the prosecutor will be able to give you a more accurate time.
When it is your turn to give evidence, you will be asked to take the witness stand, state your name and qualifications in full and take an oath to tell the truth.
Your purpose in court is to testify regarding your medical findings, without bias. It is NOT your responsibility to prove or disprove anything regarding the case.
Do not hesitate to say, “I do not know” or “This is beyond my field of experience/expertise.”
Refer to the Magistrate as “My Lord” or “My Lady”.

Commonly Asked Questions in Court

When asked, “Is it possible that …” the best answer is usually “Anything is possible, but in my opinion, it is probable/improbable.” If you are subsequently asked why this is the case, you can continue on to give your reasoning.
Is the presence of a genital discharge a definite sign of sexual abuse? Not all discharges are because of an STI. It is possible to have discharges caused by organisms which are not transmitted sexually, e.g. fungal infections or due to poor hygiene.
Doctor-Patient confidentiality - If you are questioned about confidential matters that were disclosed to you during clinical examination that are not directly relevant to the case, e.g. relating to pregnancy or the presence of an STI etc. you may question the relevance of the information as follows: “My Lord, my professional ethics do not allow me to divulge irrelevant confidential information about my patients – am I obliged to answer the question?” If the Magistrate insists that you answer, then you are legally bound to answer the question.
Is it possible that the child was abused without any clinical evidence of penetration or injury? While a medical examination can sometimes confirm that a child has been sexually assaulted, it can never exclude it. This can be as a result of the following:
- Delay in reporting which allows for complete healing of any injuries.
- Abuse consistent with no clinical findings – exhibitionism, voyeurism, viewing or creating pornography, fondling, oral sodomy, etc. Genital inflammation caused by contact rubbing may resolve in minutes to hours and minor abrasions may not be detectable to the naked eye.
- Elasticity – the hymen’s tissue is elastic and full penetration by an object, finger or even penis, may cause no visible trauma. In some cases, the perpetrator prepares the child by “physical grooming” by inserting smaller objects in the child’s genital or anal areas with lubricants to allow for the tissues to stretch, thereby reducing the chances of visible trauma.
- Healing – injuries in children heal rapidly and may heal without scarring. In addition, injuries to the hymen and anus heal faster than in other parts of the body.
- Oestrogen – the presence of oestrogen reduces the chance of the hymen getting injured during penetration and may also conceal previous scars. Oestrogen passes from mother to child during birth and may remain in the child’s body for up to 2 years. The presence of oestrogen close to puberty also masks scars and injuries from penetrative injuries to the hymen.
- Intentional destruction of evidence – the perpetrator may force the victim to bath, shower, urinate, change clothes or even have an abortion, etc. in order to hide evidence.
- Lack of technology – minor injuries may not be visible to the naked eye and may require special technology e.g. colposcopy, to document these injuries. Where technology is not available, the injuries may go unnoticed.
Could these clinical findings have been caused by masturbation/tampons/straddle injuries? (Bays and Chadwick) Questions about tampons, straddle injuries and masturbation are commonly addressed to the doctor testifying as an expert medical witness in court. Studies have shown that there is no difference in the hymens of girls who use tampons and those that do not. It has also been shown that masturbation is clitoral or labial, and does not cause hymenal injury. Straddle injuries are usually unilateral, external or anterior and have an associated history of an acute injury, with NO damage to the hymen.

Step by Step Guide to the Management of Child Abuse; Rainbow Clinic, RMMCH; Version: July 2023; Testifying in Court