2Human sexuality„Sigmund Freud had said that sexual satisfaction is analogous to satisfaction of hunger. Sex is a natural phenomenon and is necessary for the continuity of human race on this planet of earth and sexual exploitation is the worst form of degradation of those who indulge in it.”
3Human sexualityThe visual stimulation & the equivalents of genital organs.bottom – breastspudenda labials - lipsConstant sexual attractiveness/receptiveness of womenThe mono & polygamic trends
5ParaphiliasParaphilias are sexual dysfunctions or behaviours that stem from a deviant sexual focus. The „trademark” of paraphilias is that they involve a high degree of obsessive/compulsive thoughts and behaviours, and are complicated by intense fantasies of the sexual focus. There is an extensive list of known paraphilias. It is important to keep in mind that each paraphilic behaviour involves a specific focus (specific stimuli), which in many cases is the primary sexual arousal for the person.
6ParaphiliasExhibitionism – focus on exposing oneself to an unsuspecting personFrotteurism – focus on touching or rubbing against an unsuspecting personFetishism – focus on non-living objects, such as underwear, shoes, leather, and the like
7Paraphilias Paedophilia – focus on children and young adolescents Sadism – sexual arousal from inflicting great pain and suffering onto othersMasochism – sexual arousal from having great pain, humiliation, and suffering inflicted onto them
8Paraphilias Voyeurism – people or viewing an unsuspecting person Transvestic Fetishism – sexual arousal from dressing as the opposite sex (note, it is primarily sexual arousal from crossdressing)
9ParaphiliasThere are hundreds of paraphilias and paraphilic behaviours. Men appear to be, much more drawn to paraphilic behaviour than women.Some paraphilic interests are socially acceptable, such as fetish objects, sadism, masochism, and even some forms of paedophilia.There is always a question of the legal aspects.
10ParaphiliasOn the Internet, one can purchase "used panties", blow-up dolls, and other fetish items. There appears to be a proliferation of pornographic businesses that would like to satisfy the needs of many men by offering "teen porn", "teeny porn", "barely legal", and so forth. This would be another example of a socially acceptable (by that we mean it is tolerable and even encouraged) paedophilic behaviours.
11Paraphilias - focus is on Formicophilia – small creaturesKlismaphilia – enemasUrophilia – urineCoprophilia – fecesScatophilia – sexual talk on PhoneVomerophilia – vomitNecrophilia – corpses
12Paraphilias - focus is on Gerontophilia – elderly peopleAcrotomophilia – amputated peopleInfantilism – being treated as an infantPartialism – a specific part of the bodyPictophilia – porn, pictures, moviesTriolism – viewing partner having sexHypoxyphilia – reduced oxygen intake
13ParaphiliasMost adult sexual offenders will have two or more paraphilias, and may have an even wider paraphilic interest range; however, even though an offender may be in treatment, it is somewhat rare for him or her to disclose these paraphilias or interests. Polygraph tests, penile pletysmographs and other assessments tools have been used, with varying degrees of success, to assist in identifying these interests.
15Varieties of Necrophilia Among the first researchers to describe cases of necrophilia was Richard von Krafft-Ebing, a German neurologist who published Psychopathia Sexualis in As a type of lust-inspired crime, he lists case after case of people who indulged in erotic acts in the presence of a corpse.Von Krafft-Ebing believed that necrophilia, while perverse, might be simply a matter of having no hindrances to sexual satisfaction. Perfect subjuga-tion is itself erotic for some people.
16Varieties of Necrophilia Necrophilia is an erotic attraction to corpses, with the most common motive cited by psychologists as the attempt to gain possession of an unresisting or non-rejecting partner. The activity fits the DSM-IV psychiatric diagnosis of "Paraphilia, Not Otherwise Specified," although many self-professed necrophiles reject such a „shallow approach” to what they feel and do.
17Varieties of Necrophilia According to Dr. Jonathan Rosman and Dr. Phillip Resnick, there are three basic types of "true" necrophilia:Necrophilic homicide, which is murder to obtain a corpseRegular necrophilia, the use of corpses already dead for sexual pleasureNecrophilic fantasy, envisioning the acts but not acting on them
18Varieties of Necrophilia In their study of 122 cases, more people fit into the second category than the other two. More than half of them worked in a morgue or some other aspect of the funeral industry.Supposedly (if one can judge such a secret activity), necrophiles are primarily male (about 90%)
19Varieties of Necrophilia Contrary to common belief, say Rosman and Resnick, most necrophiles are heterosexual, although about half of the known necrophiles who have killed were gay. In only about 60% is there a diagnosed personality disorder, with 10% being psychotic. The most common occupations through which necrophiles in their study came across corpses include hospital orderly, morgue attendant, funeral parlor assistant, cleric, cemetery employee, and soldier—although the majority of people thus employed are not tempted to violate a corpse.
20Varieties of Necrophilia Most corpse violations occur just prior to burial, but there have been cases where the corpse is disinterred from a cemetery plot.
22RapeThe term “rape” is derived from the Latin word “rapere” meaning to steal, seize or carry away, it implies hiding and attacking woman by man for the satisfaction of his sexual desire. It is the ultimate violation of self.Defined as an act of sexual intercourse with a person, against her or his will or without her/his consent – with the usage of force or its substitute.
23RapeEvery nine minutes a woman is raped and this does not include the unreported cases. It is believed that for every case that finds its way into police files, two, three or even four are never reported. Many women feel that nothing will be done about it anyway and she will be put under harassment and shame. The victim may appear frightened because assailants may have threatened to return and kill her or her near one if she went to the police.
24RapeFinkelhor’s study (1979) revealed that 20% of female and 10% of male students had been sexually abused as children. One estimate is that one in six women will be raped in her lifetime. The incidence is continuously increasing (Martin et al, 1983).In a study of rape cases in the USA, Smithyman (1995) says that for every 100 rape cases, only 25 are reported to the police, only 13 persons are arrested, 9 persons prosecuted and less than 5 convicted.
25RapeRape is a violent crime which has many severe effects on the victim both in the long term and in the short term. For example, 36% women who are injured during a rape require medical attention. 25 to 45% of rape survivors suffer from non-genital trauma, 19-22% suffer from genital trauma, up to 40% obtain STDs and 1 - 5% become pregnant as a result of the rape.
26RapeThere are an estimated 32,000 rape related pregnancies in the United States annually. Sexual assault survivors' visits to their physicians increase by 18% the year of the assault, 56% the year after and 31% the second year after the assault. The consequences of rape are not always physical though, and are not always immediate. 80% of rape victims will suffer from chronic physical or psychological conditions over time.
27RapeRape survivors are also 13 times more likely to attempt suicide than not crime victims and 6 times more likely than victims of other crimes. 26% of women with bulimia nervosa were raped at some point in their lives. The mental health costs of sexual assault victims are very high, studies have shown that % of rape and child sexual abuse victims receive some sort of mental health treatment as a result of the victimization.
29Examination of victim Consent for the Examination is mandatory. Signature of consent seems necessary – get a signed informed consent for a medical examination.The question of consent of the minors.
30Examination of victim The Interview - notes Calm or overwrought? Unperturbed or hysterical?In some instances, a delayed reaction may set in after the examination or after the victim has been taken to her home. Occasionally, an apparently unruffled person may request a medication "to settle her nerves."
31Examination of victim Questioning when the attack took place? where? under what circumstances?was a condom used?did the victim believe the assailant achieved an orgasm?has the victim bathed, showered, or douched?
32Examination of victim Questioning victim's marital status menstrual historychildren and their agesrecent genital diseases and operationsuse of contraceptives
33Examination of victim Questioning The victim should be encouraged to relate the incident in her own words. False modesty must be banished. Language should be noted as used.
34Examination of victim Questioning Any form of sexual behaviour tah took place should be brought out although some victims are reluctant to acknowledge involvement in such an act. The victim should not be led, but certain things should be suggested gently to her so that the whole picture may be made clear.
35Examination of victim Questioning The victim should be asked about pain during or after the act, about any bleeding. This last is important in girls who claim to have been chaste prior to the incident. Very important, particularly in a virgo intacta, is whether or not she inserts tampons during menses.
36Examination of victim Clothing Although the study of the victim's clothing rightly belongs to the police. The examiner should comment on it, determining first if the clothing now on the victim is the same as worn by her at the time of the attack. If it is, describe it.
37Examination of victim Physical examination This portion of the examination encompasses the body in its entirety with the exception of the pelvic region, which, being a "target" area, is reserved for the specific examination in which more attention will be focused on it.
38Examination of victim Physical examination The character, colour, location, size, and severity of all wounds should be documented. If bruises, contusions, and lacerations are too numerous to list, measure a few representative ones and note "A multitude of bruises on posterior thorax, a representative one measuring from_____ to ______ cm.
39Examination of victim Physical examination An attempt should be made to determine the age of all bruises, contusions, and lacerations. The last is simple, but attempting to date a bruise can be difficult. Sometimes, if deep, a bruise cannot even be seen for a day or two. That is why a victim should be examined again after 24 hours, if possible, by the same physician.
40Examination of victim Specific examination This is devoted to the the female genitalia. As previously mentioned, in the interview the examiner has already ascertained whether the victim douched after the encounter. Most women, unless physically unable to do so, take a douche after the attack either because they feel unclean, or because they are afraid of the possibility of pregnancy.
41Examination of victim Specific examination Motile spermatozoa are often recovered from the vagina after douching.There should be careful inspection, first, of the mons veneris, both labia, the clitoris, vestibular bulbs, vestibule, Bartholin's ducts, and finally, the hymen itself if present.
42Examination of victim Specific examination Negative observations such as "No abrasions, lacerations, or bruises seen on the labia minora or majora" should be made as well as positive ones.Explore the vestibule to determine if there are mucosal abrasions. Inexperienced or hurried penile thrusting can lead to injury.
43Examination of victim Specific examination The opening or entrance to the vagina figures prominently in the examination, in the victim's psyche, and in potential legal proceedings. If the introitus is wide owing to the victim's having had one or more children and experienced much coitus, it is arbitrarily labeled a "marital" introitus. Check how many fingers You can put into vagina.
44Examination of victim Specific examination At the other end of the scale is the virgin with an "intact" hymen. Frequently the layman considers it to be an easily viewed, easily identified membrane stretching across the entrance to the vagina.
45Examination of victim Specific examination Its presence is not absolute proof of virginity. Cases have been described in which repeated coitus has failed to rupture a particularly tough membrane, and some are on record in which only the birth of a child finally ruptured the hymen.
46Examination of victim Specific examination The hymen is a circular or crescent-shaped, moderately elastic mucous membrane about 1 mm thick with a connective tissue core and stratified squamous epithelium on both surfaces. It varies in shape from individual to individual, but the commonest is a ring or annular type when stretched.
49Examination of victim Specific examination When a virgin has her first intercourse, the hymen is most often torn either posteriorly or in the midline. The remaining pieces of hymen, red and bleeding, retract toward the hymeneal ring as swollen, tender nubs of tissue. These edges, healing within a week or 10 days, depending upon how extensive the tear, are called carunculae myrtiformes or carunculae hymeneales. In time and with frequent copulation, these small fleshy tags may disappear completely.
50Examination of victim Specific examination An absent hymen does not always point to sexual intercourse. For example, a young girl who masturbates frequently and regularly either manually or with a bottle might have a wide hymeneal introitus or no hymen. A girl who pets heavily with her sweetheart may remain a virgin, yet have no hymen. In rare instances, there may be congenital absence of a hymen.
51Examination of victim Specific examination Between the marital introitus and the one with an intact hymen is what many examiners call the "nonvirginal" introitus.the hymen is absent, but healed carunculae hymenales are seenthe woman is nulliparous (?)an unlubricated adult speculum can be inserted with little or no discomfort
52Examination of victim Specific examination Under good illumination and with the patient in the dorsosacral position, gentle traction laterally on the labia will draw them aside, exposing the vestibule and the entrance to the vagina. If the hymen is present, the examiner questions if it has been injured or if it is intact.
53Examination of victim Specific examination In this regard, a particularly useful tool is a set of four graduated plastic spheres of different diameters, each attached to a plastic rod used as a handle. Two purposes are served with these spheres: first, the physician estimates the size of the hymenal aperture.
54Examination of victim Specific examination The average diameter of the adult erect penis ranges from 3 to 5 cm.Second, one can make certain that the hymen is intact, a very difficult task with a naturally notched hymen.
55Examination of victim Specific examination Any changes in the look of hymen or vagina should be noted.Whichever speculum is used, no spermicidal lubricators of speculum should be put on.
56Examination of victim Specific examination Searching for three components:BloodIts source (laceration, menses)Foreign substancesTaking the swabs (gonococci and semen residues)
57Examination of victim Microscopic studies Presence of spermatozoa Sperm mobility (from 2 to 7 and more days?)
58Examination of victim Chemical Tests Florence Test Barberio's Test Acid PhosphataseCreatine PhosphokinasePrecipitin TestBlood Group Determination from Seminal Fluid
60Child sexual abuse (CSA) „Sexual abuse in childhood or adolescence is reported, for instance, by one-third of women in Barbados, Canada, Netherlands, New Zealand, Norway and the United States.”
61Child sexual abuse (CSA) In a study conducted under the joint sponsorship of the U.S. National Institute of Child Health and Human Development, the Swedish Allmanna Barnhuset Foundation, and the Swedish Social Science Research Council, a group of experts studied the child sexual abuse problem on an international level.Oslo, Norway reported victims at an incidence rate of 0.22%.The study concluded that there was a great frequency of cases that could not be substantiated.
62Child sexual abuse (CSA) Bendixen, M., et al. (1994). "The impact of child sexual abuse - A study of a random sample of Norwegian students." Child Abuse & NeglectThe long-term impact of CSA has most typically been concentrated on the psychological outcomes. The aim of the present study was to examine the relationship between CSA and self-reported complaints including both psychological and psychosomatic problems as well as absenteeism.
63Child sexual abuse (CSA) A random sample of 510 female and 486 male students completed a questionnaire that included questions about CSA. The overall response rate was 75.3%. A symptom scale was constructed by asking the respondents to rate themselves on a three-category scale for 13 items concerning both psychological and somatic health problems. They were also asked to indicate how many days the problem had caused them to be absent from class or work during the year prior to the study.
64Child sexual abuse (CSA) CSA was reported by 116 of the students (11.7%). CSA was associated with a broad range of health problems; including genital pain/infections and headache/abdominal/muscular pain as well as psychological disorders such as anxiety and suicidal ideations. A linear relationship was demonstrated between the severity of CSA and the symptom score, as well as between the severity of CSA and days absent from work. Postpubertal onset of abuse and close relationship with the offender were positively associated with the number of sick-leave days.
65You will have to choose appropriate words from Your own language!! Examination of victimThe InterviewWith children, it is necessary to speak their language. Learn what they call a penis.You will have to choose appropriate words from Your own language!!