7.2 Sexual Crimes, Violence Against Women & Child Abuse

Why this area matters

The TOS lists "sexual crimes" among the medicolegal cases. Physicians in emergency rooms, rural health units and Women and Children Protection Units (WCPUs) are often the first to examine survivors. The exam tests the legal elements, the examination technique, interpretation of findings, and the mandatory reporting and referral duties.

Rape and sexual assault (RA 8353, as amended by RA 11648)

The Anti-Rape Law of 1997 moved rape from crimes against chastity to crimes against persons, so it no longer needs a private complaint. Article 266-A of the Revised Penal Code now defines two forms.

1. Rape by carnal knowledge. After RA 11648, this applies to any person who has carnal knowledge of another person under any of these circumstances:

• (a) through force, threat or intimidation;
• (b) when the offended party is deprived of reason or otherwise unconscious;
• (c) by fraudulent machination or grave abuse of authority;
• (d) when the offended party is under 16 years of age or is demented, even if none of the other circumstances is present.

Under the RA 11648 proviso, there is no criminal liability when the age difference is 3 years or less and the act is proven consensual, non-abusive and non-exploitative. This exception does not apply if the victim is under 13.

2. Sexual assault. Committed under the same circumstances, by inserting the penis into another person's mouth or anal orifice, or any instrument or object into the genital or anal orifice of another person.

Other key points:

• Penetration need not be complete. Even slight penetration of the labia completes carnal knowledge, and emission is not required.
• A husband can be guilty of raping his wife. Under Article 266-C, the subsequent forgiveness of the wife extinguishes the criminal action or penalty, unless the marriage was void from the start.
• The death penalty provisions are no longer applied because of RA 9346 (2006), but qualifying circumstances still raise the penalty within the scale. Examples are a victim under 18 abused by a parent or relative, or a victim in police custody.

Related crimes:

• Acts of lasciviousness (Art. 336): lewd acts without carnal knowledge, under the circumstances of rape.
• Qualified and simple seduction (Arts. 337 and 338, as amended): now cover minors 16 and over but under 18.
• RA 7610 penalizes sexual abuse and lascivious conduct with children exploited in prostitution or subjected to other sexual abuse.
• RA 9208, as amended by RA 10364: trafficking in persons.
• RA 11930 (2022): online sexual abuse and exploitation of children.

Examining a survivor

1. Prioritize safety and medical care. Treat injuries first, then do the forensic examination with informed consent, from the survivor or from a parent or guardian for a child. Explain each step, offer a support person, and use a trained examiner of the gender the survivor prefers when possible.
2. Take the history in the survivor's own words: time, place, acts done, any bathing, douching or change of clothing since, and the last consensual intercourse.
3. Do a general examination for extragenital injuries: bite marks, grip bruises on the arms and inner thighs, neck injuries, and signs of drugging.
4. Examine the anogenital region using the clock-face description. Note fresh lacerations (bleeding, edema), healed lacerations, the depth of any hymenal tear (partial versus complete, meaning reaching the base), and perineal and anal injuries. Colposcopy and photography help.
5. Collect evidence before washing: vaginal, anal and oral swabs (spermatozoa, PSA, DNA), fingernail scrapings, pubic hair combings, clothing in paper bags, and blood and urine for toxicology if drugging is suspected. Keep the chain of custody.
6. Provide care:
   • pregnancy testing and counseling;
   • HIV post-exposure prophylaxis when the survivor comes within 72 hours;
   • presumptive treatment or testing for sexually transmitted infections;
   • hepatitis B vaccination;
   • psychological first aid and referral to a WCPU, the DSWD and law enforcement.

Interpreting hymenal and genital findings

• The hymen varies: annular, crescentic, fimbriated, septate, cribriform, imperforate. It may be elastic, so it can stay intact after penetration. It may also tear from causes other than intercourse.
• Healed lacerations show only that penetration happened at some earlier time; they do not date the event.
• Philippine courts repeatedly hold that a medical examination is not indispensable to prove rape and that hymenal laceration is not an element of the crime. A credible, consistent testimony from the victim can convict. Medical findings corroborate.
• Write findings objectively, for example "deep healed laceration at 6 o'clock". Do not write legal conclusions such as "victim was raped".

Violence against women and their children (RA 9262)

RA 9262 penalizes physical, sexual, psychological and economic abuse committed against a woman by:

• her husband or former husband;
• a person with whom she has or had a sexual or dating relationship;
• a person with whom she has a common child.

It also covers abuse of her child. The law provides protection orders: barangay, temporary and permanent. Health workers must document injuries, respect confidentiality, and refer the woman to the barangay VAW desk, police women's desks, the DSWD or the courts. Battered woman syndrome is recognized as a defense for a woman who harms her abuser.

Child abuse (RA 7610)

Definition. Child abuse is maltreatment, habitual or not, including:

• psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment;
• any act by deeds or words that debases or demeans a child;
• unreasonable deprivation of basic needs;
• failure to give immediate medical treatment to an injured child.

Mandatory reporting. Under the Rules and Regulations on the Reporting and Investigation of Child Abuse Cases (Sec. 4), the head of any public or private hospital or clinic, and the attending physician and nurse, must report to the DSWD, orally or in writing, within 48 hours of knowledge of examining or treating a child who appears abused. The DSWD then investigates within 48 hours of the report.

Red flags for physical abuse:

• a history inconsistent with the injury or the child's developmental stage, and delay in seeking care;
• patterned bruises (loop marks from a cord, hand slaps, belt buckles) and bruises in a non-mobile infant;
• multiple injuries of different ages;
• posterior rib fractures and classic metaphyseal (corner or bucket-handle) lesions;
• abusive head trauma: subdural hemorrhage, retinal hemorrhages and encephalopathy in an infant, from shaking or impact;
• immersion burns with sharp stocking-glove lines or spared flexural creases, and cigarette burns.

Do a skeletal survey in children under 2 with suspected abuse, admit when home is unsafe, and work with the hospital child protection unit.