Page 149 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL V. PHYSICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

take all the necessary samples from individuals alleging (d) Follow-up
sexual assault. If there is no laboratory available, it
may still be worthwhile to obtain wet swabs and dry 468. Many infectious diseases can be transmitted by
them later in the air. These samples can be used later sexual torture or ill-treatment, including sexually
for DNA testing. Strict precautions must be taken transmitted infections, such as gonorrhoea,
to prevent allegations of cross-contamination when chlamydia, syphilis, HIV, HPV, hepatitis B
samples have been taken from several different victims, and C, herpes simplex, anogenital warts,
particularly if they are taken from alleged perpetrators. vulvovaginitis resulting from trichomoniasis,
There must be preservation and documentation monilial vaginitis, bacterial vaginosis and pinworm
of the chain of custody for all forensic samples. infection, as well as urinary tract infections.

(c) Examination after the immediate phase 469. Appropriate laboratory tests and treatment should be
prescribed in all cases of sexual torture or ill-treatment.
465. In cases in which the alleged sexual torture or In the case of gonorrhoea and chlamydia, concomitant
ill-treatment occurred more than a week earlier infection of the anus or oropharynx should be
and there are no signs of bruises or lacerations, considered at least for examination purposes. Initial
there is less immediacy in conducting a pelvic cultures and serologic tests should be obtained in cases
examination. Time can be taken to try to find the of sexual assault and appropriate therapy initiated.
most qualified person to document findings and the The presence of sexually transmitted infection may
best environment in which to interview the individual. be consistent with an account of sexual torture but
However, it may still be beneficial to photograph does not necessarily confirm torture was the cause.
residual lesions properly, if this is possible.
470. Sexual dysfunction is common among survivors
466. The clinical evaluation should be recorded as described of torture or ill-treatment, particularly among
above, then examination and documentation of those who have suffered sexual torture or rape,
the general physical findings. In women who have but not exclusively. Sexual dysfunction may occur
delivered babies before the rape, and particularly in those who have not suffered sexual torture
in those who have delivered them afterwards, or it may be that they have not yet disclosed it.
pathognomonic findings are not likely. It may Symptoms may be physical or psychological in
take some time before individuals are willing to origin or a combination of both and include:
discuss those aspects of the torture that they
find most shameful or stigmatizing. Similarly, (a) Aversion to members of the opposite sex or
alleged victims may wish to postpone the more decreased interest in sexual activity;
intimate parts of the examination to a subsequent
consultation, if time and circumstances permit. (b) Fear of sexual activity because a sexual partner will
“know” that the victim has been sexually tortured or
467. In only a minority of cases is physical evidence found fear of having been damaged sexually. Torturers may
when examining genitalia after an assault. When have threatened this and instilled fear of homosexuality
examining later on, when the person may have had in men who have been anally tortured. Some men
subsequent sexual activity, whether consensual or not, have had an erection and, on occasion, ejaculated
or given birth, caution must be taken in attributing during anal rape. They should be reassured that
any findings to a specific incident of alleged torture or this is a physiological response and does not imply
ill-treatment. Therefore, for both women and men, the consent, enjoyment or necessarily reflect their sexual
most significant component of a medical evaluation orientation;
may be the examiner’s assessment of background
information (e.g. correlation between allegations of (c) Profound effects on the psyche due to
torture or ill-treatment and acute injuries observed forced transgressions of sexual orientation and
by the individual), the demeanour of the individual gender identity;
and the psychological impact of the experience.
(d) Inability to trust a sexual partner;

(e) Disturbance in sexual arousal and erectile
dysfunction;

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