Medicolegal aspects of Virginity and Defloration (Forensic Medicine)

1. Virginity And
Defloration
Dr Vivek Kumar
2ND PGT,
Deptt. Of FSM, NBMCH

2. ANATOMY OF FEMALE REPRODUCTIVE SYSTEM

4. Virginity (Virgo intacta) –
Inexperience of sexual intercourse
Defloration – Loss of virginity

5. Medicolegal Importance -
Nullity of Marriage
Divorce
Sex offences
Defamation

6. Marriage
??????

7. • Nullity of marriage – Marriage never existed
as per law.
a. Impotent
b. Lunatic
c. Pregnant
d. Underage
e. Already married

8. Divorce
Adultery,
unnatural sex practices,
cruelty,
incurable insanity,
VDs

9. Features of virginity
Breast – firm, elastic, hemispherical undeveloped nipple with areola pink
in fair complexioned women and dark brown in dark women,
Nipple - small

10. Labia majora –
Two elongated folds - Downwards and backwards from mons
venoris –
meet in front – Ant commissure and in back post-commissure.
Thick, firm, elastic and rounded and closely apposed to each
other to cover completely vaginal orifice
Labia Minora –
Two thin folds of skin
pink, soft, elastic and sensitive covered by labia majora.

11. Fourchette – Lower portions of minora fused in midline and form a fold.
Posterior commissure – Intact
Fossa nevicuraris – The depress space between vaginal orifice and
fourchette.
Vestibule - Triangular space
Clitoris – Small and unenlarged

12. Vagina – Length – 7.5cm
Wide – 6cm
Deep – 9cm
It the narrow, tight, reddish, sensitive to touch, walls are
approximated, Irregular shape, rugosity in mucosa,

13. Hymen –
Thin fold of mucous membrane covering vaginal
orifice.
About 1mm thick.

14. Types :
Imperforate
Infantile
Annular
Semilunar (Crescentic)
Fimbriated
Cribriform
Septate
Fringe like or marginal
Ruptured – Carunculae myrtiformes

18. Rupture (Causes) –
Sexual intercourse
Masturbation
Accidents
Medical interference
Artificial manoeuvres – Sola pith
Ulceration –
C. Diptheriae
Fungal
S.T.D
Irrititaion
Introduction of Sanitary tampoons

19. • Explain why –
1. A female has history of repeated sexual
intercourse but on examination her hymen
found to be intact.
2. A female has no history of sexual intercourse
but on examination hymen found to be
ruptured.

20. Principal signs of virginity
a. Intact hymen
b. Normal cond. Of fourchette and post. Com
c. Narrow tight vagina with rugosity

21. VIRGINITY DEFLORATION
Breast – Hemispherical, firm elastic with Loose lax pendulous, enlarged areola
small areola and non pointed nipple with prominent nipple
Labia Majora – well developed apposed to each Not apposed to each other dialated and /
other, completely cover V. ORIFICE Swollen gaping on abduction of thigh does
no gaping on full abduction of thigh not cover V.ORIFICE
Labia Minora – Thin firm elastic and completely Thick, non elastic dialated and / swollen
covered by L. Majora and not covered by L. Majora completely
Vestibule Wide, evidence of rupture sometimes
Hymen Intact disappeared and torned
Fossa Nevicuraris
Fourchette
Hymenal Opening – Small edges are distinct, Loose, elastic, allows 2 -3 fingers
dose not allow more than tip
of little finger
Vagina – Narrow Wide
Tight Deep Reduction of Rugosity
Rugosity Capacious

22. Pseudo virgin :
a) Hymen not ruptured since it is thick, fleshy,
cartilaginous, even after sexual intercourse other signs
will confirm non virginity
b) Free margin of hymen sometimes fimbriated and shows
numerous notches round the clock

23. TRUE VIRGIN FALSE VIRGIN
1. Breast Elastic, hemispherical, unenlarged
nipple with brown areola
Loose, Lax, flabby
2. Labia Majora Firm, well apposed and does not gap
on abduction of thigh
Flabby, may gap on
abduction of thigh
3. Clitoris and
Labia Minora
Unenlarged clitoris, narrow vestibule,
Labia minora is elastic and pink, do
not protrude out of vulva
Clitoris enlarged, vestibule
gaping, L.minora loose,
blackish-brown, cutaneous,
4. Hymen Intact hymen, free regular margin,
popening allowing tip of little finger
Intact but thick, elastic
distensible allowing 2 to 3
fingers easily, Evidence of
C. mytiformis
5. Vagina Narrow, conical, vaginal mucosa
rugosed
Deep, roomy, dilated and
capacious with less rugosed
wall
6. Fourchette Normal, intact Normal and intact

24. Impotence and Sterility
• Impotence – Physical incapacity to
accomplishing the sexual act.
• Sterility – Inability to procreate.
Female -failure to conceive
Male – failure to impregnate

25. IMPOTENCY

26. Impotence in Male :
• Persistent inability to develop or maintain
penile erection sufficient to conclude coitus to
orgasm and ejaculation.

28. Factors responsible for sexual intercourse
Stimuli : a) verbal
b) visual
c) superficial contact
(a) Male – Erectio, intromossio, ejaculatio
With secretion form cowper’s gland and
seminal vesicles
(b) Female – Enlargement of clitoris secretion of
vagina

29. • Vera Copula ?
• Impotentia Ejaculandi ?
• Ejaculation precox ?

30. Orgasm –
Both partners have feelings of mutual release of
physical and physiological tension after release of
secretion, irrespective of sex

31. MEDICOLEGAL SIGNIFICANCE
Civil – Nullity of marriage,
Divorce,
Legitimacy,
Supposititious child.
Criminal – Adultery, rape, unnatural sex,
defamation and Black mailing,
workmen’s compensation act.

32. • sec12 of Hindu Marriage Act 1955 or
sec 24 of Special Marriage Act 1954
# # Article 21 of the constitution of India

33. Cause in male (impotence)
I. Congenital :
1. Absence of Penis / Testis
2. Double penis
3. Hypo and epispadiasis with deformed penis
4. Intersex
5. Cryptorchidism

34. II. Inflammatory :
A. Local – Balanitis, balanoprosthitis,
phimosis and Paraphymosis,
orchitis [Temporary]
B. General – Tuberculosis, S.T.D.,
pneumonitis, typhoid, malaria,
meningitis, nephritis,
Causes of Paraplegia
Causes of Hemiplagia
G.P.I. Tabes dorsalis

35. III. Endocrinal – Diabetes mellitus, Thyrotoxicosis,
Addison’s Dis,
Hypopitituitarism
IV. Neoplastic – CA. Penis,
Seminoma / Teratoma testis
V. Age-

36. VI. Injury / Surgical interference – Penis, testis,
ligation of hypogastic arteries,
cerebellum, SP. Cord, spine.
VII. Drugs – Opium, barbiturate, cannabis, alcohol,
L.S.D., tobacco, dexidrin, phenothiazines,
tranquillisers, antihypertensive.
VIII. Psychiatric – Schizophrenia, M.D.P.,
anxiety neurosis,
# Impotence quoad hanc
# Bridal Night Impotence

37. Causes in Female (Impotence)
• I. Congental –
Absence of vagina,
imperforated hymen,
turner's syndrome,
kraurosis vulvae

38. II. Local inflammatory :
Vaginitis Fungal
Cervicitis Bacterial
Endometritis
Prolapse uterus
III. General :
Tuberculosis, S.T.D.,
pneumonitis, typhoid, malaria,
meningitis, nephritis

39. III. Age,
IV. Surgical interference
V. Drugs
VI. Neoplastic – Ovariam tumour, vaginal tumour,
T.O. Mass, Large bleeding fibroid.
VII. Psychiatric – Same as male
Vaginismus

40. Vaginismus :
• Reflex spastic contraction of –
a) Levator ani
b) Adductor muscles
c) Perineal muscles
d) Erector spinae muscle
Body become Arched, Resting on head and heal

41. Aetiology :
• Religious orthodoxy
• Husband’s impotence and Frigidity
• Previous psychological trauma
• Dysparaunia
• Homosexuality

42. Frigidity :
Failure on part of subject to respond to
sexual stimulation in its initiation or
maintenance of sexual performance.

43. Sterility (Male) causes
I. Congenital –
II. Inflammatory – Same as in impotence
male
III. Opr. Like hermioraphy, prostatectomy,
orchidectomy.
IV. All other causes as in impotence male.
V. Auto immuno agglutination reaction.

44. Agglutination of semen -
Due to incompatibility of agglutinin present in
vaginal secretion with formation of sperm
agglutinating antibodies.
Impairment of motility and penetration powers of sperm

45. Sterility in Female –
All are same in impotence in female
+
I. Blockage of tube
II. Atresia vagina
III. Adhesion labia

46. EVALUATION
1. Sexual history : libido, erection, ejaculation,
orgasm
2. Medical history : DM, HTN, Peyronie's disease
3. Psychological
4. Physical exam :Genital, general , and undescended
testis , Bulbocavernous reflex (pelvic nerve integrity of
S2-4 )
5. Blood studies : hormonal evaluation : prolactin
concentration ( to exclude prolactinoma ,
testosterone, FSH)

47. 6. Nocturnal penile tumescence
7. PIPE TEST
8. Duplex ultrasound :
9. Cavernosometry
10. Cavernosography
11. Penile arteriography

48. What Is Nocturnal Penile Tumescence (NPT)?
test to help differentiate psychogenic from organic
erectile dysfunction because penile rigidity and not just
tumescence is required for coitus. It should record both
penile tumescence and rigidity.
NPT
normal with psychogenic ED
absent or impaired with organic ED

49. Duplex Ultrasound
To evaluate cavernosal arteries and thus arterial inflow
into the corpora cavernosa of penis.

50. What Are Cavernosometry And
Caversonography?
Cavernosometry : measures ICP while saline flow rates
needed to obtain and maintain full erection are
determined
Cavernosography: contrast is infused into c. cavernosa
radiographic imaging to document pathways of any
venous leakage from the corpora.

51. Adult penis – 10 – 16 cm L
8 – 12 cm C
3 – 5 cm D
Below – 5 – 8 cm L – Incompatible.
Axis of erect penis – 20 – 32°

54. opinion
• If there is no physical defect, deformity or
abnormality and subject is healthy -
• There is nothing to suggest that the individual
examined is not capable of performing sexual
intercourse in the ordinary way on the date of
examination.

55. • In the presence of gross permanent and
incurable defect, deformity of the genitals
opinion is ---- Subject is incapable of
performing sexual intercourse in the ordinary
way alike a normal potent person