ECAV Practice Paper Clinical considerations for speculum use in sexual assault medical forensic examinations: A trauma informed perspective

 A targeted posterior fornix sample can be obtained.  A fourth sample – the endocervical sample – can be collected. The exact forensic value of this sample is not yet known.  The vagina and cervix can be checked for injuries. This is particularly important when there is bleeding or ongoing pain but can be positive even in the absence of symptoms. Even when the baseline suspicion is low, a normal finding can still be reassuring to the patient.  Trace evidence, such as hair or vegetation, can be sought and collected.  Potential negatives include:  patient discomfort, both physical and emotional  the potential for retraumatisation of the patient, given the significant rates of childhood sexual abuse amongst women  negative impacts on the acceptability of future speculum examinations, if the examination is performed in a disrespectful or unskilled manner  concerns about DNA contamination from the equipment  concerns about DNA transfer when the speculum is inserted  uncertainty about whether lubricant use affects the detection of sperm of DNA  allegations from the defence that speculum insertion caused any injuries seen  allegations from the defence that the speculum insertion contaminated the sampling site  a requirement for examiners to be skilled in speculum use  the cost of the disposables, such as the speculum and lubricant.