Steps For the Veterinary Examiner to Take in Cases of Suspected Animal Sexual Abuse

• 1. Ensure there is appropriate law enforcement seizure paperwork in place, or consent form/ permission of animal owner to perform an exam.
• 2. Review any witness statements or written accounts of the ASA. The affidavit for a search warrant should have a detailed history and explanation of the theory of the offense.
• 3. Obtain a verbal history of the alleged assault from law enforcement, family, or available witnesses. Write down any statements verbatim and quote it in the history.
• 4. Review a detailed health history if available.
• 5. If the owner is present, explain what the exam will entail, and the extent of the injuries discovered.
• 6. Physical exam to assess the animal’s condition, to include general overall health and specific potential injuries related to any potential animal sexual assault or nonaccidental injury. Overall exam should include whole-body alternate light source (ALS) examination, wholebody radiography, and infrared photography when possible.
• 7. Perform objective documentation of injuries with notes, sketches, and photography where possible.
• 8. Collect and preserve potential trace evidence. Collect blood and samples for complete blood counts, chemistry, and toxicology screening. In a female patient who may have been penetrated vaginally, the first urine passed should be caught and preserved by refrigeration. This urine sample should not be spun in the centrifuge.
• 9. Provide treatment for any conditions found.
• 10. Observe body language/mannerisms of the family members who are present. If unusual or suspicious, include in law enforcement notification.
• 11. Refer to resources available to assess follow-up needs, regular DVM as appropriate (Bradley and Rasile, 2014a,b).

The Physical Exam

A complete nose-to-tail exam should be conducted with the examining veterinarian and assistants wearing powder-free gloves, with the animal contained on a clean white sheet or butcher paper to catch any trace evidence that may be shed during the exam. The examining veterinarian must bear in mind that coercion must be used to allow the perpetrator to abuse an animal sexually, and such restraint may be physical (stunning blows to the head, binding restraints of head, muzzle, and/or limbs, forceful gripping), chemical (sedative agents), or through behavioral training for a conditioned response. Any observed signs of such coercion should be noted in the medical record, diagrammed, photographed, or videotaped as might be appropriate.

If sedative or anxiolytic drugs are going to be used to aid in the physical exam, radiography, and evidence collection, and pharmacology may have been used to perform the animal sexual assault, bloodwork should be collected prior to the administration of sedative, anesthesia, or analgesia.

A careful, deliberate, systemic, and complete head-to-tail exam should be performed looking for injuries such as abrasions, bruises, pattern injuries, lacerations, bite marks, burns, head trauma, blunt force injuries, injuries to the ears (chronic changes to the ear canals may be seen with repeated restraint by the ears), evidence of ligatures and/or bindings (around muzzle or limbs), toenail injuries, petechia in the sclera or fundus related to strangulation or attempted strangulation injuries around neck, and tail injuries, especially at the base.

The examination should include considerations for detection and collection of trace evidence, and detection and documentation of suspected injuries differentiated from accidental or natural causes of injury or disease which may mimic nonaccidental ASA injury. Trauma or trace evidence of ASA may be found because of human oral contact or penetration by a penis or a foreign object to the genitalia, perineum, oral cavity, or elsewhere on the animal, or evidence of animal oral contact or penetration of a person.

Crescent-shaped or ovoid fingertip bruises may be present on the caudal abdomen or medial thighs. These bruises are consistent with a strong manual grip hold for restraint. In deceased animals, a careful dissection with reflection of the skin should be performed to asses any bruises that are not evident on external exam of the shaved skin.

In smaller animals, where orifices are too small to allow penile, digital, or object penetration, the perineum or cloacal region may be invaginated through the pelvic opening. In these cases, there may be a large “target lesion” where the fur or feathers are wet, clumped, or missing in a large circle around the center of the target. This type of abuse is almost always fatal.

For the genital examination of a female dog, begin with the external genitalia and work inward. Sedation will facilitate the internal speculum exam for females. This should be performed without the use of lubricants, so the introduction of a speculum must be done with great care. A sterile human plastic vaginal speculum can be used for this exam (these can be equipped with light source). An otoscope with sterile cone can be used for exam and light source.

Observe for internal injuries of the vaginal opening, vaginal wall, and cervix opening, noting any injury to the fossa clitoris, left and right labium, vaginal opening, vestibule, urethral opening, perineum, and anus. With vaginal penetration the vulva may protrude inward. Vaginal prolapse may be present in the spayed female. Once swabbing has been performed, lubricants may be used if it will facilitate photography of internal lesions.

For the male external genitalia, examine the urethral opening, prepuce, sheath, scrotum, perineum, and anus. (Radiograph or palpate the penis do diagnose fracture of the os penis.) Rectal prolapse and prostatitis may be present. Look for bite marks or bruising to the penis and scrotum and lacerations in the folds of the anal opening. Assess circumferentially so all surfaces of the penile shaft are examined.

The rectal opening may be penetrated in animals of either sex, and rectal prolapse may result. A perineal and rectal examination should be completed along with photos of the external anal tissue, documenting any tissue tears. During all internal examinations, be alert for any possible retained foreign bodies.