Describe the medicolegal aspects of virginity, pregnancy and delivery.

Virginity and Defloration

• The only reliable statement a doctor can make is whether there are signs of recent sexual intercourse — a fresh hymenal tear, genital injury, and semen — or of pregnancy or childbirth. Virginity as such cannot be certified
• Signs of recent defloration — a fresh, bleeding, tender tear of the hymen, most often in the posterior half; bruising and tenderness of the vulva and fourchette; and semen. These heal within 3 to 7 days, and the tear then becomes a permanent healed notch
• Medicolegal contexts — sexual offences; nullity of marriage on the ground of non-consummation; and, in India, "virginity testing" demanded for social, marital or employment reasons, which is unlawful, unscientific and a violation of dignity, and which a doctor should refuse to perform

Signs of Pregnancy

Signs of Recent and Remote Delivery

• The permanent signs of past delivery are few and should be known — carunculae myrtiformes, a transverse cervical os, white striae, and permanent pigmentation of the areola. These indicate that the woman has borne a child at some time, but cannot date it
• Medicolegal importance — concealment of birth and infanticide, where the question is whether the accused woman has recently delivered; criminal abortion; disputed inheritance and legitimacy; blackmail and false claims of pregnancy; and the identification of an unknown body

Applied Aspects

• Refuse to certify virginity; it cannot be established medically, the examination is degrading, and "virginity testing" for social or employment purposes is unlawful
• Never perform a two-finger examination for any of these purposes; it is prohibited and its findings are worthless
• Distinguish signs of recent intercourse from signs of virginity; the first is answerable and the second is not
• Use the lochia to date a recent delivery; its colour and character give a reasonable estimate over the first three weeks, which is often the question in a suspected infanticide
• Look for caruncullae myrtiformes and a transverse cervical os where past delivery is in question; these are permanent and are the reliable signs
• A positive pregnancy test is not a certain sign; only detection of the fetus is, and ultrasound has made this straightforward
• Precocious pregnancy is possible from the menarche, and pregnancies in girls of 10 or 11 are recorded — a fact of direct POCSO relevance
• Superfetation and superfecundation are recognised — a second conception in an existing pregnancy, and two ova fertilised by different men — and both have arisen in paternity disputes
• The usual period of gestation is about 280 days from the last menstrual period, and Indian courts have accepted a range in legitimacy cases
• Signs of recent delivery persist for about a week or two — lochia, a large soft uterus, engorged breasts, and perineal tears; and signs of remote delivery are permanent but non-specific
• Do not opine that a woman has delivered on breast changes alone; lactation occurs without pregnancy and the older textbook signs are unreliable
• Pseudocyesis must be considered in a woman convinced she is pregnant with a negative test and scan; it is a psychiatric condition, not a deception
• Ultrasound has displaced almost all the classical signs, and a medicolegal opinion on pregnancy should rest on it where it is available
• A negative pregnancy test does not exclude recent delivery, and the hormone falls over weeks after the pregnancy ends
• Signs of remote delivery are permanent but non-specific — striae, a patulous os and a lax abdominal wall — and prove only parity
• Feigned pregnancy and concealed pregnancy both occur, the first for gain and the second from fear, and each has medicolegal consequences
• Examine for delivery in any suspected infanticide; establishing that a particular woman recently delivered is the first link in the case
• Lochia changes colour predictably — red for about 4 days, then pale, then white by about 10 days — and gives a rough dating of delivery
• The uterus involutes at about 1 cm a day, returning to the pelvis by about 10 to 12 days and to near-normal size by 6 weeks
• Striae gravidarum fade from pink to white over months, so their colour distinguishes a recent from a remote delivery
• An intact hymen does not exclude pregnancy, and pregnancy with an intact hymen is documented; the two questions are separate
• Photograph and measure any perineal tear, and record the state of the cervical os, which is transversely slit after childbirth
• Take the opinion on delivery cautiously in a multipara, where the remote signs of earlier deliveries confuse the picture
• Virginity is not a medical diagnosis, and no examination establishes it; the doctor reports findings and declines the label
• Colostrum may be expressed from about the sixteenth week, and persists for weeks after delivery, so it dates neither precisely
• Quickening is felt at about 18 to 20 weeks in a primigravida and earlier in a multipara, which bears on the age of a fetus in abortion cases
• Record the state of the breasts, uterus, perineum and lochia together; no single sign dates a delivery and the combination does
• Ultrasound settles pregnancy and its duration, and a medicolegal opinion should rest on it rather than on the classical signs