When a sexual assault survivor presents to a hospital in India — whether a child under the Protection of Children from Sexual Offences (POCSO) Act or an adult under the Bharatiya Nyaya Sanhita (BNS) — the examining medical officer occupies a uniquely important position. The doctor is simultaneously a caregiver, a forensic evidence collector, and a future witness whose medical report may be central to the prosecution of a serious crime.

The obligations are demanding, the legal framework is detailed, and the consequences of errors — whether evidence contaminated, prohibited tests performed, mandatory reports omitted, or survivor consent violated — can be severe for the doctor, devastating for the survivor's case, and significant for justice in the criminal proceedings.

This guide sets out the complete legal framework governing sexual assault medical examinations in India, covering what the law requires, what it prohibits, and how doctors should conduct and document these examinations.

"The medical officer in a sexual assault case is not investigating a crime — that is the police's role. The doctor's job is to provide compassionate care, collect and preserve evidence properly, and document findings accurately. Overstepping that role — particularly by opining on whether assault occurred — both violates the survivor's rights and weakens the legal case."
— Dr. Namit Gupta, Senior Medico-Legal Expert

The Legal Framework

The Bharatiya Nyaya Sanhita (BNS) — Replacing the IPC

With effect from 1 July 2024, the Indian Penal Code (IPC) was replaced by the Bharatiya Nyaya Sanhita, 2023 (BNS). The offence of rape, previously under Section 375/376 IPC, is now defined under Section 63/64 BNS. The definition of rape and the aggravated categories remain substantively similar — rape by a person in a position of authority, by a police officer, or causing death or persistent vegetative state all attract enhanced punishment under the BNS, just as they did under the IPC.

For the examining medical officer, the substantive change is not in the definition of the offence but in the procedural law: the Code of Criminal Procedure, 1973 (CrPC) has been replaced by the Bharatiya Nagarik Suraksha Sanhita, 2023 (BNSS), which governs the medical examination of sexual assault survivors in Section 184 (previously Section 164A CrPC).

Section 184 BNSS (Previously Section 164A CrPC): Examination of Victims

Section 184 BNSS provides that when a person alleged to be the victim of a rape offence is brought before a registered medical practitioner for examination:

  • The examination must be conducted by a registered medical practitioner — any registered medical practitioner, not only a gynaecologist or forensic expert
  • The examination should be performed, wherever practicable, by or in the presence of a female registered medical practitioner
  • The medical practitioner must obtain the written informed consent of the survivor (or of a person competent to give consent on her behalf, in the case of a child or person of unsound mind) before the examination
  • The examination must be conducted without delay
  • The medical report must be forwarded to the Investigating Officer without delay

POCSO Act, 2012: Special Provisions for Child Victims

Where the survivor is a child (under 18 years), the Protection of Children from Sexual Offences Act, 2012 (POCSO) applies in addition to the criminal law. Key provisions relevant to the examining medical officer include:

  • Section 19 POCSO — Mandatory Reporting: Every person (including a doctor) who has apprehension or knowledge that a sexual offence under POCSO has been or is likely to be committed must report this to the Special Juvenile Police Unit (SJPU) or the local police. Failure to report is a criminal offence punishable with up to six months' imprisonment. This is non-negotiable — even if the child or the child's family does not wish to report, the doctor is legally bound to do so.
  • Section 27 POCSO — Medical Examination: The medical examination of a child victim must be conducted by a registered medical practitioner — and wherever possible, by a female practitioner. The examination should take place in the presence of the child's parent or another trusted person chosen by the child, unless the child objects.

Criminal Law Amendment Act, 2013

The Criminal Law (Amendment) Act, 2013 — enacted in the wake of the December 2012 Delhi gang rape case — introduced sweeping changes to the law on sexual offences. It expanded the definition of rape, increased minimum sentences, created new offences (acid attack, stalking, voyeurism), and, critically, introduced specific obligations on the medical establishment through amendments to the CrPC (now BNSS). It also amended the Indian Evidence Act to make the survivor's sexual history inadmissible and to remove the presumption of consent.

Who Can Perform the Examination?

Any registered medical practitioner (RMP) under the NMC or a State Medical Council can perform the examination. The law does not restrict the examination to forensic specialists or gynaecologists. This is intentional — in many parts of India, especially at the Primary Health Centre or Community Health Centre level, a specialist may not be available, and insisting on one would cause dangerous delays in both medical care and evidence collection.

The law's preference for a female doctor ("wherever practicable") reflects sensitivity to the survivor's experience — but it is a preference, not a requirement. A male doctor may examine a survivor if no female doctor is reasonably available, and the examination should not be delayed to await a female doctor at the cost of evidence loss.

Consent: The Foundational Requirement

Written informed consent must be obtained before the examination begins. For an adult survivor, this means:

  • Explaining, in language the survivor understands, what the examination involves and why each element is needed
  • Explaining that evidence collected will be shared with the police and may be used in court
  • Confirming that the examination is voluntary and can be stopped at any point
  • Obtaining a signed consent form before proceeding

The consent cannot be coerced or assumed. A survivor who is in shock, highly distressed, intoxicated, or unconscious may not have capacity to give valid consent; in such cases, the standard framework for incapacitated patients applies, and the urgency of medical care (not forensic evidence collection) takes priority.

For a child victim under POCSO, consent is given by the parent or guardian. Where the suspected perpetrator is the parent or guardian, or where they are unavailable, a court-appointed guardian or a trusted adult chosen by the child may give consent. The child's own assent — age-appropriately sought — remains important and should be documented.

Mandatory Reporting: A Non-Negotiable Obligation

Child Victims (POCSO)

Section 19 of POCSO imposes a mandatory reporting obligation on every person — including doctors, nurses, and other healthcare workers — who has knowledge or reasonable apprehension that a child has been or may be subjected to a sexual offence. The report must be made to the SJPU or local police. Failure to report is a criminal offence punishable with imprisonment up to six months and/or a fine.

This obligation exists regardless of whether the child or the child's family consents to reporting, and regardless of whether the perpetrator is a family member. The law explicitly removes discretion: if you know or reasonably suspect, you must report.

Adult Survivors

For adult survivors, Section 39 BNSS (previously Section 39 CrPC) requires any person having knowledge of an offence to report it. However, courts have recognised a tension between this duty and the survivor's autonomy as an adult. The approach in medical practice has generally been to inform the adult survivor of her right to report, provide her with information about the process, and document whether a report was made — while respecting her decision if she declines. The doctor should record this conversation and the survivor's choice in the medical notes.

The Two-Finger Test: Absolutely Prohibited

The per vaginum examination (colloquially and notoriously known as the "two-finger test") — which involved inserting fingers into the vagina purportedly to assess the laxity of the introitus and the "condition of the hymen" — was declared unconstitutional by the Supreme Court of India in Lillu @ Rajesh & Anr. v. State of Haryana (2013).

The Supreme Court held that the test:

  • Violates the survivor's right to privacy, physical integrity, and dignity under Article 21 of the Constitution
  • Has no scientific validity — neither the presence nor absence of a hymen, nor its condition, has any bearing on whether sexual assault occurred
  • Has no evidentiary value — the Supreme Court specifically directed that evidence of a survivor being "habituated to sexual intercourse" should not be admitted by courts
  • Re-traumatises survivors and creates a chilling effect on reporting

The Ministry of Health and Family Welfare guidelines issued in 2014 (and updated in 2022) explicitly prohibit the two-finger test and all references to the "condition of the hymen" as a proxy for sexual activity or "habituation." Any doctor who performs this test today is committing professional misconduct, exposing themselves to a complaint before the State Medical Council and potentially a legal notice from the survivor. The courts have been clear — the test has no place in modern forensic medicine.

The Correct Examination Protocol: MoHFW 2022 Guidelines

The Ministry of Health and Family Welfare published updated guidelines on medico-legal care for survivors/victims of sexual violence in 2022. These represent the authoritative standard for examination protocol in India.

1. Taking History

The history should be taken in the survivor's own words, in a private and confidential setting, with a trained female attendant or support person present. The history should record: the date, time, and location of the assault; the nature of the assault as described by the survivor; any acts by the survivor after the assault (bathing, changing clothes) that may affect evidence; and any relevant medical history (prior pregnancy, contraception, STI history).

The history is a clinical document — it should reflect what the survivor said, not the doctor's interpretation or judgement. Do not use language that implies disbelief or assigns blame.

2. General Examination

A systematic general physical examination is conducted first: vital signs, general appearance, signs of intoxication or altered consciousness, evidence of restraint (ligature marks, bruising over wrists), and any injuries to non-genital areas (face, neck, arms, thighs, breasts). All injuries must be documented with their size, shape, location (using a body diagram), colour, age assessment (fresh/healing/healed), and probable causation (blunt force, sharp force, bite, ligature).

3. Anogenital Examination

The anogenital examination must be conducted without the two-finger test. It should include visual inspection for injuries, foreign material, and semen stains — not digital examination unless there is a specific clinical indication unrelated to the assault determination. Findings are documented with diagrams and, where available, photographic evidence. The examination should assess for tears, bruising, swelling, and discharge — describing what is present, not opining on what it means for the question of whether assault occurred.

4. Sample Collection and Chain of Custody

Evidence collection is among the most critical and legally consequential aspects of the examination. Samples must be collected, labelled, sealed, and transferred to the police with a complete and unbroken chain of custody. A broken chain of custody — undocumented transfers, unsealed samples, mislabelled specimens — can render evidence inadmissible in court.

Samples to collect (as clinically appropriate):

  • Vaginal/cervical swabs — for semen (motile sperm microscopy), DNA, and STI testing; ideally collected within 72 hours of assault
  • Oral swabs — if oral penetration is alleged or suspected
  • Anal swabs — if anal penetration is alleged or suspected
  • Skin swabs — from areas where contact is reported (neck, breasts, bite marks) for DNA and saliva
  • Clothing — the clothes worn at the time of the assault should be collected separately, placed in paper bags (not plastic — plastic degrades biological evidence), labelled, and sealed
  • Pubic hair combings and clippings — for trace evidence including pubic hair from the assailant
  • Nail scrapings — if the survivor scratched the assailant, fingernail scrapings may contain the assailant's DNA
  • Blood sample — for DNA typing, and for toxicology if drug-facilitated assault is suspected
  • Urine sample — for drug screen in suspected drug-facilitated assault
  • Pregnancy test

Every sample must be labelled with the patient's name/reference number, the type of sample, the body site, date and time of collection, and the collector's name. Samples must be sealed in front of the collecting officer and the chain of custody form completed and signed at each transfer. When samples are handed to the police, a receipt must be obtained and retained in the clinical record.

Medical Care: Not Just Evidence Collection

The examination is also a medical consultation, and the survivor's immediate health needs must not be subordinated to evidence collection. The MoHFW guidelines specify the following care to be offered at first contact:

  • Emergency contraception: Levonorgestrel 1.5mg (or ulipristal acetate) should be offered and provided if within 72–120 hours of the assault, with counselling about efficacy and the option of intrauterine device insertion if preferred
  • STI prophylaxis: Empiric prophylaxis against gonorrhoea, chlamydia, trichomoniasis, and HIV PEP (post-exposure prophylaxis within 72 hours) should be offered as per the national guidelines
  • Hepatitis B prophylaxis: If the survivor is unvaccinated
  • Wound care and tetanus prophylaxis: For any injuries
  • Psychological first aid: The survivor should be offered basic psychological support, information about available counselling services, and a referral to a rape crisis centre or psychological support service where available

What the Medical Report Should and Should NOT Say

The medical report submitted to the police (and potentially used in court proceedings) has strict rules about what it must contain and what it must not say.

What the Report Must Include

  • A description of all injuries — their location, nature, size, and approximate age
  • A description of findings on anogenital examination — what was observed, without characterising its significance
  • A record of samples collected and handed to the police, with chain of custody details
  • Results of immediate tests (pregnancy test, any point-of-care tests)
  • Treatment provided
  • The examining doctor's registration number and signature

What the Report Must NOT Say

  • Whether sexual assault occurred: This is the court's determination, not the doctor's. The report documents findings; it does not conclude on the ultimate question of whether the offence was committed.
  • Anything about "habituation": As held in the two-finger test judgment, references to a survivor being "accustomed to sexual intercourse" or having "an old hymenal tear" as evidence of prior sexual activity are prohibited and have no place in the report.
  • Opinions on the survivor's credibility: The doctor's role is clinical, not evaluative. Whether the history is "consistent with" the injuries is a factual observation; whether the survivor is telling the truth is not a medical opinion.

The MLR Proforma and Confidentiality

The Medico-Legal Report (MLR) proforma for sexual assault cases is standardised under the MoHFW 2022 guidelines. Completed MLRs are submitted to the SJPU or local police, and to the court if directed. They are not provided to the media, to the survivor's family without her consent (in the case of an adult survivor), or to any unauthorised person.

Confidentiality obligations under the NMC Code of Medical Ethics apply. Any disclosure of a survivor's identity — even inadvertently — may constitute a violation of Section 228A IPC (now equivalent BNS provision), which prohibits the disclosure of a rape victim's identity.

Conclusion: The Doctor's Role Is Both Medical and Legal

Sexual assault medical examinations sit at the intersection of urgent medical care and serious criminal justice. A doctor who understands the legal framework — who knows what to do, what not to do, what to collect, and what not to say — provides both better care to the survivor and better evidence to the court. Conversely, a doctor who performs the prohibited two-finger test, fails to report a child victim's assault, or renders a court-usurping opinion on whether assault occurred, does a disservice to the survivor and faces professional and legal consequences.

If you are a medical officer with questions about sexual assault examination protocols, or you have received a legal notice related to such an examination, contact our medico-legal team for expert guidance.