KEJAHATAN

SEKSUAL
dr. Farah Primadani Kaurow, SpFM
PJJ FK YARSI
2021
 Definition

Sexual assault can be any sexual behaviour or act which is threatening,

violent, forced, coercive or exploitive and to which a person has not
given consent or was not able to give consent.

• The sexual penetration of another person;

• Without the person’s consent.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 1. Pemerkosaan
2. Pelecehan seksual
BENTUK- 3. Eksploitasi/ perdagangan seksual
4. Eksploitasi seksual
BENTUK 5. Pemaksaan aborsi
KEKERASAN 6. Pemaksaan perkawinan
SEKSUAL? 7. Penyiksaan seksual
8. Intimidasi seksual
9. Pemaksaan kontrasepsi

- Kekerasan Seksual di Indonesia: Data, Fakta, & Realita. 2016

- GUIDELINES FOR MEDICO-LEGAL CARE FOR VICTIMS OF SEXUAL VIOLENCE. WORLD HEALTH ORGANIZATION GENEVA. 2003
 Penetration of the vagina
(including the labia
majora), anus or urethra of
any person with any part
of the body of another
Sexual person or any object
manipulated by another
Penetration? person;
Sexual penetration is
established by any of
the following: Introducing any part of the
penis of a person into the
mouth of another person;
SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
Manipulating any part of the
body of another person so as
to cause penetration of the
vagina (including labia
majora), anus or urethra of
the offender;
Engaging in cunnilingus or
fellatio — whether the vagina
is penetrated or not, or
whether the penis enters the
mouth or not
 Consent…??
• Consent means a consent freely and voluntarily given.
• Consent is not freely and voluntarily given if it is obtained by force, threat,
intimidation, deceit or any fraudulent means.
• Furthermore, a failure to offer physical resistance does not of itself constitute
consent.
• A child under the age of 13 years is incapable at law of consenting to an act which
constitutes an offence against the child

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 Sexual assault is not a medical
diagnosis

It is a crime that can be reported to and

investigated by the police, and the outcome
(in terms of a conviction) is ultimately
determined by a Jury or in some cases a
Judge in a Court of Law.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 Incidence/ Prevalence…??

It is difficult to gauge an
accurate incidence and
prevalence of sexual assault.

A number of methods, each

with their own limitations, are
used including official crime
statistics and victimisation and
community prevalence surveys.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 IMPORTANT NOTE…!!
• Although sexual assault occurs more frequently in females, males are also victims
of sexual assault.
• In over half of the female sexual assaults, the offender is known to the victim.
• Adolescents and women under 25 years of age are most at risk of sexual assault.
• The majority of people do not report the sexual assault to the police.
• Not all people who have been sexually assaulted seek medical attention.
• The prevalence of sexual assaults appears to be greater in vulnerable individuals
or marginalised groups, for example in people with disabilities.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 DELIK SUSILA DALAM UNDANG-
UNDANG
Dari Undang-Undang dalam KUHP, dapat dikelompokkan 4 macam persetubuhan
di luar perkawinan yang dilarang dan diancam pidana penjara, yaitu:
- Perzinahan
- Perkosaan
- Persetubuhan dengan wanita yang pingsan atau tidak berdaya, dan
- Persetubuhan dengan wanita yang umurnya belum cukup lima belas tahun.

KITAB UNDANG-UNDANG HUKUM PIDANA

 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP Pasal 284

1. Diancam dengan pidana penjara paling lama sembilan bulan:

a. seorang pria yang telah kawin yang melakukan gendak (overspel), padahal
diketahui bahwa pasal 27 BW berlaku baginya,
b. seorang wanita yang telah kawin yang melakukan gendak, padahal diketahui
bahwa pasal 27 BW berlaku baginya;
2. Tidak dilakukan penuntutan melainkan atas pengaduan suami/istri yang
tercemar, dan bilamana bagi mereka berlaku pasal 27 BW, dalam tenggang
waktu tiga bulan diikuti dengan permintaan bercerai atau pisah-meja dan
ranjang karena alasan itu juga.
KITAB UNDANG-UNDANG HUKUM PIDANA
 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 285

• Barang siapa dengan kekerasan atau ancaman kekerasan memaksa

seorang wanita bersetubuh dengan dia di luar perkawinan, diancam karena
melakukan perkosaan dengan pidana penjara paling lama dua belas tahun.
KUHP pasal 286

• Barang siapa bersetubuh dengan seorang wanita di luar perkawinan,

padahal diketahui bahwa wanita itu dalam keadaan pingsan atau tidak
berdaya, diancam dengan pidana penjara paling lama sembilan tahun.­
KITAB UNDANG-UNDANG HUKUM PIDANA
 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 287

1. Barang siapa bersetubuh dengan seorang wanita di luar perkawinan,

padahal diketahuinya atau sepatutnya harus diduganya bahwa umurnya
belum lima belas tahun, atau kalau umurnya tidak jelas, bahwa belum
waktunya untuk dikawin, diancam dengan pidana penjara paling lama
sembilan tahun.
2. Penuntutan hanya dilakukan atas pengaduan, kecuali jika umur wanita
belum sampai dua belas tahun atau jika ada salah satu hal berdasarkan pasal
291 dan pasal 294.

KITAB UNDANG-UNDANG HUKUM PIDANA

 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 288

1. Barang siapa dalam perkawinan bersetubuh dengan seorang wanita yang

diketahuinya atau sepatutnya harus diduganya bahwa yang bersangkutan
belum waktunya untuk dikawin, apabila perbuatan mengakibatkan luka-
luka diancam dengan pidana penjara paling lama empat tahun.
2. Jika perbuatan mengakibatkan luka-luka berat, dijatuhkan pidana penjara
paling lama delapan tahun.
3. Jika mengakibatkan mati, dijatuhkan pidana penjara paling lama dua belas
tahun.

KITAB UNDANG-UNDANG HUKUM PIDANA

 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 289

Barang siapa dengan kekerasan atau ancaman kekerasan memaksa

seorang untuk melakukan atau membiarkan dilakukan perbuatan
cabul, diancam karena melakukan perbuatan yang menyerang
kehormatan kesusilaan, dengan pidana penjara paling lama sembilan
tahun.

KITAB UNDANG-UNDANG HUKUM PIDANA

 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 290

Diancam dengan pidana penjara paling lama tujuh tahun:

1. barang siapa melakukan perbuatan cabul dengan seorang, padahal diketahuinya bahwa
orang itu pingsan atau tidak berdaya;
2. barang siapa melakukan perbuatan cabul dengan seorang padahal diketahuinya atau
sepatutnya harus diduganya, bahwa umumya belum lima belas tahun atau kalau
umumya tidak jelas, yang bersangkutan belum waktunya untuk dikawin;
3. barang siapa membujuk seseorang yang diketahuinya atau sepatutnya harus diduganya
bahwa umurnya belum lima belas tahun atau kalau umumya tidak jelas yang
bersangkutan atau kutan belum waktunya untuk dikawin, untuk melakukan atau
membiarkan dilakukan perbuatan cabul, atau bersetubuh di luar perkawinan dengan
orang lain.
KITAB UNDANG-UNDANG HUKUM PIDANA
 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 291

1. Jika salah satu kejahatan berdasarkan pasal 286, 287, 289, dan 290
mengakibatkan luka-luka berat, dijatuhkan pidana penjara paling
lama dua belas tahun;
2. Jika salah satu kejahatan berdasarkan pasal 285, 286, 287, 289 dan
290 mengakibatkan kematian dijatuhkan pidana penjara paling lama
lima belas tahun.

KITAB UNDANG-UNDANG HUKUM PIDANA

 DELIK SUSILA DALAM UNDANG-UNDANG

KUHP pasal 292

Orang dewasa yang melakukan perbuatan cabul dengan orang lain

sesama kelamin, yang diketahuinya atau sepatutnya harus diduganya
belum dewasa, diancam dengan pidana penjara paling lama lima tahun.

KITAB UNDANG-UNDANG HUKUM PIDANA

 UNDANG-UNDANG
PERLINDUNGAN ANAK
PR buat kalian yah….
UNDANG-UNDANG
PKDRT
PR buat kalian yah….
 Korban tidak membawa SPV…??

Korban tidak mau dilakukan

Seandainya… visum…??

Korban/ keluarga korban tidak mau

melaporkan ke kepolisian...??
KEPENTINGAN
FORENSIK

1. Mencari tanda-tanda
kekerasan
2. Mencari tanda
persetubuhan (adanya
sperma/ mani; kehamilan;
IMS)
 Pemeriksaan terhadap
korban Seksual
1. Setting/ Place
2. Time
3. Healthcare provider
4. Ethical issues (Autonomy,
beneficence, non-maleficence, justice)
5. Local policies and laws  Surat
Permintaan Visum dari Kepolisian
6. Inform Consent  this is important!!

- GUIDELINES FOR MEDICO-LEGAL CARE FOR VICTIMS OF SEXUAL VIOLENCE. WORLD HEALTH ORGANIZATION GENEVA. 2003
 Kapan meminta consent??
Consent is obtained for each of the following aspects:

• Physical examination. • Hepatitis B

• Genital examination. vaccination/immunoglobulin.
• Photographs. • Verbal report to police.
• Collection of medical specimens. • Release of forensic specimens to
police.
• Collection of forensic specimens.
• Medicolegal report to police.
• Collection of forensic toxicology
specimens.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 Forensic History

ANAMNESA Medical History

Past Events
 FORENSIC HISTORY
5W1H+  What, When, Where, Who, Why ----- How?

1. What  kejadiannya apa saja? Penetrasi? Dicium? Diraba? Pakai penis/ alat? Berapa kali
kejadian?
2. When  waktunya kapan? Penting u/ pengambilan sampel
3. Where  lokasi kejadian?
4. Who  siapa pelakunya? Berapa orang??
5. How  Riw ancaman/ bujuk/ kekerasan ?? Diberi minuman/ makanan yang membuat pingsan/
tidak berdaya? Riw penggunaan kondom? Penetrasi di dalam/ di luar vagina?? Riw douche
setelah kejadian?
6. +  keluhan yang dirasa setelah kejaidan dan saat pemeriksaan?
keluhan  tidak hanya fisik, tp tnyakan psikis dan lain2
 Riw Haid/ Riw melahirkan/ Riw kontrasepsi
 MEDICAL HISTORY
Health consequences
• The health consequences of sexual violence are numerous and varied, and
include physical and psychological effects, both in the short-term and in the long-
term.
• Most significantly perhaps, sexual abuse can have devastating long-term
psychological effects, influencing and radically altering a person’s entire life
course.
Physical consequences

• Individuals who have experienced sexual assault may suffer a range of physical injuries,
genital and non-genital, or in extreme cases, death.
• In addition, rape victims are at an increased risk from:
— unwanted pregnancy;
— unsafe abortion;
— sexually transmitted infections (STIs), including HIV/AIDS;
— sexual dysfunction;
— infertility;
— pelvic pain and pelvic inflammatory disease;
—urinary tract infections.
Physical consequences

• Genital injuries in women are most likely to be seen in the posterior fourchette, the
labia minora, the hymen and/or the fossa navicularis.
• The most common types of genital injuries include:
— tears;
— ecchymosis (i.e. bruising);
— abrasions;
— redness and swelling.
Physical consequences

Non-genital physical injuries typically include the following:

• bruises and contusions;
• lacerations;
• ligature marks to ankles, wrists and neck;
• pattern injuries (i.e. hand prints, finger marks, belt marks, bite marks);
• anal or rectal trauma.
Psychological consequences

Just as there is no typical victim, there is no typical reaction to the experience of sexual violence;
psychological effects vary considerably from person to person.
• rape trauma syndrome;
• post-traumatic stress disorder;
• depression;
• social phobias (especially in marital or date rape victims);
• anxiety;
• increased substance use or abuse;
• suicidal behaviour
GUIDELINES FOR MEDICO-LEGAL CARE FOR VICTIMS OF SEXUAL VIOLENCE. WHO. 2003
 PAST EVENTS

• Adakah riwayat kejadian serupa sebelumnya?

• Dengan pelaku yang sama?
• Berapa kali?
• Pakai pengaman?
• Riwayat kehamilan?
• Riwayat aborsi?
 PEMERIKSAAN FISIK
STATUS GENERALIS PEMERIKSAAN PEMERIKSAAN ANAL
- TTV KELAMIN
- Pem gigi (anak) - Lubang anal
- Seks sekunder - Vulva, labia mayor, labia - Lipatan-lipatan anal
minor
- Cari perlukaan (head to - Kekuatan otot anal
Toe) - Hymen
- Darah/ lendir
- Cari tanda seksualitas - Vagina/ serviks/ uterus
(bibir, leher, payudara, paha - Luka baru
bag dalam) - Luka lama
- Pem lain sesuai indikasi
 PEMERIKSAAN LAB FORENSIK

PEMERIKSAAN KE DOKTER
SPESIALIS
PEMERIKSAAN
PENUNJANG
PEMERIKSAAN PENUNJANG LAB

PEMERIKSAAN RADIOLOGIS
 FORENSIC SPECIMEN COLLECTION

Vulval gauze wipe taken

Oral swab, smear and by the patient +/- smear Urine for
First void urine
rinse performed by the doctor toxicology
or nurse

Blood for toxicology — only Peri-anal gauze wipe

obtained if a qualified health taken by the patient +/- Skin swabs and
practitioner is available to smear performed by the smear Clothing
collect blood sample. doctor or nurse.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 KONSUL SPESIALIS
Bersifat kasuistik
Sesuai indikasi  tiap korban akan meiliki kebutuhan yang berbeda-beda

- Konsul obsgyn
- Konsul Anak
- Konsul Kulit-Kelamin
- Konsul Psikiatri
- dll
 If there is a risk of pregnancy from the assault, Postinor
1 (levonorgestrel) can be given as a single dose of 1.5
milligrams, up to 72 hours after the sexual assault.

This does not increase the frequency of side effects

such as nausea and vomiting.
Emergency
Contraception..? The efficacy of Postinor 1 decreases with time so
treatment should be given as soon as possible
following unprotected sexual intercourse.

If given within 24 hours, 95% of expected pregnancies

will be prevented, within 24–48 hours, 85% prevented
and within 49–72 hours, 58% prevented.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 The copper-containing intrauterine device was first described in
1976 for use as an emergency contraceptive agent. It is very
effective with studies showing 99.8% to 99.9% of expected
pregnancies prevented. It is a method of emergency contraception
that could be considered if it has been more than 72 hours since
the sexual assault

Emergency Mechanism of action — copper ions are released, which

decrease egg and sperm motility and survival and also act
Contraception..? on the endometrium to inhibit implantation.

Side effects — infection, perforation,

dysmenorrhoea, menorrhagia

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 Sexual Transmitted Disease…??
• Baseline sexually transmitted infection screening.
• Prophylactic antibiotic treatment.
• Follow up sexually transmitted infection screening at one month and three
months.
• Follow up at six months may be considered for follow up of Hepatitis C serology.

SARC Medical and Forensic Manual. Government of Western Australia, Dept of health
 Sexual violence can thus be regarded as a global problem, not only in the geographical
sense but also in terms of age and sex.

GUIDELINES FOR MEDICO-LEGAL CARE FOR VICTIMS OF SEXUAL VIOLENCE.

GENDER AND WOMEN’S HEALTH, FAMILY AND COMMUNITY HEALTH INJURIES AND VIOLENCE PREVENTION, NONCOMMUNICABLE DISEASES AND MENTAL HEALTH
WORLD HEALTH ORGANIZATION GENEVA. 2003
 Next Learning

1. Pemeriksaan selaput dara

2. Pemeriksaan anal
3. Pem lab forensik untuk kasus seksual
4. Pengambilan sampel forensic untuk kasus seksual
 Terima kasih
dr. Farah Primadani Kaurow, SpFM
farahkaurow@gmail.com
0813-8110-9581