Implications of Genital Mutilation at Autopsy

Gender Identity in Forensic Death Investigation: A Narrative Review and Suggested Guidelines for Documenting and Reporting

ABSTRACT

In the current body of forensic literature, there is little guidance available regarding death investigations of transgender, intersex, and gender diverse individuals. An increase in the prevalence of gender diverse identifying people and the frequency in which these individuals experience a premature death makes it more likely these deaths will fall under the jurisdiction of the medical examiner's office. The inability to navigate these diverse cases due to a lack of training, education, and support may leave forensic professionals without the tools needed to accurately represent these deaths.This narrative review is intended to provide the foundational knowledge needed by forensic death investigators when investigating gender identity in death, including suggested guidelines for a more effective and empathetic death investigation. A better understanding of the implications and applications of this information when included in reports will bolster the quality and quantity of the data reported and collected. This will lead to more accurate monitoring and reporting of violent, suicidal, and homicidal deaths of transgender, intersex, and other gender diverse individuals, and a higher identification rate of unidentified remains with gender diverse markers.

Female genital mutilation - An overview for forensic practitioners

Female genital mutilation (FGM) refers to all procedures that partially or totally remove the external female genitalia, or to all other deliberate injuries to the female genital organs for non-medical reasons. It is thought that over 200 million girls and women have had some form of FGM, with more than three million girls being at risk annually. The procedure varies in severity from partial or complete removal of the clitoris (Type 1) to oversewing of the vaginal opening, so-called infibulation (Type 3). There are no medical benefits from FGM, with complications increasing with the amount of tissue damage that has been inflicted. Side effects may be psychological and physical including excessive scarring, pain, infections, sexual dysfunction with significant obstetrical complications such as fistulas and increased risks of stillbirth, as well as increased neonatal and maternal morbidity and mortality. Although primarily originating in countries in Africa, the Middle East and Asia, mass migrations in recent years have made FGM a feature in most societies. For this reason, forensic practitioners and pathologists should be aware of the anatomical features of FGM and the potential medical and psychological side effects. Accurate recording of cases is required to enable appropriate resources to be allocated for instituting preventive measures.

Postmortem predation by a clowder of domestic cats

A 69-year-old man was found lying on the floor at his home address. According to the police report every room was filled with refuse and "thirty or so cats" were resident in the house. The body showed signs of extensive post mortem animal predation with opening of the chest and abdominal cavities, loss of soft tissues of the face, loss of soft tissues and organs of the neck, loss of the lungs and heart, and injuries to the liver, right kidney, stomach, transverse colon and cecum. The cause of death could not be determined from the autopsy given the absence of certain vital organs such as the heart and lungs, and the presence of early putrefaction. The case shows that considerable soft tissue, bone and organ loss may occur when a number of animals work in concert. The collective term for such a group of cats is a clowder. The extent of post-mortem damage from animal activity therefore relies not only on the species involved, but also the numbers of participating animals.

An unusual pattern of post-mortem injury caused by Australian fresh water yabbies (Cherax destructor)

A 67-year-old woman with a history of previous cerebrovascular accidents who was confined to a wheel chair drowned in a pond in a public park. Features compatible with drowning included congestion and edema of the lungs with prominent hemolytic staining of the intima of the aortic root. Minor bruises and abrasions were identified. Toxicology was negative. An additional unusual finding was that of patterned symmetrical injuries to the earlobe and pinna of both ears. The injuries consisted of small irregular areas of skin loss that were sometimes linear and parallel and had the appearance of animal nibble marks. Given the presence in the pond of numerous Australian fresh water yabbies (Cherax destructor), and no other predators, it appeared that the injuries had been caused by post mortem feeding by these crustaceans. This case therefore extends the range of animals that may be involved in post mortem predation that may be encountered in cases of freshwater drowning/immersion in an Australian context, with a specific pattern of injury focused on the ear lobes.

Penile carcinoma - a rare cause of sudden death

Penile carcinoma is an uncommon but potentially mutilating disease with a heterogeneous etiology. We present a case in which a man died due to severe blood loss from an amputated penis. It was initially regarded as a violent death with an external cause. Autopsy found irregular defects with smooth edges in the external genital area and on both sides of the groin, with yellowish-gray callus-like structures and dried blood at the base of where the penis would have been located. Histological examination revealed the presence of squamous cell carcinoma with signs of keratinization. Subsequent investigation, along with information from the autopsy, revealed that the man suffered from penile carcinoma, thus death was attributed to exsanguination from an ulcerated femoral artery in a patient with penile carcinoma.