Against Our Will: Men, Women and Rape (Brownmiller, 1975) provided a historical perspective and discourse on the nature, breadth, and scope of sexual assault. Later articles on motivational models for sexual homicide were consistent in their discussions related to the dearth of information on the number of rape-murders committed. This is due to the fact that these are treated solely as homicides by both law enforcement and the courts.

An epic example of the complex issues involved in sexual homicide was the 1964 murder of Kitty Genovese. Kitty was stalked, raped, and murdered in Queens, New York City. Thirty-eight people heard her cries or witnessed some part of her death. While in court, the defendant, 29-year-old Winston Moseley, calmly announced, “I just set out to find any girl that was unattended and I was going to kill her” (Brownmiller, 1975, p. 199).

The famed Boston Strangler, Albert DeSalvo, strangled and stabbed 11 women between June 1962 and January 1964, including elderly victims. DeSalvo left their sexually mutilated bodies posed garishly, with a nylon stocking around the victim’s neck (Brownmiller, 1975, p. 200). The murders stopped in 1964, when DeSalvo was hospitalized in Bridgewater State Hospital for observation. DeSalvo also operated as the “Cambridge Measuring Man” and “Green Man”. As “Measuring Man,” he gained entrance to young girls’ apartments by posing as the representative of a model agency. DeSalvo would “measure” their breasts and hips. As “Green Man,” he tied his victims to the bed; he then either raped or sodomized them or attempted to do so. DeSalvo gave indications of the sexual dysfunction of premature ejaculation. The charge that sent him to prison was breaking and entering (Brownmiller, 1975, p. 201). When later asked about a 75-year-old female victim, he replied, “Attractiveness has nothing to do with it. She was a woman. When this certain time comes on me, it’s a very immediate thing” (Brownmiller, 1975, p. 205).

Research on sexual murderers suggests that these crimes are based on persistent, violent sexualized thoughts and fantasies (Ressler, Burgess, & Douglas, 1988). Therefore, the meaning and performance of acts committed during a murder vary with the offender. The sexual acts may vary from actual rape (with penetration before, during, or after death) to symbolic acts, which may include the insertion of foreign objects into body orifices of the victim (Douglas, Burgess, Burgess, & Ressler, 1992).

Following are typologies of rapists from the perspective of criminal investigative analysis , a program of the National Center for the Analysis of Violent Crime (NCAVC) of the Federal Bureau of Investigation (FBI).

Before the actual autopsy, the clarification of individual roles and responsibilities is essential. There are unavoidable areas of potential overlap, including the collection of clothing, photography, documentation of nongenital trauma, and the collection of samples from potential bite marks (Crowley, AAFS, 1998). Although a FNE may routinely collect, examine, package, and document clothing for a living sexual assault victim, this may or may not be the routine for a particular medical examiner’s/coroner’s (ME/C’s) office. For the postmortem milieu, creation of checklists for team members is a pragmatic way to ensure that someone with the appropriate skill level is attending to all the tasks at hand. Unlike the procedure followed with the antemortem patient, the opportunity to reexamine (i.e., return for an additional follow-up examination) is rare. The forensic nurse may be in an advantageous position to provide overview of this process or at least ensure that the role she or he has undertaken is symbiotic and efficacious with other members of the homicide team.

As an example of potential role overlap, if a forensic odontologist is not readily available, the FNE may collect saliva samples or provide castings of a potential bite mark. If at all possible, the FNE will conduct the genital examination and collect biological specimens before the forensic pathologist conducts the general autopsy. However, there are instances where the autopsy has already been performed and the nurse examiner is consulted afterward. Flexibility is essential.

The anogenital examination should be preceded by a preliminary overview of the body by the forensic pathologist, with notation of gross features, such as clothing, general physical status, grossly apparent nongenital trauma, and other findings. The genital examination can then include prompt collection of biological specimens. It also avoids obscuring the genital area “field” by leakage of body fluids through the vaginal opening (Crowley, AAFS, 2003).

Set up a work area before the examination begins. Although this step seems obvious, some jurisdictions do not have a centralized morgue. In some cases, private mortuaries are used to conduct the actual autopsy. Space may be limited. If sufficient counter space is not available, a spare gurney may be covered with paper drapes or even personal protective gowns to use as a workstation. In addition to the usual, customary supplies used during an antemortem examination, the postmortem milieu brings to the stage a new set of ubiquitous factors and considerations (Table 20-1).

Open a sealed sexual assault evidence kit (Fig. 20-1). Arrange items in the anticipated order of collection. If a Lucite air-drying box is available, swabs and slides can be lined up, in slots prelabeled or marked with a pencil/slide marker to indicate each body cavity or anatomical site of collection. A 10% bleach solution should be available to disinfect the swab-drying box between patients, to avoid cross-contamination of DNA.

Note both on the form and on the evidence kit which law enforcement agency is investigating the case. This case number often serves as the case identifier for evidentiary samples, photographs, and documentation forms. Some case data, such as the cause and manner of death, should always be verified with the forensic pathologist, and this information can be completed after it is available.

In the process of documentation, the following items should be indicated:

Document any identifying information available at the time of the postmortem anogenital examination. Also describe the general appearance of the body at the time of the discovery of the decedent. There is often a scarcity of information available at the initial point in the investigation. However, the FNE can document the need to review the medical history, when available (Crowley, 2004). Where information is missing or unknown, indicate as such. Examiners should try to record the following:

If information and records are available, the examiner should glean as much as possible about the victim’s prior health and lifestyle. Document the source of the data.

Document the physical condition in which the body was found. After consultation with the forensic pathologist, note the following:

The examiner may assist or collect any clothing found on or with the body. Items of clothing may be evaluated relative to particular features of the crime. Examples are tears in clothing that may correspond to wounds on the victim’s body, weapon use, or undergarments that are on backward/inside out. Observe for tears, rips, stains, and overt foreign matter. Backlighting of clothing items can also be incorporated.

If the clothing is still on the patient at the time of the nurse examiner’s arrival, the nurse should place two sheets of examination paper on the floor. This will permit collection of bits/particles of trace evidence or debris, which may fall out when the clothing is removed from the body. Avoid shaking clothing items or folding garments across a stain. Collect debris, fibers, and any foreign material; inspect and package the clothing over the protective sheets of paper, reviewing each clothing item. It may be helpful to scan items, especially underpants, with a light source (e.g., a Wood’s lamp or an alternate light source). Salient items may be photographed.

Using paper bags, package items of clothing separately. Ascertain if any bed linens/bedding were collected from the scene, if appropriate. Itemize and provide a brief description of the items on the outside of the paper bag; this should ideally be done before inserting them into the bag. Note obvious tears, stains, or other marks on the paper evidence bag and label accordingly. The top sheet of paper used for protection from contamination by the floor should be packaged into a separate, labeled bag/bindle. The bottom sheet(s), directly in contact with the morgue floor, should be discarded.

Depending on local protocol, the nurse examiner may either assist with collection of these specimens or simply note that they were collected by the ME/C staff. All of the vitreous humor and urine are collected with a clean needle and new syringe.

In some cases, and depending on local protocol, the HIV status of the decedent may be requested. The local public health department may request serology after accidental exposure to blood or body fluids by emergency first responders. To satisfy this request, an extra red-top tube of peripheral blood can be obtained during the autopsy. This tube can be spun down in the morgue laboratory; the decanted serum is saved. This serum would then be submitted to the pubic health laboratory for HIV testing (Peterson, 2009).

Any wounds and body cavities should be inspected for obvious signs of debris, trace evidence, or body fluids. The entire body can be scanned for suspicious stains or fluorescence. Darken the room and scan the entire body using either a Wood’s lamp or alternate light source. If an alternate light source is not available, a Wood’s lamp is still considered a useful adjunct for general scanning to help discern potential stains and guide the collection of evidentiary swabs (Golden, 2008).