A/HRC/13/39/Add.5 53. A distinct category of torture which I also raised in one of my earlier reports to the Human Rights Council is sexual violence.29 Rape and other sexual forms of abuse are intended to violate the dignity of the victim in a very specific manner. Beyond the actual physical pain, sexual violence results in severe psychological suffering and leaves most victims traumatized for very long periods of time. While the overwhelming majority of victims of sexual violence are undoubtedly women, I encountered cases where male detainees had been sexually abused in several countries. The fear of stigmatisation and feeling of shame makes both women and men reluctant to speak out about their illtreatment. 54. Most of the torture methods I encountered leave clearly visible traces, which I also take as an indication that the actual perpetrators were entirely sure that they would not be held accountable and therefore did not make any effort to conceal the ill-treatment of their victim. At the same time, there is an increasing variety of torture methods applied with the intent not to leave any visible physical traces. These methods comprise inter alia the exposure to extreme temperatures, stress positions, beatings with sand-filled plastic bottles, shaking or submersion in water. The increased use of these methods calls for the strengthened and increased availability of forensic medical expertise in places of detention and in the overall efforts to combat torture. Forensic medical science allows torture allegations to be corroborated and is instrumental in countering the emerging loopholes facilitating impunity. The Istanbul Protocol (Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment) of 1999 set an indispensable standard in this regard.30 55. The establishment of psychological torture methods is a particular challenge. Mock executions, sleep deprivation, the abuse of specific personal phobias, prolonged solitary confinement, etc. for the purpose of extracting information, are equally destructive as physical torture methods. In most cases, victims of mental abuse are left dependant on counselling and other psychological or psychiatric support for long periods of time. Moreover, their suffering is very often aggravated by the lack of acknowledgement, due to the lack of scars, which leads to their accounts very often being brushed away as mere allegations. 56. When it comes to the prevalence of certain specific torture methods, it appears noteworthy that certain methods were regularly applied all over a country or by specific units, such as anti-terrorism units. Such patterns suggested that some form of “torture training”, whether formal or informal, must have been provided. This, in turn, is a strong indication that torture is not limited to isolated cases but inflicted in a routine if not systematic manner. 57. Furthermore, the persistence of torture methods over time is an instructive criterion for evaluating the success or failure of attempted reforms of the criminal justice system and other sectors. A number of countries I visited had undergone a political transformation during recent years, moving from an autocratic regime to democracy. Nevertheless, in several cases, the same torture methods were applied as during the earlier regime, suggesting that reforms had not sufficiently penetrated the work of, for example, ordinary law enforcement agents. 29 30 18 A/HRC/7/3. HR/P/PT/8/Rev.1