30 A practical guide to the Istanbul Protocol – for medical doctors V. OPTHALMOLOGICAL Acute eye symptoms in torture survivors are conjunctivitis, probably caused by dirty cloths used for blindfolding, which the victims often have to wear for many days and nights on end. Very few long-lasting eye symptoms that are possibly related to tor- ture have been described. Perron-Buscail, Lesueur, Chollet, and Arne (1995) observed opacities in the cornea 10 years after electric torture in the eyes, influencing the vision. (See also § 178 in the Istanbul Protocol.) VI. GYNAECOLOGICAL EXAMINATION Throughout history, sexual harassment of women has been a weapon of war and power (Axelsen & Sveaas, 1994). In many countries, acts of sexual violence are a common method of torture or inhuman treatment inflicted on women (Amnesty International, 2001). It is found that female victims of torture are raped more often than men, although men are also frequently subjected to rape (Allodi & Stiasny, 1990). Gender-based and sexual violence is frequently a hidden problem. Women of any age may be raped, including women over 60 years of age or children (WHO, 1996). It must be emphasised that gender-based violence and rape may be only one among many traumas that women have suffered, and that physical consequences are often accompanied by psychological and social consequences. The impact of gender-based abuse on physical health may be immediate and long-term. However, women who are abused rarely seek medical care for acute trauma (PATH, 2002). Barriers for seeking medical care may be reduced by ensuring a sufficient number of female health care workers, and by training health professionals working with refugees and torture victims to recognise victims of sexual violence and rape. It is important to allow the victim sufficient time to disclose the trauma (Shanks & Schull, 2000). Before gynaecological examination, the purpose of the examination should be clear: is it to identify treatment needs or is it to document alleged sexual abuse? In the case of documentation of human rights abuses for legal purposes, it is essential to collect detailed information. It is important that the alleged victim gives her informed consent. When examining victims of sexual violence, every precaution should be taken to minimise retraumatisation. A safe and confidential environment should be ensured. Cultural differences, religion and traditional beliefs may affect the meaning given to experiences, the symptoms expressed, and how people cope with the violent experiences (Kane, 1995).