containing gamezán to suffocate him [...] [and that] he had problems defecating [...]”.149 The mother of the alleged victim also indicated that when she went to visit her son at the penitentiary center five days after his capture, he told her that they "beat him in the ribs" and put something in his rectum.150 191. In addition, the body of evidence provided in this case includes three reports prepared by doctors made seven years after the alleged torture suffered by Mr. Valenzuela in May 1998. Two of them were submitted during the proceedings before the Commission. In the first place, the medical certificate of Edna Karina Vaquerano Martínez, issued on June 15, 2005, in which she concluded that Mr. Valenzuela “present[ed] a mental examination consistent with a person who has experienced torture, abuse and violence”.151 Second, the psychological expert opinion of Juan Cristóbal Aldana Alfaro, in which he concluded that “Tirso shows the characteristics of a tortured person both from a physical and psychological point of view”, showing “metabolic changes and somatic disorders […] sexual dysfunctions that are common in tortured people, especially those who have suffered sexual torture or rape”. 152 However, in light of these reports, there is evidence of the medical examination issued on February 25, 2005 by Carlos Guillermo Quijada Sandoval, coordinator of the Medical Services of the Penitentiary System, in which he concluded the opposite, since it established that “the physical and mental state of the patient does not present any evidence of aggression or physical mistreatment”153, and it was stated in response to a question put to the alleged victim, that on the date of the medical examination, Mr. Valenzuela stated “he had not suffered any aggression or mistreatment.” In addition, although said doctor describes the emotional state of the alleged victim, it does not appear that he performed a psychological or psychiatric examination. 192. This Court recalls statements in its existing case law regarding “the absence of physical signs does not mean that ill-treatment has not occurred, because these acts of violence against the individual often do not leave permanent marks or scars."154 In accordance with the foregoing, the Court considers it relevant to assess the medical and psychological certificates issued on June 15, 2005 by Mrs. Vaquerano Martínez and Mr. Aldana Alfaro, which are consistent with the account of the victim himself and the other witnesses and relatives who saw him, while they conclude that Mr. Valenzuela, due to his mental and psychological condition, “exhibits characteristics of a tortured person 193. Based on the foregoing, it is proven that Mr. Valenzuela suffered a series of acts of violence during his detention, when he was in the custody of the State. Therefore, it is up to this Court to determine whether said acts constituted torture and sexual violence in light of Article 5(2) of the Convention, and the case law of the Court, through the analysis of whether the act was: (i) an intentional act; (ii) caused severe physical or mental suffering, and if it (iii) was committed with a given aim or purpose.155 194. Regarding the first and third elements, it has been proven that on May 27, 1998, Mr. Valenzuela Ávila was subjected to different acts of violence deliberately carried out by state agents, in order to obtain information about the death of the prosecutor SJR. Regarding the second element, it is proven that Mr. Valenzuela received a series of blows, suffocation and Statement made by Mrs. Rosa María Mendoza López on May 22, 2004 (file of annexes to the Merits Report, annex 2, fs. 115 to 116). 150 Statement made by Mrs. Florinda López de López at the public hearing before the Court on March 7, 2019. 151 Medical report of Edna Karina Vaquerano Martínez, supra. 152 Psychological expert opinion rendered by Juan Cristóbal Aldana Alfaro, supra. 153 Note from Doctor Carlos Guillermo Quijada Sandoval to the General Director of the Guatemalan Penitentiary System on February 28, 2005 (file of annexes to the Merits Report, annex 10, fs. 170 to 173). 154 Cf. Case J. v. Peru, supra, para. 329, and Case of Favela Nova Brasilia v. Brazil, supra, para. 249. 155 Cf. Case of Bueno Alves vs. Argentina, supra, para. 79, and Case of Women Victims of Sexual Torture in Atenco v. Mexico, supra, para. 194. 149 47