89 advising the latter that she may be accompanied by someone she trusts if she so wishes. 420 This appraisal must be performed in keeping with protocols designed specifically for documenting evidence in cases of gender-based violence. 421 253. The reports assessed in this chapter reveal that: (a) the forensic personnel who performed the physical examination of Gladys Espinoza on May 18, 1993, were all male, and there is no record that she had been offered the presence of a person of the sex she preferred, 422 even though acts of sexual violence had already been reported; (b) there is no record in the reports on the appraisals made of Gladys Espinoza in April and May 1993, of any account provided by her of the acts that occurred during her arrest and following this, in particular, the acts of torture and other ill-treatment to which she was subjected; 423 (c) there is no other documentation, in particular, photographic documentation, to substantiate the comments of the personnel who appraised her, 424 and (d) there is no interpretation of the probable connection between the physical symptoms and the possible acts of torture to which Ms. Espinoza referred in her statements (supra para. 77), 425 beyond the indication in the appraisal of May 18, 1993, of “signs compatible with a recent unnatural act” (supra para. 167). 254. In addition, the case file reveals that the first physical examination that made an assessment of the sexual integrity of Gladys Espinoza was performed on May 18, 1993, even though the State had been aware of the acts of rape and other forms of sexual violence to which she had been subjected since at least April 28, 1993 (supra para. 75). 255. In this regard, when referring to the investigation in cases of torture, the Istanbul Protocol indicates that “[t]he timeliness of such medical examination is particularly important,” and that it “should be undertaken regardless of the length of time since the torture.” 426 Nevertheless, this Protocol notes that “[d]espite all precautions, physical and psychological examinations by their very nature may re-traumatize the patient by provoking or exacerbating symptoms of post-traumatic stress by reviving painful effects and memories.” 427 420 Cf. Case of Fernández Ortega et al. v. Mexico, supra, para. 194, and Case of J. v. Peru, supra, para. 344. 421 Cf. World Health Organization, Guidelines for medico-legal care for victims of sexual violence, supra, inter alia, pp. 28 and 29. 422 Cf. Medical certificate No. 1816-H of the Institute of Forensic Medicine of Peru of May 18, 1993 (evidence file, folio 1571). 423 Cf. Medical forensic appraisal of the Abduction Investigation Division of the Peruvian National Police of April 22, 1993 (evidence file, folio 1565); Medical certificate No. 16111-L of the Institute of Forensic Medicine of April 20, 1993 (evidence file, folio 1567); Report No. 235-SE.HO.PNP.604000.93 of the Hospital of the Peruvian National Police of April 26, 1993 (evidence file, folio 1569); Report No. 052-ODINFO-DINCOTE of the Counter-terrorism Division of April 26, 1993 (evidence file, folio 1576), and Medical certificate No. 1816-H of the Institute of Forensic Medicine of Peru of May 18, 1993 (evidence file, folio 1571). 424 Cf. Medical forensic appraisal of the Abduction Investigation Division of the Peruvian National Police of April 22, 1993 (evidence file, folio 1565); Medical certificate No. 16111-L of the Institute of Forensic Medicine of April 20, 1993 (evidence file, folio 1567); Report No. 235-SE.HO.PNP.604000.93 of the Hospital of the Peruvian National Police of April 26, 1993 (evidence file, folio 1569); Report No. 052-ODINFO-DINCOTE of the Counter-terrorism Division of April 26, 1993 (evidence file, folio 1576), and Medical certificate No. 1816-H of the Institute of Forensic Medicine of Peru of May 18, 1993 (evidence file, folio 1571). 425 Cf. Medical forensic appraisal of the Abduction Investigation Division of the Peruvian National Police of April 22, 1993 (evidence file, folio 1565); Medical certificate No. 16111-L of the Institute of Forensic Medicine of April 20, 1993 (evidence file, folio 1567); Report No. 235-SE.HO.PNP.604000.93 of the Hospital of the Peruvian National Police of April 26, 1993 (evidence file, folio 1569); Report No. 052-ODINFO-DINCOTE of the Counter-terrorism Division of April 26, 1993 (evidence file, folio 1576), and Medical certificate No. 1816-H of the Institute of Forensic Medicine of Peru of May 18, 1993 (evidence file, folio 1571). 426 Istanbul Protocol, supra, para. 104. 427 Istanbul Protocol, supra, para. 149.