The article considers historical aspects of conducting medical examinations and medical evidence using forensic medical knowledge in the investigation of crimes related to the sexual inviolability of the individual in the 19^th — early 20^th centuries. The main criterion for establishing the fact of rape was «deprivation of virginity», i.e. the fact of anatomical rupture of the hymen or damage to the external genitalia and anus. The decisive role in recording this feature was played by the opinions of district and hospital doctors, who acted as experts. Their medical assessment directly determined further proceedings on the case, including sending materials to the courts. Historical reconstruction of the procedure for medical examinations of women and minors in the commission of sexual crimes in Tsarist Russia by district doctors is carried out on the example of the Yekaterinburg district of the Perm province. Based on the results of the work, a conclusion is made about the improvement of the procedure for medical forensic gynecological examinations throughout the 19^th-20^th centuries in district towns, a gradual transition to a scientific basis using the works of Russian and European scientists.