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Medical Care and Treatment of the Sexual Assault Victim
Sexual assault is defined as any sexual act performed by one person on another without the person's consent. Sexual assault includes genital, anal, or oral penetration by a part of the accused's body or by an object. It may result from force, the threat of force, or the victim's inability to give consent. The annual incidence of sexual assault and rape is 200 per 100,000 persons, accounting for 6% of all violent crimes. Approximately one in five women is sexually assaulted by the time she is 21 years of age.
Psychologic effects
A woman who is sexually assaulted loses control over her life during the period of the assault. Her integrity and her life are threatened. She may experience intense anxiety, anger, or fear. After the assault, a "rape-trauma" syndrome often occurs. The immediate response may last for hours or days and is characterized by generalized pain, headache, chronic pelvic pain, eating and sleep disturbances, vaginal symptoms, depression, anxiety, and mood swings.
The delayed phase is characterized by flashbacks, nightmares, and phobias.
Clinical Care of the Sexual Assault Victim |
Medical
Obtain informed consent from the patient Obtain a gynecologic history Assess and treat physical injuries Obtain appropriate cultures and treat any existing infections Provide prophylactic antibiotic therapy and offer immunizations Provide therapy to prevent unwanted conception Offer baseline serologic tests for hepatitis B virus, human immunodeficiency virus (HIV), and syphilis Provide counseling Arrange for follow-up medical care and counseling |
Legal
Provide accurate recording of events Document injuries Collect samples (pubic hair, fingernail scrapings, vaginal secretions, saliva, blood-stained clothing) Report to authorities as required Assure chain of evidence |
Medical evaluation
Informed consent must be obtained before the examination. Acute injuries should be stabilized. About 1% of injuries require hospitalization and major operative repair in, and 0.1% of injuries are fatal.
A history and physical examination should be performed. A chaperon should be present during the history and physical examination to reassure the victim and provide support. The rape patient should be asked to state in her own words what happened, identify her attacker if possible, and provide details of the act(s) performed if possible.
Previous obstetric and gynecologic conditions should be sought, particularly infections, pregnancy, use of contraception, and date of the last menstrual period. Preexisting pregnancy, risk for pregnancy, and the possibility of preexisting infections should be assessed.
Physical examination of the entire body and photographs or drawings made of the injured areas should be completed. Bruises, abrasions, and lacerations should be sought. Superficial or extensive lacerations of the hymen and vagina, injury to the urethra, and occasionally rupture of the vaginal vault into the abdominal cavity may be noted. Bite marks are common. If oral penetration has occurred, injuries to the mouth and pharynx may be noted.
Pelvic examination should assess the status of the reproductive organs, collect samples from the cervix and vagina, and test for Neisseria gonorrhoeae and Chlamydia trachomatis.
A Wood light should be used to find semen on the patient's body: dried semen will fluoresce. Sperm and other Y-chromosome-bearing cells may be identified from materials