Sexual Assault Flashcards
what are the key factors to document in a history of sexual assault
Any injuries requiring urgent medical care
History required to assess the risk of pregnancy, STIs, HIV and Hep B / C
History to guide forensic examination and sampling
- Date and Time of assault
- nature of assault
- number of assailants
- details of assailants if known to assist risk assessment
- nature of assault - oral, anal, vaginal
- condom use
- ejaculation
Define abrasion
Superficial wound caused by friction damage
Damage to epidermis
Causes bleeding and execution of serum
Define ecchymosis
Bruise
Extravasation of blood into the skin and subcutaneous tissues
area >1cm
Define haematoma
localised collection of blood outside of the blood vessels
Palpable as a fluctuant mass
Caused by trauma or by blood coagulation disorders
define petechiae
small red dots seen on the skin
<3mm diameter
occur due to capillary damage
Cause of peri-oribtal petechiae
crying
vomiting
coughing
strangulation / asphyxiation
define laceration
a full thickness skin split
caused by blunt trauma
edges of the wound tend to be ragged
define incised wound
full thickness linear skin injury caused by a sharp instrument
Under what circumstances may a doctor release confidential information to the courts
With patient consent
If the requested to do so by law or ordered to do so by court
what proportion of children in the UK have been sexually abused
1 in 20 children in the UK have been sexually abused
What should be included in a professional witness report
Name and qualifications and experience
Basic information of the events - names, dates, locations
Reason the report has been requested
History and examination findings
results of any investigations
details of any additional documents or diagrams
conclusion of the report writer based on the facts
Definition of rape
Intentional, non-consensual penetration of the vagina, anus or mouth with a penis
What form of consent is recommended before performing a forensic medical examination
Written consent
Components of a sexual assault history
The incident - approximate time any events after the incident current symptoms or injuries Pmhx / surgical hx medication / Allergies sexual hx / O+G hx Drug and alcohol hx social hx
Components of an examination in a SARC
Height, weight
BP, pulse, temp, resp rate
Head to toe examination - document findings on body diagrams
forensic samples - wet swab first then dry swab
+/- speculum / proctoscope
Possible psychological impact of sexual assault
Anxiety irritability poor concentration sexual dysfunction depression drug or alcohol issues suicidal ideation PTSD
What is the commonest substance used in a drug facilitated sexual assault
Alcohol
Vulnerability factors for CSE
More females than males Average age 13-15 years old Life experiences associated with increased risk of CSE: • Family dysfunction • Prior (sexual) abuse / neglect • Going missing / running away • Substance misuse • Disengagement from education • Social isolation • Low self esteem • Socio-economic disadvantage • Learning difficulties / disabilities • Peers who are sexually exploited • Gang-association • Attachment issues • Homelessness • Being in care
Possible warning signs of CSE
- Missing from home or care
- Physical injuries
- Drug or alcohol misuse
- Involvement in offending
- Repeated STIs, pregnancies and termination
- Absent from school
- Change in physical appearance
- Evidence of sexual bullying/vulnerability through the internet and/or social networking sites
- Estranged from their family
- Gifts from unknown sources
- Recruiting others into exploitative situations
- Poor mental health
- Self-harm or thoughts of or attempts at suicide
Immediate needs of a patient presenting within 7 days of a sexual assault
Immediate safety
Treatment of injuries
Offer referral for FME in SARC
baseline screening STIs +/- STI prophylaxis
Baseline HIV test or save serum sample
HIV PEPSE (within 72 hours)
Hepatitis B vaccination (and Hepatitis B immunoglobulin if assailant likely or known surface antigen carrier)
Emergency contraception
Self-harm risk identification
Be aware of child and vulnerable adult protection issues
Medium term needs of a patient presenting >7 days after a sexual assault
STI screening - at baseline and/or 2 weeks after assault
Hepatitis B vaccination as appropriate
Pregnancy testing as appropriate
Assessment of coping abilities
Identify symptoms PTSD
Practical and psychosocial support
Long term needs of a patient presenting 1 year + after a sexual assault
STI screening
Psychological problems dealt with with support of the GP +/- appropriate referrals for counselling / psychological therapies
Assess for PTSD - consider referral for CBT or EMDR
GP may also consider anti-depressant medication
Forensic timescale for gathering DNA from kissing / licking / biting
48 hours
Forensic timescale for gathering DNA from Oral penetration
48 hours
Forensic timescale for gathering DNA from Vaginal penetration
7 days
Forensic timescale for gathering DNA from Digital penetration
12 hours
Forensic timescale for gathering DNA from Anal penetration
72 hours
What is in an Early Evidence Kit (EEK)
urine sample pot
mouth swab
mouth rinse
allowing early collection of DNA evidence and toxicology
For a patient presenting after sexual assault what antibiotics may be considered for prophylaxis against STIs
Ceftriaxone 1g IM STAT
doxycycline 100mg BD 7/7
+/- metronidazole 2g STAT or 400mg BD 7/7
What is the % pregnancy risk associated with rape
Rape carries a 5% risk of pregnancy
Psychological consequences of sexual assault
Anxiety
Depression
- V common - Appear early
PTSD poor concentration and memory problems irritability being easily startled / hyper vigilance to threat sleep disturbances appetite disturbance relationship difficulties sexual dysfunction suicidal ideation self-harm
