Sexual Assault/safeguarding adults and children/FGM Flashcards
Forensic window for kissing/biting/licking? .
48hours
Forensic window for anal penetration?
72hrs
Forensic window for vaginal penetration?
7/7
Forensic window for digital penetration?
12hrs
Define rape?
Penis to penetrate mouth/anus/vagina without consent (all others are touching or sexual penetration without consent)
Is vaginal penetration with a finger without consent considered rape under the law?
No it is sexual penetration, rape must use a penis.
Initial assessment following assault?
Time/location/type of assault (inc. ejaculation), number of assailants, violence, injuries, condom se, contraception, hep b vaccine status. Risk assess for PEP/hep B/C and self harm.
Discuss role or forensics and police. Do not examine until established if would like forensic samples. Can offer baseline STI screen.
Follow up for sexual assault?
2/52 NAATs, if no PEP 45/7 HIV and 3/12 STS, 6/12 hep. Hep B vaccine 0/7/21 days. PT 3/52. Psychological wellbeing/safety.
What are the aspects of Fraser guidelines?
13-16 for sexual health. Understands advice/mature enough to make decision, HCP cannot persuade YP to inform parents, YP having or will start having sexual activity with or without contraception, without contraception the YP physical or mental health will suffer, In YP best interest to have advice without parental consent.
Things to ask <18 who attends ISHS?
ID and confidentiality. Presenting complaint, medical hx, meds, allergies, smoking, drugs, alcohol, who do you live with (siblings and adults), parents/career aware you’re here?, service involvement, career/bereavement/missing/looked after, sexual hx and risk, contraception, able to talk about sex, say no, any sexting/photos/gifts for sex, age of partner when do you spend time together, where did you meet, age of first SI. Spotting the signs proforma.
Fraser guidelines?
- The young person understands the advice being given.
- The young person cannot be convinced to involve parents/carers or allow the medical practitioner to do so on their behalf.
- It is likely that the young person will begin or continue having intercourse with or without treatment/contraception.
- Unless he or she receives treatment/contraception their physical or mental health (or both) is likely to suffer.
- The young person’s best interests require contraceptive advice, treatment or supplies to be given without parental consent.
Mental capacity assessment elements?
Person can understand the information relevant to the decision, retain the information relevant to the decision, use or weigh the information and communicate the decision (by any means).
Signs of abuse?
Bruise, fear, change in behaviour around someone, multiple attendances, fear of going home, low self esteem, poor nutrition, poor hygiene, unable to afford basics
Types of abuse?
Physical, emotional, domestic violence, financial, modern slavery, organisational, discriminatory, neglect, self neglect.
Steps in safeguarding adult with DV
Hx and type of abuse, injuries, previous service involvement, every tried to leave.
Check immediate safety - if unsafe and risk of harm discuss with safeguarding leads and consider police.
If ongoing but no immediate risk DASH/MASH form, any children. Raise with safeguarding teams.
Define FGM?
all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.
Areas at most risk of FGM?
Middle Africa, Indonesia and Malaysia.
What is type 3 FGM?
narrowing the vaginal opening by creating a seal, formed by cutting and repositioning the labia (infibulation)
What is type 4 FGM?
other harmful procedures to the female genitals, including pricking, piercing, cutting, scraping or burning the area
What is type 2 FGM?
removing part or all of the clitoris and the inner labia, with or without removal of the labia majora (excision)
What is type 1 FGM?
Removing part or all of the clitoris (clitoridectomy)
Is is illegal to aid/abet, perform or take to a place including aboard where FGM is done - what is the prison sentence for both
under FGM act 2003. 14 years in prison and 7 years if failing to protect a girl
A 16 yo female attend seeking emergency contraception, she chooses an IUD. On examination you find the labia majora are absent, on further questioning she reports being cut as a child in Ethiopia before moving to the uk.
What do you need to do?
Check her health and safety, ask details about her parents and any siblings (esp female), getting names, addressed and contact details ideally. Statutory requirement to report to social care/police as under 18 and a crime has taken place. Speak with your safeguarding lead.
A 29 yo female attends with vaginal discharge, you examine her and suspect BV, confirmed on microscopy. During the examination you notice she had an absent clitoris. On further questioning she reports having been cut as a young girl in Chad before moving to the uk. What do you need to do?
Check her health and any long term including psychological complications regarding FGM. Ask if she has any siblings esp <18 and any female children or family plans. Find out her feelings about FGM and discuss UK law. If daughters and you suspect a risk of them having FGM mandatory to report, if woman doesn’t agree with FGM, sufficient to ensure you’ve spoken about the law and implications.
