Sexual Asssult Flashcards
What are the epidemiology behind sexual assault
1: 6 women
1: 33 men
433000 cases a year
Most common in 18-34 yr old range
most of these statistics are not certain though since reporting varies
Populations at highest risk for sexual violence
Age 18-34
Female sex
Homosexual (LGBT)
Native and African American
Inmates
Military (especially women)
What factors make it more and less likely to report sexual violence?
More likely
- attacked by stranger
- sustained injuries
- weapons were used (either actually or just as a threatening mechanism)
- victim is married
- higher education
- different race
Less likely
- was an acquaintance or intimate partner
- alcohol or drug use was involved
What are common reasons not to report sexual violence
It is believed that 65% of rapes are not reported
Fear of reprisal (most common reason)
Not enough information to give or fear of a lack
Belief that Police would not or could not do anything
Did not want the offender to be put in prison
Doesnt want family or friends to known
Unsure about perpetrators intent
Three factors related to police poor handling of reported rape crimes and undercount stats
Police not accepting rape and other sex crimes for investigation
Police misclassifying rape and other sex crimes
Police “unfounding” rape cases at an extremely high rate
What is the most common drug used in rape?
Alcohol (30-80%) of total rapes/sexual assault
What is the BET theory
Belief Empathy and Time
All three are used to help rape victims get through their event
“Bottom line is victim is telling the truth with their story”
How to do a medical exam
Must get consent to perform he exam
- in Idaho you cant report the assault to the police if the victim doesn’t want that
- victim has all the power
Explain each step and why the questions are asked
Maintain dignity and non judgement attitude
- always have body draped and covered except the one part you are looking at
- *if the patient doesnt want to report it you can get a “Jane Doe” kit still for information**
- these kits still get processed
LIVES mnemonic
Listen
Inquire about needs and concerns
Validate
Enhanced safety
Support
Reasons why victims may exaggerate or omit account of assault
Some details are embarrassing To them
Psychological trauma was inflicted
Memory may be impaired due to alcohol
Immigration status and fear of authorities
Illegal behavior was done by victim in some way and they are scared that they will be blamed for incident if these details are present
Judicial word bans
Rape
Assailant
Attack
Victim
Sexual assault forensics examiner
Death
Important details about acquiring a History of sexual assault victims
Ask open ended questions
Ask same questions as normal history as it pertains to past medical hx, risk factors for increased injury, medications currently taking, allergies and immunizations
excited utterances heard during history is okay to be used as evidence but must be a direct quote
descriptive statements are very helpful in the prosecution of the case that moves forward also
Medical charting stuff
Use direct quotes always
Use specific descriptions
- however DONT say NAD
Use active tense
Use anatomic terms
DONT say patient is drunk
Avoid “claims or alleges”
Describe loss of memory or “cameo” events specifically
Documenting and asking about Bodily injury during sexual assault cases
Always ask about a bruise or injury you find on the patient
- always document the patients decision on an injury
Decisive injuries
- check fingernails, hands and abrasions
- use proper judgement
Always evaluate the psychological symptoms of a patient also
Intimate partner violence is more likely to show serious injuries than stranger
Ano -genital injuries in sexual abuse cases
Vaginal injuries are seen in roughly 25%
- if no prior intercourse = double the chance of vaginal injury
- if multiple penetrance = double the chance also
Less likely to see these injuries if
- sedative used
- delayed physical exam (wounds heal)
Anal injuries are roughly 27%
Factors that influence genital injury
During forced missionary = there is no pelvic Tilt so there is much more likely to be injury to the vegetal introitus and the posterior fourchette
Outer 1/3 of vagina has more nerve endings = more pain if external genitalia is injured during forced sex
Before sexual maturity and after menopause = more likely to see hymen tears and excessive blood in the vaginal canal
remeber that most victims of sexual assult dont have physical findings
Treatment of sexual assault includes
Medical assessment and treatment of obvious injuries
Prevention of pregnancy and STD (treat both if present also, assuming patient wants pregnancy treated)
Collect proper forensic evidence
Provide psychologic support
- reassurance, anxiety and guilt need to be addressed
Identify available local resources for sexual assault victims
Pregnancy in sexual assult
Is roughly 5% but might be closer to 7%
Not every rape has ejaculation
Sperm motility in cervix is present for up to 7 days
Emergency contraceptive options
Levonorgestrel 1.5mg 1 time
- synthetic progestin
Ulipristal acetate 30mg 1 time
- SERM for progesterone Which inhibits ovulation but doesnt prevent implantation
STDs in rape
If the patient is not vaccinated against hep B = start hepatitis vaccine series
post exposure prophylaxis for HOV should be talked about with every patient but ultimately give them the choice to decide if they want to take it
- if the assailant is know to be HIV (+) or there are very severe injuries = more important to try to get patent on PEP
Also screen for
- chlamydia, gonorrhea, syphills
Mental health complications
70% of sexual assult victims experience severe distress which can increase risks for PTSD long term (94% chance during the first two weeks after rape and 30% chance for up to and after 9 months from the rape)
Avoidance reactions = dispassion, smiling and quiescence (doesnt mean they aren’t concerned)
33% are suicidal
10x more likely to use other major drugs after rape
