[L. rapere, to seize]
Sexual assault or sexual violence perpetrated on one person by another against the will of the victim. Rape involves an attempt at or actual penetration of the vagina or another body orifice by a penis, finger, other body part, or inanimate object. A majority of rapes are inflicted by someone known to the victim.
SEE: rape and sexual assault prevention; SEE: syndrome, rape-trauma; SEE: sexual abuse
Approximately 620,000 women 18 years and older were forcibly raped in 2010. Some studies have indicated that an incident involving rape occurs about every 2.5 min, and that 1 out of 6 women will be raped sometime during her life.
SYMPTOMS AND SIGNS
Complete penetration by the penis or emission of seminal fluid is not necessary to constitute rape. Most rapes include force, intimidation, or violence, but acquiescence because of verbal threats does not indicate consent
When an episode of rape is reported, the event has profound personal, medical, social, and legal ramifications. In patients who present for immediate evaluation, e.g., at an Emergency Department or Women's Health Clinic, the sexual assault nurse examiner plays a crucial role in providing comfort to the patient, performing a thorough and compassionate diagnostic evaluation, and collecting forensic evidence.
The medical care of the rape victim must include timely prophylactic treatment for sexually transmitted diseases (including HIV/AIDS), prophylaxis against hepatitis B, and prophylaxis against pregnancy.
SEE: rape and sexual assault prevention.
The health care professional provides sensitive care, esp. psychological support, remains with the patient and encourages her to express her feelings. If available, a Sexual Assault Nurse Examiner should be summoned. State regulations regarding the reporting of rape should be followed. The health care professional explains and assists with the psychological, oral, pelvic, and rectal examinations and diagnostic tests. Directions should be followed exactly in collecting rape evidence such as head and pubic hair combings, nail scrapings, and vaginal, oral, or anal specimens for police investigation. The patient should be allowed as much control as possible throughout examination, treatment, and interview procedures. An assault and sexual history is obtained, including whether the female rape victim was menstruating and, if so, the type of menstrual protection used.
Attempts are made to obtain as accurate a history of the rape as possible. Meticulous documentation is required. Medically relevant evidence of the patient’s emotional reactions and state should be included, with care taken not to record one’s own feelings or thoughts. The interviewer should be aware that medical records may be called in evidence in a court of law. Prior to the examination, the patient should be asked whether she has douched, bathed, or washed her perineal area before coming to the hospital. She may need to urinate, but should be cautioned not to wipe or clean the perineum in any way. As she changes into a hospital gown, her clothing is collected in paper bags, with each bag labeled accurately (with the patient’s name, collector’s name, chain of evidence, location, date, and time).
After determining the patient’s allergy history, prescribed treatments of associated injuries are given. Topical ice packs may be used to reduce vulvar swelling and discomfort. Analgesics and sedatives or anti-anxiety agents are prescribed as needed. Photographs to document any injuries are taken. Crisis intervention services are offered to assist the patient. Assistance is offered to help the patient explain the rape to family. Arrangements are made for someone to escort the patient home. Follow-up services and written and verbal instructions for prescribed medications, including drug actions and possible side effects, are provided. The importance of returning for sexually transmitted disease testing is explained: some microbiological cultures take days or longer to reveal results. Psychological counseling is encouraged to help the patient cope with aftereffects of the rape-trauma. Legal proceedings may revive the trauma of the event for the victim. Further counseling and support is provided as needed. Female victims should be referred to Women Organized Against Rape or a local rape crisis center for ongoing empathic care and advice.
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