Rape and Sexual Assault Health Article

When to call the doctor

Many children and adolescents are reluctant to report rape and sexual assault for a number of reasons. Often the victim fears retaliation from the offender. He or she may be afraid that family, friends, the community, or the media may learn about the offense. There may be a concern about being judged or blamed by others. The victim may think that no one will believe the assault occurred or that they were somehow at fault. Unreported rape and sexual assault are especially common when the offender is known to the victim, such as a family member or respected member of the community (e.g., clergy, teacher).

Parents who suspect that their child or adolescent has been raped or sexually assaulted should take the child to see a doctor and psychologist or psychiatrist. Signs that a child or adolescent may have been raped or sexually assaulted include shying away from physical affection, unexplained bleeding from the rectum and/or vagina, bruising around the breasts and genitals, and hiding or throwing away undergarments. Any child or adolescent who is raped or sexually assaulted should be taken to an emergency room immediately so that evidence against the perpetrator can be gathered, and medical treatment can be given.

Diagnosis

Rape and sexual assault are diagnosed by interviewing the patient and parents, physical and gynecological examination, and laboratory tests for the presence of seminal fluid. In many cases, children or adolescents do not report the rape or sexual assault, but they do show obvious signs of physical violence. When rape is suspected, diagnosis may be made by a psychiatrist or psychologist based on sessions with the victim. In cases where obvious signs of the crime are not visible, and immediate treatment is not received, the victim may develop post-traumatic stress disorder (PTSD), also known as rape trauma syndrome, which is a mental health disorder that describes a range of symptoms often experienced by someone who has undergone a severely traumatic event. In such cases, diagnosis of rape or sexual assault is revealed through therapy sessions for PTSD.

Approximately 31 percent of rape victims develop PTSD as a result of their assault. The symptoms of PTSD include:

• recurrent memories or flashbacks of the incident
• nightmares
• insomnia
• mood swings
• difficulty concentrating
• panic attacks
• emotional numbness
• depression
• anxiety

Treatment

Once a victim of rape or sexual assault reports the crime to local authorities, calls a rape crisis hotline, or arrives at the emergency room to be treated for injuries, a multidisciplinary team is often formed to address his or her physical, psychological, and judicial needs. This team usually includes law enforcement officers, physicians, nurses, mental health professionals, victim advocates, and/or prosecutors.

The victim may continue to feel fear and anxiety for some time after the incident, and in some instances this may significantly impact his or her personal and academic life. Follow-up counseling should, therefore, be provided for the victim, particularly if symptoms of PTSD become evident.

Forensic medical examination

Because rape is a crime, there are certain requirements for medical evaluation of the patient and for record keeping. The forensic medical examination is an invaluable tool for collecting evidence against a perpetrator that may be admissible in court. Since the great majority of victims know their assailant, the purpose of the medical examination is often not to establish identity but to establish nonconsensual sexual contact. The Sexual Assault Nurse Examiner program is an effective model that is used in many U.S. hospitals and clinics to collect and document evidence, evaluate and treat for sexually transmitted diseases (STDs) and pregnancy, and refer victims to follow-up medical care and counseling. Many nurse examiners are specially trained to handle cases that involve children and adolescents. The "Sexual Assault Nurse Examiner Development and Operation Guide," prepared by the Sexual Assault Resource Service, describes the ideal protocol for collecting evidence from a sexual assault victim. This protocol includes the following:

• performing the medical examination within 72 hours of the assault
• taking a history of the assault
• documenting the general health of the victim, including menstrual cycle, potential allergies, and pregnancy status
• assessing for trauma and taking photographic evidence of injuries
• taking fingernail clippings or scrapings
• taking samples for sperm or seminal fluid
• combing head/pubic hair for foreign hairs, fibers, and other substances
• collecting bloody, torn, or stained clothing
• taking samples for blood typing and DNA screening

After evidence is collected, rape victims are treated with appropriate medical care for their injuries. In female children and adolescents, vaginal tears and injuries may require suturing; in male children and adolescents, anal tears and injuries are common and may require suturing and other treatment.