Rape and Sexual Assault Health Article

Prognosis

Children and adolescents who have been raped or sexually assaulted are three times more likely to experience another rape in adulthood. Victims of rape and sexual assault who report their attack greater than one month afterwards are more likely to suffer from PTSD, mood swings, and major depression than victims who report their attack immediately, most likely because victims who report their attacks immediately receive appropriate interventional care, particularly mental health support and counseling. For adolescents, untreated rape and sexual assault can result in serious long-term psychological effects. One in 10 sexually assaulted adolescents attempt suicide, and about 50 percent are diagnosed with phobias, depression, substance abuse, and other psychological disorders. Compared to those who have never been victimized, rape victims are three times more likely to have a major depressive episode, four times more likely to have contemplated suicide, 13 times more likely to develop alcohol dependency problems, and 26 times more likely to develop substance abuse problems. In addition, school performance in many sexually assaulted adolescents declines, and many eventually fail academically. Even when treated, rape and sexual assault can cause poor self-esteem, sexual dysfunction and impaired sexual and personal relations, insomnia, anxiety, eating disorders, and other psychological symptoms that last into adulthood.

Lasting psychological trauma is especially serious in male children and adolescents who are raped or sexually assaulted. Young boys may be more reluctant to discuss their attack and may harbor feelings of resentment and anxiety over potential homosexuality. Assaulted young boys may, in turn, commit sexual assault themselves in the future. Appropriate psychological therapy is necessary for improved long-term outcomes.

Prevention

Usually, rape and sexual assault cannot be prevented, and it is important that children and adolescents, who often think they are at fault after an attack, be told that there was nothing they could have done to prevent the attack. However, measures to reduce the likelihood of a rape or sexual assault and to increase the chances of an assailant being caught can be taken:

• Children and adolescents can be instructed on safety and strangers and inappropriate touching, and the importance of telling parents about any uncomfortable situation.
• Parents can monitor social activities, particularly for older adolescents, who may attend events (e.g., parties with no adult supervision) without their parents' knowledge.
• Adolescents can be educated about "date-rape" drugs and methods to prevent their consumption (e.g., never leaving drinks unattended at a party). And they can be informed about the dangers of alcohol consumption.
• Parents can encourage open communication regarding normal sexual development and activity and emphasize the importance of saying no in compromising or uncomfortable situations.

Sexually transmitted disease (STD) prevention

STDs are a source of concern for many victims of sexual assault. The most commonly transmitted diseases are gonorrhea, chlamydia, genital warts, and acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV). STDs are transmitted in up to 30 percent of rapes. Treatment involves antibiotics and antiviral medications, depending on the STD. In some instances, cultures may be taken during the medical examination and at time point afterward to test for gonorrhea or chlamydia. It is important that the victim receive information regarding the symptoms of STDs and be counseled to return for further examination if any of these symptoms occur.

Pregnancy prevention

Female adolescents at risk of becoming pregnant after an assault should be counseled on the availability of emergency contraception. According to the Food and Drug Administration (FDA), emergency contraception (in the form of a course of pills) is not effective if there is a pregnancy but works to prevent pregnancy from occurring by delaying or preventing ovulation, by affecting the transport of sperm, and/or by thinning the inner layer of the uterus (endometrium) so that implantation is prevented.