Sexual violence resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

Sexual violence is a public health issue as well as violation of human rights. It has many forms,for example rape, sexual assault, sexual coercion, sexual harassment, sexual exploitation,sexual battery. It occurs without the consent of the victim or when the victim refuses or is unable to give a consent due to age, intoxication, illnesss or any other reasons.It is a common problem that may be seen in primary care.It is important for physicians to identify if a person has suffered any type of sexual violence and take care of their safety.

Causes

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of sexual violence.[4][5][6]

 
 
 
 
 
 
Patient with history of sexual violence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about the complaint
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about Circumstances of attack, including :

❑When did it happen,tell me the date, time, and location.

❑ Is the location familiar to you?

❑ Can you provide any information about assailants (number, name if known, description)

❑Did they use any weapon

❑Did you get any threats recently?

❑ Type of sexual contact (vaginal, oral, rectal)

❑ Did they use condom?

❑Was there any extragenital injuries sustained?

❑Occurrence of bleeding (patient or assailant)

❑Did they ejaculate, if yes, where did they ejaculate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about activities of the patient after the attack:

❑Did you douch or take a bathe

❑Did you use a tampon or sanitary napkin

❑Did you urinate or defecate

❑Is there a history of use of toothpaste, mouthwash, enemas, or drugs

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history:

❑Last menstrual period

❑Date of previous coitus and time, if recent

❑Contraceptive history for example oral contraceptives, intrauterine device
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination and evidence collection:

❑ Look for general (extragenital) trauma or injury to any area

❑ Examine genitals to look for trauma to the perineum, hymen, vulva, vagina, cervix, or anus

❑Collect any foreign material for example stains, hair, dirt, twigs on the body

❑perform examination with Wood’s lamp or colposcopy when available

❑Collect any small samples of clothing, including an unstained sample, should be collected and examined

❑Collect hair samples, including loose hairs adhering to the patient or clothing, semen-encrusted pubic hair, and clipped scalp and pubic hairs of the patient. Try to collect at least 10 of each for comparison.

❑ Check the condition of clothing, check if it is damaged, stained, or if there is any foreign material attached to any part of body

❑Take semen from the cervix, vagina, rectum, mouth, and thighs

❑Take blood from the patient

❑Look for any dried samples of the assailant’s blood taken from the patient’s body and clothing

❑Collect urine, saliva, and smears of buccal mucosa

❑Collect fingernail clippings and scrapings

❑Collect other specimens, as described by the history of the patient or physical examination

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the following investigations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Laboratory tests:

❑ Do Acid phosphatase to detect the presence of sperm. This test is very helpful if the assailant had a vasectomy, is oligospermia, or used a condom, which may cause sperm to be absent. If the test cannot be done immediately, a specimen should be placed in a freezer

❑Saline suspension from the vagina to look for sperm motility. This is helpful if t can be done immediately on time to spot the motile sperm

Semen analysis for sperm morphology and presence of A, B, or H blood group substances

❑Tests for STDs.

❑Blood typing

❑Urine testing, including drug screen for example drug screening for flunitrazepam (the date rape drug) and gamma-hydroxybutyrate should be considered and pregnancy tests

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order the follow-up tests:

❑Tests for STDS at 6 weeks: Gonorrhea, chlamydial infection, human papillomavirus infection (initially using a cervical sample from a Papanicolaou test), syphilis, and hepatitis

❑At 12 weeks: HIV infection

❑At 6 months: Syphilis, hepatitis, and HIV infection
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of


 
 
 
 
 
 
 
Patient comes with history of sexual violence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-pharmacological treatment and psychologic support
 
 
 
 
 
 
 
Pharmacological treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stress Inoculation Training (SIT)
Prolonged Exposure Therapy (PE)
Cognitive Processing Therapy (CPT)
Cognitive therapy
• Eye Movement Desensitization Reprocessing (EMDR)
Supportive Counseling
 
 
 
 
 
 
• Medications for PTSD
•Medications for prevention of infections
• Contraceptives for unwanted pregnancy


Non-pharmacological treatment of insomnia:

Treatments for sexual assault victims include treatment of PTSD, fear and anxiety, and/or depression

 
 
 
 
 
 
 
 
 
 
 
 
Stress Inoculation Training (SIT)
 
Includes:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prolonged Exposure Therapy
 
Includes:


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cognitive Processing Therapy (CPT)
 
Includes:


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-pharmacological treatment
 
 
 
 
Eye Movement Desensitization Reprocessing
 
Includes:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cognitive therapy
 
Includes:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Supportive Counseling
 
Includes:


 
 
 
 
 
 

Do's


  • Make sure the victim is not left alone.
  • Provide emotional support and reassure the victim that they are not at fault for what happened.
  • If the victim has been raped, a doctor will use a rape kit to collect hair, semen, clothing fibers, and other evidence of the attacker's identity
  • Even if the victim is not sure they want to report about the violence, it is important to collect and preserve evidence so it can be accessed at a later date, if required.
  • If the victim wishes to report about the violence, the staffs of the hospital will call the police from the emergency room.
  • Victims should be treated for sexually transmitted diseases (STDs)
  • Victims should be told about emergency birth control. It is important to receive birth control and treatment for STDs within 72 hours of the assault for maximum effectiveness. Although victims can get emergency contraception up to 5 days after but it will be less effective.

Don'ts

  • To preserve evidence, the victim should not take a bathe, go to the bathroom, comb their hair, or change clothes until they have received a medical examination.
  • Do not clean up anything at the site of the assault.

References

  1. Tharp AT, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, Matjasko JL (April 2013). "A systematic qualitative review of risk and protective factors for sexual violence perpetration". Trauma Violence Abuse. 14 (2): 133–67. doi:10.1177/1524838012470031. PMID 23275472.
  2. Maxwell, Christopher D.; Robinson, Amanda L.; Post, Lori A. (2003). "The Nature and Predictors of Sexual Victimization and Offending Among Adolescents". Journal of Youth and Adolescence. 32 (6): 465–477. doi:10.1023/A:1025942503285. ISSN 0047-2891.
  3. Ybarra, Michele L.; Mitchell, Kimberly J.; Hamburger, Merle; Diener-West, Marie; Leaf, Philip J. (2011). "X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?". Aggressive Behavior. 37 (1): 1–18. doi:10.1002/ab.20367. ISSN 0096-140X.
  4. Basile, Kathleen C.; Smith, Sharon G.; Chen, Jieru; Zwald, Marissa (2020). "Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women". Journal of Interpersonal Violence: 088626051990033. doi:10.1177/0886260519900335. ISSN 0886-2605.
  5. Holmes MM, Resnick HS, Kilpatrick DG, Best CL (August 1996). "Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women". Am J Obstet Gynecol. 175 (2): 320–4, discussion 324–5. doi:10.1016/s0002-9378(96)70141-2. PMID 8765248.
  6. "Medical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition".


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