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Evaluation and management of adult sexual assault victims

Carol K Bates, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Sexual assault is defined as any sexual act performed by one person on another without consent. It may result from the use of force, the threat of force, or from the victim's inability or refusal to give consent. Sexual assault victims do not "entice" their assailants; sexual assault is an act of conquest and control.

The evaluation and treatment of sexual assault are discussed here. Trauma evaluation and sexually transmitted infections are reviewed separately. (See "Initial management of trauma in adults" and "Screening for sexually transmitted infections".)


According to an extensive systematic review of studies of sexual violence perpetrated by non-partners, sexual violence against women is common throughout the world [1]. The review noted that data is scant in particular regions (central sub-Saharan Africa, Middle East, Eastern Europe, Asia Pacific) and therefore, must be interpreted cautiously, but reported that the prevalence appeared to be highest in central sub-Saharan Africa (21 percent; 95% CI 4.5-37.5) and southern sub-Saharan Africa (17.4 percent; 95% CI 11.4-23.3). When interpreting this study, it is important to remember that sexual violence perpetrated by intimate partners was not included, and that were such data added the overall prevalence would be much greater.

The lifetime prevalence of sexual assault in the United States is approximately 18 to 19 percent in women and 2 to 3 percent in men [2,3]. In a national phone survey of college women, 2.8 percent reported a completed or attempted sexual assault in a given year; the estimated cumulative rate over four years may be as high as one in four [4]. In one series, almost 30 percent of undergraduate women reported a drug-related assault, with alcohol the most common substance involved [5]. A study of Canadian women college students reported that nearly 80 percent of sexual assaults involved alcohol or drugs [6]. There may be some educational programs that can reduce the risk of sexual assault on college campuses [7,8]. A majority of sexual assault victims have some acquaintance with their attackers [9]. Two-thirds of assaulted women over 55 are assaulted in their own home or in a care facility [10]. In men, the prevalence of assault appears to be higher among those who are gay, bisexual, veterans, prison inmates, and those seeking mental health services [11].

Historically, statistics from the United States federal government included only assaults upon women in the category of "forcible rape." In 2013, the definition was changed to "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim" and has been broadened to include male victims, though this still excludes statutory rape. Reports of sexual assault using the former definition had generally declined annually since 1994 [12]. However, reported sexual assaults probably represent only a fraction of those committed [13]. Only 10 to 15 percent of all sexual assaults are reported to police, and women who know their assailant are less likely to report the assault [14].


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Literature review current through: Sep 2016. | This topic last updated: Oct 25, 2016.
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