Evaluation and management of adult sexual assault victims

INTRODUCTION

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 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 diseases are reviewed separately. (See "Initial management of trauma in adults" and "Screening for sexually transmitted infections".)

EPIDEMIOLOGY

Lifetime prevalence of sexual assault in the United States is estimated to be 18 percent in women and 3 percent in men [1]. In a national phone survey of college women, 2.8 percent reported completed or attempted sexual assault in a year; the estimated cumulative rate in four years may be as high as one in four [2]. In one series, almost 30 percent of undergraduate women reported a drug-related assault, with alcohol the most common substance involved [3]. About 50 percent of sexual assault victims have some acquaintance with their attackers. Two-thirds of assaulted women over 55 are assaulted in their own home or in a care facility [4]. In men, the prevalence of assault appears to be higher among those who are gay, bisexual, veterans, prison inmates, or seeking mental health services [5].

Statistics from the United States federal government only include assaults upon women in the category of "forcible rape," which excludes statutory rape and male victims. Reports of sexual assault using this definition have generally declined annually since 1994 [6]. Reported sexual assaults, however, probably represent only a fraction of those committed [7]. Only 10 to 15 percent of all sexual assaults will be reported to police and women who know their assailant are less likely to report the assault [8].

SCREENING

The issue of screening for domestic violence, including sexual assault, is reviewed separately. (See "Intimate partner violence: Diagnosis and screening".)

                        

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