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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

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 data 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 completed or attempted sexual assault in a year; the estimated cumulative rate in 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]. 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 [6]. In men, the prevalence of assault appears to be higher among those who are gay, bisexual, veterans, prison inmates, or seeking mental health services [7].

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 [8]. Reported sexual assaults, however, probably represent only a fraction of those committed [9]. 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 [10].

                        

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Literature review current through: Aug 2014. | This topic last updated: Sep 16, 2014.
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References
Top
  1. Abrahams N, Devries K, Watts C, et al. Worldwide prevalence of non-partner sexual violence: a systematic review. Lancet 2014; 383:1648.
  2. Tjaden P, Thoennes N. Extent, nature, and consequences of rape victimization: Findings from the national violence against women survey. Department of Justice 2006. www.ncjrs.gov/pdffiles1/nij/210346.pdf (Accessed on January 29, 2010).
  3. Breiding MJ, Smith SG, Basile KC, et al. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization - national intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ 2014; 63 Suppl 8:1.
  4. Fisher BS, Cullen FT, Turner MG. The sexual victimization of college women. Department of Justice 2000. www.ncjrs.gov/pdffiles1/nij/182369.pdf (Accessed on January 29, 2010).
  5. Lawyer S, Resnick H, Bakanic V, et al. Forcible, drug-facilitated, and incapacitated rape and sexual assault among undergraduate women. J Am Coll Health 2010; 58:453.
  6. Eckert LO, Sugar NF. Older victims of sexual assault: an underrecognized population. Am J Obstet Gynecol 2008; 198:688.e1.
  7. Peterson ZD, Voller EK, Polusny MA, Murdoch M. Prevalence and consequences of adult sexual assault of men: review of empirical findings and state of the literature. Clin Psychol Rev 2011; 31:1.
  8. Federal Bureau of Investigation Uniform Crime Reports. www.fbi.gov/ucr/ucr.htm (Accessed on August 27, 2007).
  9. Burgess AW, Fawcett J. The comprehensive sexual assault assessment tool. Nurse Pract 1996; 21:66, 71.
  10. Jones JS, Alexander C, Wynn BN, et al. Why women don't report sexual assault to the police: the influence of psychosocial variables and traumatic injury. J Emerg Med 2009; 36:417.
  11. Linden JA. Clinical practice. Care of the adult patient after sexual assault. N Engl J Med 2011; 365:834.
  12. Sexual assault; ACOG educational bulletin. Int J Gyn Obst 1997; 60:297.
  13. Ramin SM, Satin AJ, Stone IC Jr, Wendel GD Jr. Sexual assault in postmenopausal women. Obstet Gynecol 1992; 80:860.
  14. A national protocol for sexual assault medical forensic evaluations adults/adolescents.US Department of Justice, Office of Violence Against Women. April 2013, NCJ 228119. https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf (Accessed on April 06, 2014).
  15. Maguire W, Goodall E, Moore T. Injury in adult female sexual assault complainants and related factors. Eur J Obstet Gynecol Reprod Biol 2009; 142:149.
  16. Jänisch S, Meyer H, Germerott T, et al. Analysis of clinical forensic examination reports on sexual assault. Int J Legal Med 2010; 124:227.
  17. Astrup BS, Ravn P, Thomsen JL, Lauritsen J. Patterned genital injury in cases of rape--a case-control study. J Forensic Leg Med 2013; 20:525.
  18. Slaughter L, Brown CR, Crowley S, Peck R. Patterns of genital injury in female sexual assault victims. Am J Obstet Gynecol 1997; 176:609.
  19. Drocton P, Sachs C, Chu L, Wheeler M. Validation set correlates of anogenital injury after sexual assault. Acad Emerg Med 2008; 15:231.
  20. White C. Genital injuries in adults. Best Pract Res Clin Obstet Gynaecol 2013; 27:113.
  21. Hampton HL. Care of the woman who has been raped. N Engl J Med 1995; 332:234.
  22. Ciancone AC, Wilson C, Collette R, Gerson LW. Sexual Assault Nurse Examiner programs in the United States. Ann Emerg Med 2000; 35:353.
  23. North Dakota Sexual Assault Evidence Collection Protocol. 4th edition, May 2005. www.ndcaws.org/assault/2004%20CASAND%20Protocol%20-%20final.pdf (Accessed on September 27, 2008).
  24. Carr ME, Moettus AL. Developing a policy for sexual assault examinations on incapacitated patients and patients unable to consent. J Law Med Ethics 2010; 38:647.
  25. www.ovw.usdoj.gov/ovw-fs.htm (Accessed on June 11, 2008).
  26. Young WW, Bracken AC, Goddard MA, Matheson S. Sexual assault: review of a national model protocol for forensic and medical evaluation. New Hampshire Sexual Assault Medical Examination Protocol Project Committee. Obstet Gynecol 1992; 80:878.
  27. Hammer RM, Moynihan B, Pagliaro EM. Forensic Nursing: A Handbook for Practice, Jones and Bartlett, Sudbury 2006. p.570.
  28. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1.
  29. Gostin LO, Lazzarini Z, Alexander D, et al. HIV testing, counseling, and prophylaxis after sexual assault. JAMA 1994; 271:1436.
  30. Rossi R, Lancia M, Gambelunghe C, et al. Identification of GHB and morphine in hair in a case of drug-facilitated sexual assault. Forensic Sci Int 2009; 186:e9.
  31. Gaulier JM, Sauvage FL, Pauthier H, et al. Identification of acepromazine in hair: an illustration of the difficulties encountered in investigating drug-facilitated crimes. J Forensic Sci 2008; 53:755.
  32. Rambow B, Adkinson C, Frost TH, Peterson GF. Female sexual assault: medical and legal implications. Ann Emerg Med 1992; 21:727.
  33. Glaser JB, Schachter J, Benes S, et al. Sexually transmitted diseases in postpubertal female rape victims. J Infect Dis 1991; 164:726.
  34. Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006; 55:1.
  35. Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep 2005; 54:1.
  36. Rich JD, Macalino G, Merchant RC, et al. HIV seroprevalence of adult males incarcerated for a sexual offense in Rhode Island, 1994-1999. JAMA 2002; 288:164.
  37. HIV in prisons, 1994. Bureau of Justice Statistics Bulletin, March 1996, NCJ -158020. www.ojp.usdoj.gov/bjs/pub/pdf/hivip94.pdf (Accessed on September 03, 2006).
  38. HIV in prisons, 2007-2008. Bureau of Justice Statistics Bulletin, December 2009, NCJ-228307. http://bjs.ojp.usdoj.gov/content/pub/pdf/hivp08.pdf (Accessed on December 21, 2009).
  39. Casey C, Vellozzi C, Mootrey GT, et al. Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions. MMWR Recomm Rep 2006; 55:1.
  40. Glasier A. Emergency postcoital contraception. N Engl J Med 1997; 337:1058.
  41. Burgess AW, Holmstrom LL. Rape: Crisis and Recovery, Robert J. Brady Co, Bowie 1979.
  42. Wiley J, Sugar N, Fine D, Eckert LO. Legal outcomes of sexual assault. Am J Obstet Gynecol 2003; 188:1638.
  43. McGregor MJ, Du Mont J, Myhr TL. Sexual assault forensic medical examination: is evidence related to successful prosecution? Ann Emerg Med 2002; 39:639.
  44. Gray-Eurom K, Seaberg DC, Wears RL. The prosecution of sexual assault cases: correlation with forensic evidence. Ann Emerg Med 2002; 39:39.
  45. Belik SL, Stein MB, Asmundson GJ, Sareen J. Relation between traumatic events and suicide attempts in Canadian military personnel. Can J Psychiatry 2009; 54:93.
  46. McCauley JL, Amstadter AB, Danielson CK, et al. Mental health and rape history in relation to non-medical use of prescription drugs in a national sample of women. Addict Behav 2009; 34:641.
  47. Weitlauf JC, Finney JW, Ruzek JI, et al. Distress and pain during pelvic examinations: effect of sexual violence. Obstet Gynecol 2008; 112:1343.
  48. Mark H, Bitzker K, Klapp BF, Rauchfuss M. Gynaecological symptoms associated with physical and sexual violence. J Psychosom Obstet Gynaecol 2008; 29:164.
  49. Campbell R, Lichty LF, Sturza M, Raja S. Gynecological health impact of sexual assault. Res Nurs Health 2006; 29:399.
  50. McCall-Hosenfeld JS, Liebschutz JM, Spiro A, Seaver MR. Sexual assault in the military and its impact on sexual satisfaction in women veterans: a proposed model. J Womens Health (Larchmt) 2009; 18:901.
  51. Coker AL, Hopenhayn C, DeSimone CP, et al. Violence against Women Raises Risk of Cervical Cancer. J Womens Health (Larchmt) 2009; 18:1179.
  52. Prentky RA, Lee AF. Effect of age-at-release on long term sexual re-offense rates in civilly committed sexual offenders. Sex Abuse 2007; 19:43.
  53. Craig, LA, Browne, KD, Stringer, I. Treatment and sexual offence recidivism. Trauma Violence Abuse 2003; 4:70.
  54. Briken P, Hill A, Berner W. Pharmacotherapy of paraphilias with long-acting agonists of luteinizing hormone-releasing hormone: a systematic review. J Clin Psychiatry 2003; 64:890.