Evaluation and management of adult sexual assault victims
- Carol K Bates, MD
Carol K Bates, MD
- Associate Professor of Medicine
- Harvard Medical School
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".)
According to an extensive systematic review of studies of sexual violence perpetrated by non-partners, sexual violence against women is common throughout the world . 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 . In one series, almost 30 percent of undergraduate women reported a drug-related assault, with alcohol the most common substance involved . 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 . In men, the prevalence of assault appears to be higher among those who are gay, bisexual, veterans, prison inmates, or seeking mental health services .
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 . Reported sexual assaults, however, probably represent only a fraction of those committed . 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 .
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- Trained providers
- Physical examination
- Forensic evaluation
- - Perpetrator evaluation
- Laboratory testing
- Initial therapy
- - Sexually transmitted infections
- - Hepatitis B infection
- - HIV infection
- - Pregnancy
- Psychosocial issues
- Legal issues
- Follow-up care
- - Long-term implications
- PROVIDER PREPAREDNESS
- TREATMENT OF PERPETRATORS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS