1 / 19

Management of Rape Victims

Management of Rape Victims. Martin Donohoe This presentation was last updated in the early 2000s – I recommend consulting more contemporary medical references. Rape. Unwanted, forced penetration (oral/vaginal/anal) reported by 33 - 46% of women who are physically abused

foy
Télécharger la présentation

Management of Rape Victims

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Management of Rape Victims Martin Donohoe This presentation was last updated in the early 2000s – I recommend consulting more contemporary medical references

  2. Rape • Unwanted, forced penetration (oral/vaginal/anal) • reported by 33 - 46% of women who are physically abused • annual incidence ³ 80/100,000 women • 7% of all violent crimes • lifetime prevalence 10% - 25%

  3. Date Rape • 40% of college women report forced sexual contact, attempted rape, or completed rape • independent of school demographics

  4. Date Rape • >25% of college males admit to using sexually coercive behaviors • 2/3 of college males report engaging in unwanted sexual intercourse • reasons: peer pressure, desire to be liked

  5. Spousal Rape • 10 - 15% of all marriages • more violent, less frequently reported then non-spousal rape • not illegal in many U.S. states/other countries

  6. High Risk Groups • Prostitutes • Military • Homeless and runaways

  7. “High Risk” Perpetrators • Male college athletes • Fraternity members • Men with restraining orders

  8. Rape • 5% chance of pregnancy • 25% chance of acquiring STD • GC = 6 - 12% • Chlamydia = 4 - 17% • Syphilis = 0.5 - 3% • 1 -2/1,000 odds of acquiring HIV • varies

  9. Rape • Underreported • Less than 1% of rapists convicted • Average prison time for those convicted: • rape = 1 year • armed robbery = 3 - 5 years • murder = 8 years • Chemical Castration Laws

  10. The Physician’s Duties in Caring for Victims of Sexual Assaults • Medical • medical history • evaluate and treat physical injuries • cultures • treat pre-existing infections NEJM 1995; 332:234-7

  11. The Physician’s Duties in Caring for Victims of Sexual Assaults • Medical • offer post-exposure HIV prophylaxis • offer post-coital contraception (vs. in utero paternity testing f/b selective abortion) • arrange medical followup • provide counseling NEJM 1995; 332:234-7

  12. Physical Examination ofSexual Assault Victims • Collection of clothing • External evaluation • abrasions, lacerations, ecchymoses, bite marks • Oral cavity • secretions, injuries, cultures NEJM 1995; 332:234-7

  13. Physical Examination ofSexual Assault Victims • Genitalia • hair combing, hair sampling, vaginal secretions, injuries, cultures • Rectum • injuries, cultures NEJM 1995; 332:234-7

  14. Prophylaxis for Adult Victims ofSexual AssaultAntibiotic Prophylaxis • Ceftriaxone (250 mg IM) or Spectinomycin (2 g IM) PLUS • Doxycycline (100 mg po bid x 7d) or Azithromycin (1 g po x 1) PLUS • Metronidazole ( 2 g po x 1)

  15. Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy • 2 OCP tablets (each with 50 mcg ethinyl estradiol) po q12° x 2 OR • 3 OCP tablets (each with 35 mcg ethinyl estradiol) po q12 ° x 2 PLUS • Antiemetic

  16. HIV Post-Exposure Prophylaxis for Adult Victims ofSexual Assault • HIV Prophylaxis (studies ongoing) • Consult ID • start up to 72° after rape • Baseline HIV test and referral to experienced clinician within 72 hours of starting PEP

  17. Ensure Victim’s Safety • Social worker involvement • Restraining order • Phone numbers of shelters, hotlines • Safe place to go

  18. Domestic Violence Shelters • Availability poor • up to 70 - 80% of women and 80% of children turned away on any given night • Woefully underfunded • Average length of stay = 14 days; most allow 30 day max stay • Over 50% of all homeless women and children are fleeing domestic violence

  19. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org

More Related