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Management of Rape Victims

This comprehensive overview addresses the management and support for rape victims, highlighting critical statistics and guidelines for healthcare professionals. It includes key epidemiological data, such as the prevalence of rape among women, high-risk groups, and the legal challenges faced in prosecution. Additionally, it provides recommendations for the medical treatment of victims, including necessary post-exposure prophylaxis, counseling provisions, and evidence collection techniques. This resource emphasizes the importance of informed care and community support for survivors.

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Management of Rape Victims

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  1. Management of Rape Victims Martin Donohoe Information within does not constitute clinical advice regarding treatment – I recommend consulting contemporary medical references

  2. Rape • Unwanted, forced penetration (oral/vaginal/anal) • Reported by 33 -46% of women who are physically abused

  3. Rape • Annual incidence ³ 80/100,000 women • 7% of all violent crimes • Lifetime prevalence up to 25% • 1/3 Native Americans/Alaskan Natives victims of attempted rape or rape • Migrants, those in war zones and refugee camps at high risk

  4. Rape • Annual incidence of at least 300,000women in US • Forcible rape every 6.2 seconds (FBI) • 7% of all violent crimes • Additional 3.7 million confronted with unwanted sexual activity • Lifetime prevalence 13-39% in women; 3% in men

  5. Epidemiology of VAW • 2011 CDC study • 18% of women have been raped; 1.4% of men • Women: 52% by partner; 41% by acquaintance • Men: 52% by acquaintance; 15% by stranger

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

  7. 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

  8. 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

  9. High Risk Groups • Prostitutes • Military • See the “Women’s Health” and “War and Peace” pages of the Public Health and Social Justice website for other slide shows and articles covering: • Violence against women in the military • War, rape and genocide • Homeless and runaways

  10. High Risk Groups • Gays, lesbians, bisexuals, transgendered • Alcohol and drug users • College students • Persons under age 24

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

  12. Rape • 5% chance of pregnancy • 25% chance of acquiring STD • GC = 6 - 12% • Chlamydia = 4 - 17% • Syphilis = 0.5 - 3%

  13. Rape • 5% chance of pregnancy • 25% chance of acquiring STD • GC = 6 - 12% • Chlamydia = 4 - 17% • Syphilis = 0.5 - 3%

  14. Rape and HIV • 1 -2/1,000 odds of acquiring HIV from HIV+ rapist • 1-2/100,000 overall risk of HIV from vaginal penetration • 2-3/10,000 from anal penetration

  15. Rape and Pregnancy • Noninvasive prenatal genetic testing through amplification of fetal alleles from maternal blood very accurate for identifying father • Can be performed at 8-14 weeks gestation • vs. amniocentesis and chorionic villus sampling (10-15 weeks, risks to mother and fetus) • May assist mother’s decision to carry vs. terminate pregnancy

  16. Rape • Underreported (16-38% notify law enforcement; 17-43% present for medical evaluation) • Fewer than ½ of rape cases successfully prosecuted; as few as 1% of rapists convicted

  17. Rape • Large backlog of untested rape kits (over 180,000) • H.R. 4114 and S.B 2736 (Justice for Survivors of Sexual Assault) bills pending in Congress

  18. Rape • Average prison time for those convicted: • rape = 1 year • armed robbery = 3 - 5 years • murder = 8 years • Chemical Castration Laws

  19. 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 and NEJM 2011;365:834-41

  20. 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 and NEJM 2011;365:834-41

  21. Physical Examination ofSexual Assault Victims • Collection of clothing • External/internal evaluation • abrasions, lacerations, ecchymoses, bite marks; colposcopy, toluidine blue staining • Oral cavity • secretions, injuries, cultures • Note: time limits for evidence collection vary by state (72-120 hrs) • NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

  22. Physical Examination ofSexual Assault Victims • Genitalia • hair combing, hair sampling, vaginal secretions, injuries, cultures • Rectum • injuries, cultures NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

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

  24. Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy • Most effective oral regimen: 1 dose of 30 mg ulipristal or 1.5 mg levonorgestrelwithin 120 hours of unprotected intercourse (ulipristal twice as effective; 0.9% pregnancy rate vs 1.7%)

  25. Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy • Alternate regimen: 2 doses of 100 mcg ethinyl estradiol plus 0.5 mg levonorgestrel taken 12 hours apart (plus prn antiemetic) • Most effective: IUD implanted within 5 days • Nearly 100% effective

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

  27. Hepatitis B Post-Exposure Prophylaxis for Adult Victims ofSexual Assault • Offender HBsAg-positive: administer Hep B vaccine and HBIG • Offender’s HBsAg status unknown: administer Hep B vaccine • Rx ideally within 24 hrs, but may be effective up to 14 days • Complete Hep B vaccine series • Tetanus booster if indicated

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

  29. Domestic Violence Shelters • Availability poor • up to 70 - 80% of women and 80% of children turned away on any given night • 4 times as many animal shelters as domestic violence shelters in U.S.

  30. Domestic Violence Shelters • 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

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

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