Article: Sexual assault

Rape is forced sexual activity. For causation, sociological issues, etc. please see that article for a detailed list of related articles, including Physical sexual harassment, Long-term sexual abuse, child molestation, Torture, etc. Also see Rape (disambiguation).

This medical emergency article is limited to the practical aspects of dealing with sexual assaults once they have occurred with limited tips on prevention.

Sexual assault is any undesired physical contact of a sexual nature perpetrated against another person. While associated with rape, sexual assault is much broader and the specifics may vary according to social, political or legal definition.

According to the U.S. Department of Health and Human Services, sexual assault includes "inappropriate touching, vaginal, anal, or oral penetration, sexual intercourse that [one says] no to, rape, attempted rape, [and] child molestation."[1]

Aggressors may include, but are not limited to, strangers, acquaintances, superiors, legal entities (as in the case of torture), or even family members. Often, the act is accomplished by force sufficient to cause physical injury. At other times, even though no lasting physical injury is sustained, the psychological damage done by this intimate violation may be substantial.

Doctors and police in sexual assault response and prevention

Anyone is a potential victim of sexual assault. A person who is the victim of sexual assault may require assistance from medical and law enforcement resources. Medical and law enforcement professionals strongly recommend that a victim call for help and report what has happened.

Medical professionals are concerned for the well-being of the victim, who may need immediate medical attention, not only for injuries, but against sexually transmitted disease, and possibly to avoid unwanted conception. In many locations, EMTs, emergency room nurses and doctors are trained to help rape victims. Some emergency rooms have rape kits which are used to collect evidence.

"A victim of sexual assault should be offered prophylaxis for pregnancy and for sexually transmitted diseases, subject to informed consent and consistent with current treatment guidelines. Physicians and allied health practitioners who find this practice morally objectionable or who practice at hospitals that prohibit prophylaxis or contraception should offer to refer victims of sexual assault to another provider who can provide these services in a timely fashion." -- [2] from American College of Emergency Physicians: Management of the Patient With The Complaint Of Sexual Assault

Police are concerned to enforce the laws forbidding sexual assault and gather evidence to identify and prosecute the offender. Further, police provide safety advice and prevention tips, to prevent people from becoming victims of sexual assault.

What to do after a sexual assault

• First take measures to avoid additional harm, typically by escaping the attacker and/or moving to a place of safety.
• If an emergency exists, call for help using means available.
• Go to a hospital emergency room for medical attention.
• Find out about support and counseling options from community health resources. These include national hotlines such as the National Sexual Assault Hotline at 1.800.656.HOPE and the National Domestic Violence Hotline 1-800-799-SAFE (7233) or 1-800-787-3224 (TDD)
• Consider documenting the incident by writing down any details you can remember, to assist investigators.
• Consider whether you wish the hospital to perform rape kit evidence collection.
• Consider the extent to which you wish to answer police and detective questions, such as saying what happened in your own words and providing information about the attacker.
• Tell investigators about any physical evidence related to the crime.

What NOT to do after a sexual assault

• Shower, bathe or "clean up" as this will destroy important evidence.
• Disturb the location where the event took place, as the crime scene contains important evidence.
• Change clothing.
• Eat, drink or smoke.
• Brush teeth.
• Urinate (don't wipe) or douche

First aid for sexual assault

• Render lifesaving care and basic care as appropriate to physical injuries. Do not touch items on scene except as necessary to render patient care. (First Responder: National Standard Curricula)

• Consider whether it is best to call for help or assist the victim in self-transport to the nearest hospital emergency room.

• Due to the sensitive nature of this criminal offense, first-aiders should be scrupulous about respecting the victim's wishes.

Field care (for EMTs)

Follow local protocols. Provide supportive care for other injuries as appropriate. Fully document any care given and additional information for use by later investigators.

Clinical treatment

Victims almost universally suffer psychological damage consistent with the severity of the assault. Thus, dealing with such victims calls for tact and sensitivity from persons who would help the victim. In Western countries, forcible rape is considered a medical emergency and survivors are encouraged to call for help to report this criminal act and medical emergency.

Psychological first aid in the immediate aftermath of the assault is important to successful emotional recovery from a sexual assault. Sensitivity and tact is required. Physical injuries such as gynecologic hemorrhage may have resulted. Preventative treatment against sexually transmitted diseases may be required.

Voluntary administration of emergency contraception may be considered in societies where such administration is both socially acceptable and legal. Most Western societies fall into this classification, while most African and South American societies, and many Asian societies, do not. Health care providers in societies where emergency contraception is available should be aware that failing to inform patients of the availability may leave them open to allegations of malpractice.

All hospital emergency rooms should have complete procedures in place for assisting victims of sexual assault. Collection of evidence such as DNA samples which can help in criminal prosecution of the assailant should follow rigorous chain of custody procedures. See Rape kit.

Victims should be referred to additional resources and made aware of their rights under policy and law.

Prevention of sexual assault

Police agencies routinely offer safety tips and advice for preventing sexual assault. Many argue that there are risk factors for sexual assault that lie with the victim; that is, certain behaviors by the victim exist may increase the chance of sexual assault. Others dispute this, and argue that victim behavior is not a contributing or causal factor.

While it is widely accepted that the victim is not to blame, for would-be victims of sexual assault, there are a variety of precautions that may be taken to minimize the chance of falling victim to sexual predators. Various reputed organizations and legal agencies have provided suggestions to this end, including the U.S. Immigration and Customs Enforcement, The U.S. Department of Health and Human Services, The Canadian Women's Sexual Assault Centre, RapeCrisis.org.uk, and Amnesty International.

The advice given is extensive, and vary in specifics, they all tend to include certain precautions:

• • Avoid being alone in public, particularly at night, or in dark and/or isolated places.
  • Maintain situational awareness. Be aware of other persons.
  • Keep personal information (such as name, address and telephone numbers) on your person, and not on key-chains.
  • Keep your vehicle and home locked.
  • Avoid isolated places such as deserted parking lots or stairwells in office buildings as much as possible.
  • If a motorist asks for assistance, stand a distance from the vehicle.
  • Be alert. Never sleep in public - including buses, cabs and benches. Have car and house keys ready before you reach the door.
  • Walk facing traffic.
  • Trust your instincts- if you feel you are being followed, if you have suspicions about a minor auto accident, or being stopped by a police official, keep driving to a well-lit, populated area before stopping.
  • Don't allow yourself to be alone with someone who you do not know or trust.
  • If you are in trouble or feel you are in danger, don't be afraid to attract help any way you can. Scream, yell or run away to safety.
  • If you choose to carry any type of weapon for self-protection, give careful consideration to your ability and willingness to use it. Remember there is always the chance that it could be taken away and used against you.

See also

• Rape
• Medical emergency
• Rape kit