Rape refers to penetration of the vagina, anus, or mouth that involves threats or force.
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Victims may have tears in their genitals (such as the vagina) or anus, cuts and bruises, upsetting emotions, and difficulty sleeping.
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Sexual transmitted diseases, including infection with the HIV (human immunodeficiency virus), and pregnancy are risks.
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Women or men who are raped should be thoroughly evaluated in a center staffed by specially trained people (rape center).
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Treatment of physical injuries, antibiotics to prevent infections, emergency contraception, and counseling or psychotherapy are often needed.
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If possible, family members and close friends should meet with a member of the rape crisis team to discuss how to support a rape victim.
Rape is typically considered to be penetration of the
another person's vagina, anus, or mouth when it is unwanted and/or the
person does not consent to it (called nonconsensual). In people younger
than the age of consent, penetration of the vagina, anus, or
mouth—whether wanted or not—is considered rape (statutory rape).
Sexual assault is a broader term, including the use of
force and threats to coerce any sexual contact. The victim is a person
who does not consent or who cannot consent because of mental or physical
disability or intoxication (is incapacitated). Sexual assault also
includes seduction of a child through offers of affection or bribes and
unwanted touching, grabbing, or kissing.
The reported percentage of women who have been raped during their
lifetime varies widely: from 2% to almost 30%. The reported percentage
of children who are sexually abused is similarly high (see Sexual abuse).
Reported percentages are probably lower than the actual percentages
because rape and sexual abuse are less likely to be reported to the
police than are other crimes.
Typically, rape is an expression of aggression, anger, or the
need for power and control rather than sexually motivated. Many women
who are raped are also physically beaten and/or injured.
Men are also raped. The perpetrator is often another man, and the
rape often occurs in prison. Men are more likely than women to be
physically injured, to be unwilling to report the rape, and to have
several assailants.
Symptoms
Symptoms and complications of rape can include
Physical injuries resulting from a rape may include injuries of
the anus or genitals, such as tears in the upper part of the vagina, and
injuries to other parts of the body, such as bruises, black eyes, cuts,
and scratches.
The psychologic effects of a rape are often more devastating than the physical.
Initial symptoms
Immediately after a rape, victims may have symptoms of stress (called acute stress disorder).
The victim's behavior can range from talkativeness, tenseness, crying,
and trembling to shock and disbelief to lack of emotion, stillness, and
smiling. Lack of emotion rarely indicates lack of concern. Rather it is
probably a way to avoid thinking about what has happened or to keep
emotions under control. Or the victim may show little or no emotion
because of physical exhaustion or emotional numbness.
Rape victims typically also feel fearful, anxious, and irritable.
They may feel angry, depressed, embarrassed, ashamed, or guilty
(wondering whether they may have done something to provoke the rape or
could have done something to avoid it). Their anger may be directed at
themselves or misdirected at hospital staff or family members.
Difficulty sleeping and nightmares are common.
Posttraumatic stress disorder
Some victims develop posttraumatic stress disorder (PTSD). It is diagnosed when symptoms do the following:
Symptoms of posttraumatic stress disorder include
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Re-experiencing the trauma (for example, as flashbacks or intrusive and upsetting thoughts or images)
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Avoiding situations, thoughts, and feelings related to the trauma
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Having problems with thinking and mood (such as feeling responsible for the rape or not being able to have any positive feelings)
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Being excessively alert for signs of danger and being easily startled
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Feeling extremely tense, agitated, or irritable and unable to relax
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Having problems concentrating and sleeping
Many victims have both PTSD and depression.
For most victims, symptoms lessen substantially over a period of months.
Risk of infection or pregnancy
After a rape, there is a risk of infection with sexually transmitted diseases (such as gonorrhea, trichomoniasis, chlamydial infection, and syphilis), hepatitis B, hepatitis C, and other infections including bacterial vaginosis). Infection with the human immunodeficiency virus (HIV) is a particular concern, even though the chances of acquiring it in a single encounter are low.
A woman may also become pregnant.
Evaluation
Having a thorough medical evaluation after a rape is important.
Whenever possible, women who have been raped or sexually assaulted are
taken to a sexual assault center that is staffed by trained, concerned
support personnel, such as sexual assault nurse examiners (SANE). The
center may be a hospital emergency department or a separate facility.
Some areas have a sexual assault response team (SART), which includes
people who work in health care, forensics, the local rape crisis center,
law enforcement, and the prosecutor's office. Men who have been raped
should also seek medical attention. They are treated in much the same
way as women who have been raped.
After a rape, the victim decides whether to consent to actions
that will allow eventual prosecution. Advantages and disadvantages of
proceeding with such actions should be explained. The victim should feel
no pressure to consent, although consent is generally in the victim's
best interest.
If the victim chooses to proceed, doctors are required by law to
notify the police and to examine the victim. The examination can provide
evidence for prosecution of the rapist. The best evidence is obtained
when the rape victim goes to the hospital as soon as possible, without
showering or washing, without brushing the teeth, without clipping
nails, without changing clothes, and, if possible, without even
urinating. The medical record resulting from this examination is
sometimes used as evidence in court proceedings. However, the medical
record cannot be released unless the victim gives consent in writing or a
subpoena is issued. The record may also help the victim recall details
of the rape if the victim's testimony is required later.
Immediately after a rape, the victim may be hesitant or afraid of
undergoing a physical examination. Before the examination, victims are
asked whether they prefer a male or a female doctor. If a male doctor
examines a woman, a female nurse or volunteer is present to help allay
any anxiety the woman may be feeling. Privacy and quiet are provided
whenever possible.
Before beginning the examination, the doctor explains what will
be done during the examination and asks the victim for permission to
proceed. The victim should feel free to ask any questions about the
examination and its purpose.
The doctor asks the victim to describe the events to help guide
the examination and treatment. However, talking about the rape is often
frightening and distressing. The victim may request to give a complete
description later, after immediate needs have been met. The victim may
first need to be treated for injuries and to have some time for calming
down.
To help determine the likelihood of pregnancy, the doctor asks
the woman when her last menstrual period was and whether she uses a
contraceptive. To help interpret the analysis of any sperm samples, the
doctor asks if the victim recently had sex before the rape and, if so,
when.
The doctor notes physical injuries, such as cuts and scrapes, and
may examine the genitals and anus for injuries. Photographs of injuries
are taken. Because some injuries such as bruises become apparent later,
a second set of photographs may be taken later.
A swab is used to take samples of semen and other body fluids for
evidence. Other samples, such as samples of the perpetrator’s hair,
blood, or skin (sometimes found under the victim's nails), are
collected. Sometimes DNA testing of the samples is done to identify the
perpetrator. Some of the victim’s clothing may be kept for evidence.
If the victim consents, blood tests are done to check for
infections, including HIV infection. If the initial test results for
gonorrhea, chlamydial infection, syphilis, and hepatitis are negative,
the victim is tested again at 6 weeks. If results for syphilis and
hepatitis are still negative, tests are repeated at 6 months. Blood
tests for HIV infection may be repeated after 90 and 180 days. In women,
a Papanicalaou (Pap) test is done to check for human papillomavirus (HPV) infection after 6 weeks.
Usually, a pregnancy test
to measure the level of human chorionic gonadotropin in the urine is
done during the initial examination of women who have been raped to
detect any preexisting pregnancy. If the results are negative, the test
is repeated within 6 weeks to check for pregnancy that may have resulted
from the rape.
Treatment
After the examination, the victim is offered facilities to wash, change clothing, use mouthwash, and urinate if needed.
Any physical injuries are treated. Tears in the genitals or anus may need to be surgically repaired.
Preventing infections
For preventing sexually transmitted diseases, the victim is given antibiotics. For example, all of the following may be given:
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One dose of metronidazole given by mouth (to prevent trichomoniasis and, in women, bacterial vaginosis)
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Either doxycycline given by mouth for 7 days or azithromycin given by mouth once (to prevent chlamydial infections)
Victims who have not been vaccinated against hepatitis B are
given the vaccine, followed by two more doses, one 1 month and one 6
months after the first dose.
If test results for HIV are positive, the victim probably had HIV
infection before the rape because HIV infection acquired through sexual
intercourse typically cannot be detected until 9 days to 6 months
later. If test results for HIV are positive, treatment for HIV is started immediately.
If test results for HIV are negative, the HIV test is repeated several times over the next several months.
Regardless of test results, treatment to prevent HIV infection
may be offered to the victim. On average, the chance of developing HIV
infection after rape from an unknown assailant is low—only about 0.2%.
Risk may be higher if any of the following occurred:
Treatment to prevent HIV infection is most effective if started within 4 hours after penetration and should not be given if more than 72 hours have passed since penetration.
Preventing pregnancy
If the woman is not already pregnant, emergency contraception
is provided if the woman wants it. Usually, it consists of a high dose
of an oral contraceptive given immediately, then repeated 12 hours
later. This treatment is 99% effective if given within 72 hours of the
rape.
Inserting an intrauterine device (IUD) within 10 days of the rape is even more effective.
If pregnancy results from the rape, women may consider abortion.
Providing psychologic support
Doctors explain the psychologic reactions that commonly occur
after the rape (such as excessive anxiety or fear or guilt) to the
victim. This information can help victims accept and deal with their
reactions.
As soon as feasible, a person trained in rape crisis intervention
meets with the victim. Victims are referred to a rape crisis team if
one is located in the area. This team can provide helpful medical,
psychologic, and legal support. For victims, talking about the rape and
their feelings about it can help them recover.
Victims may be referred to a psychologist, social worker, or psychiatrist.
Family members and friends may have some of the same feelings as
the victim: anxiety, anger, or guilt. They may irrationally blame the
victim. Thus, in addition to their own feelings, rape victims may have
to handle negative, sometimes judgmental or derisive reactions of family
members and friends, as well as those of officials. These reactions can
interfere with recovery. Family members or close friends may benefit
from meeting with a member of the rape crisis team or sexual assault
evaluation unit to discuss their feelings and how they can help the
victim. Usually, listening supportively to the victim and not expressing
strong feelings about the rape are most helpful. Blaming or criticizing
the victim may interfere with recovery.
A support network of health care practitioners, friends, and family members can be very helpful to the victim.
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