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PATIENT STORIES

CASE 1

A 19-year-old college woman presents to the office after being raped 3 weeks ago. She went out on a date and was forced to have sex against her will. She states that she had been a virgin and that he made her bleed by penetrating her vagina with his penis. She tried to stop him, but was afraid to fight too hard because he was a strong man and was drunk. She is in tears as she tells her story. She waited so long to come in for help because she did not know where to turn. She took emergency contraception (EC) immediately, and a home pregnancy test taken last night was negative. She wants to be checked for any sexually transmitted infections (STIs). Upon examination, there is a tear of her hymen at the 5-o'clock position that has healed (Figure 12-1). There are no signs of infection, and sexually transmitted infection (STI) screening is performed. She is afraid to prosecute but would like to be referred to a rape-counseling program.

FIGURE 12-1

External genitalia of a 19-year-old college girl showing the tear of her hymen at approximately the 5-o'clock position. This was the result of date rape 3 weeks before the photograph was taken. (Reproduced with permission from Nancy D. Kellogg, MD.)

CASE 2

A 47-year-old woman is seen in follow-up for depression. She admits to being raped in a parking lot several months prior but did not report it to the police. She is continuing to have intrusive nightmares and flashbacks of the event. She is having difficulty concentrating at work and does not feel comfortable in social situations.

INTRODUCTION

Sexual violence is a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse.1 It may involve actual or threatened physical force, use of guns or other weapons, coercion, intimidation, or pressure. Sexual violence includes unwanted penetration (completed or attempted with or without alcohol/drug facilitation) defined as physical insertion, however slight, of the penis into the vulva; contact between the mouth and the penis, vulva, or anus; or physical insertion of a hand, finger, or other object into the anal or genital opening of another person. Sexual violence also includes unwanted sexual contact (intentional touching either directly or through clothing of the genitals, anus, groin, breast, inner thigh, or buttocks against a victim's will or when a victim is unable to consent) and noncontact unwanted sexual experiences, such as voyeurism, intentional exposure to exhibitionism, undesired exposure to pornography, verbal or behavioral sexual harassment, threats of sexual violence, or taking nude photographs of a sexual nature of another person without his or her ...

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