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Key Features

Essentials of Diagnosis

  • The term "sexual violence" is used by the Centers for Disease Control and will be used here instead of "rape"

  • Sexual violence is sometimes committed by a stranger, but more commonly is by an assailant known to the victim, including a current or former partner or spouse (a form of intimate partner violence [IPV])

  • All victims of sexual violence should be offered emergency contraception, and counseled that this method does not induce abortion

  • Knowledge of state laws and collection of evidence as required by law are essential for clinicians evaluating possible victims of sexual violence and IPV

General Considerations

  • The legal definition of rape varies state and geographic location

  • Clinicians and emergency department personnel who deal with victims of sexual violence should be familiar with the laws pertaining to sexual assault in their own state

  • From a medical and psychological viewpoint, it is essential that persons treating victims of sexual violence recognize the nonconsensual and violent nature of the crime

  • Penetration may be vaginal, anal, or oral and may be by the penis, hand, or a foreign object

  • The absence of genital injury does not imply consent by the victim

  • The assailant may be unknown to the victim or, more frequently, may be an acquaintance or even the spouse

  • "Unlawful sexual intercourse," or statutory rape, is intercourse with a female before the age of majority even with her consent

Clinical Findings

Symptoms and Signs

  • Each patient will react differently to this personal crisis, but anxiety disorders and posttraumatic stress disorder (PTSD) are common sequelae

Rape trauma syndrome

  • Immediate or acute

    • Shaking, sobbing, and restless activity may last from a few days to a few weeks

    • The patient may experience anger, guilt, or shame or may repress these emotions

    • Reactions vary depending on the victim's personality and the circumstances of the attack

  • Late or chronic (weeks or months later)

    • The individual's lifestyle and work patterns change

    • Sleep disorders or phobias often develop

    • Loss of self-esteem can rarely lead to suicide

Diagnosis

Laboratory Tests

  • Culture the vagina, anus, or mouth (as appropriate) for Neisseria gonorrhoeae and Chlamydia

  • Perform a Papanicolaou smear of the cervix, a wet mount for Trichomonas vaginalis, a baseline pregnancy test, and VDRL test

  • A confidential test for HIV viral load or antibody is recommended (with the patient's consent); antibody testing is repeated in 2–4 months if initially negative

  • Repeat the pregnancy test if the next menses is missed, and repeat the VDRL test in 6 weeks

  • Obtain blood (10 mL without anticoagulant) and urine (100 mL) specimens if there is a history of suspected or forced ingestion or injection of drugs (eg, rohypnol) or alcohol

Diagnostic Procedures

  • The ...

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