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Case 1

A 19-year-old college girl 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 11-1). There are no signs of infection and STI screening is performed. She is afraid to prosecute but would like to be referred to a rape-counseling program.

Figure 11-1

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. (Courtesy of 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.

Sexual violence is a sex act completed or attempted against a victim's will or when a victim is unable to consent because of age, illness, disability, or the influence of alcohol or other drugs.1 It may involve actual or threatened physical force, use of guns or other weapons, coercion, intimidation, or pressure. Sexual violence includes unwanted intercourse (completed sex act defined as contact between the penis and the vulva or penis and anus involving penetration); an attempted sex act, abusive 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 sexual abuse, 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 consent or knowledge or of a person unable to consent or refuse.

  • Based on the National Intimate Partner and Sexual Violence Survey (NISVS; 2010) of more than 16,000 adults, nearly 1 in 5 women (18.3%) and 1 in 71 men (1.4%) in ...

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