Rape and Sexual Assault

  • Welch J
  • Mason F
  • Mason2 F
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Abstract

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. Sexual violence is a global problem. The lifetime risk of attempted or completed rape is up to 20% for women, but men and children are also often sexually violated.' Sequelae include unwanted pregnancies; sexually trans mitted infections, including HIV; depression; and post traumatic stress disorder. Most of the literature on rape and sexual assault is retrospective, but we aim to provide an evidence based review of their management. Who is sexually assaulted? Anyone can be sexually assaulted but some people are especially vulnerable, such as adolescents and young women, people with disabilities, poor and homeless people, sex workers, and those living in institutions or areas of conflict.' Consumption of alcohol is com monly linked with sexual assault,' although covert administration of drugs seems to be unusual.' -' Perpe trators are usually one or more males known to the victim and often motivated by power and control; many women experiencing domestic violence also endure forced sexual activity.4 In Britain fewer than 20% of people who have experienced sexual violence report it to the police.4 People often seek medical help shortly or rather later after sexual assault, although they may not disclose the reason for their presentation. Legal definitions of sexual offences vary inter nationally. Practitioners should be aware of local legis lation and practice so that their actions do not compromise further investigations and court hearings. In England and Wales the law was comprehensively revised in the Sexual Offences Act 2003. Rape is defined as the non-consensual penetration of the vagina, mouth, or anus, by a penis; both sexes can be raped. Assault by penetration is the non-consensual, intentional insertion of an object other than the penis, into the vagina or anus. Specific offences relate to children. What is the initial management? Care should be guided by the individual's wishes and needs and provided sensitively in a coordinated and timely fashion to avoid the need for attendance at mul tiple services.' Considerations after recent assault include treatment of injuries, preservation of evidence, prevention of unwanted pregnancies and sexually transmitted infections, and psychosocial support. Descriptive studies have found that most women and men reporting rape prefer to be examined by a woman.' How can services be accessed? Sexual assaults are often first reported to the police. Many forces have officers with specialist training who can provide excellent initial care and facilitate access to further services such as sexual assault centres: special ist services providing around the clock forensic exam inations, other medical and psychological services, and aftercare in a secure and sensitive setting, thereby increasing access to support and services.78 As well as seeing people who have been referred by the police, sexual assault centres may also see people referred by other agencies and self referralsw' and can collect infor mation and evidence anonymously to assist in identify ing serial rapists. Treabtent of injuries Descriptive studies have reported injuries in about half of people reporting sexual assault, with non-genital injuries more common than genital injuries.') "' w The absence of genital injury does not imply consent or exclude penetration, even in women who deny pre vious sexual activity."' Injuries are usually minor but should be documented and may need treatment. Major trauma-for example, head injury-is uncommon but may be life threatening and so its management takes precedence over forensic examination. Victims with significant vaginal or anal bleeding after penile pene tration or assault with a foreign body should be

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Authors

  • Jan Welch

  • Fiona Mason

  • Fiona Mason2

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