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Sexual Assault and Rape

By

Erin G. Clifton

, PhD, University of Michigan

Medically Reviewed Jul 2022 | Modified Sep 2022
VIEW PROFESSIONAL VERSION

Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault, including rape, may cause physical injury or illness or psychologic trauma. Survivors should be evaluated for injury, sexually transmitted infections, pregnancy, and acute or posttraumatic stress disorders; they are asked to give permission for an examination to collect evidence. Treatment includes infection prophylaxis and mental health care.

  • Sexually assault victims may have tears in their genitals or anus, cuts and bruises, upsetting emotions, and difficulty sleeping.

  • Sexually transmitted infections, infection with the HIV (human immunodeficiency virus), and pregnancy are risks.

  • People who are raped should be thoroughly evaluated in a center staffed by specially trained people (rape center).

  • Treatment of physical injuries, vaccinations and antibiotics to prevent or treat infections, emergency contraception, and counseling or psychotherapy are often needed.

  • If possible, family members and close friends should meet with a member of the rape crisis team to discuss how to support the rape victim.

Rape is typically considered to be any penetration of the vagina or anus with any body part or object or penetration of the mouth with another person's sex organ when the person does not or cannot consent to it (called nonconsensual sexual contact). Consent cannot be given by a person who is incapacitated (because they are intoxicated or have mental or physical limitations). In people younger than the age of consent, penetration of the vagina, anus, or mouth—whether wanted or not—is considered rape (statutory rape).

Typically, rape is an expression of aggression, anger, or the need for power and control rather than being sexually motivated. Many people who are raped are also physically beaten and/or injured.

Sexual assault is a broader term. It is defined as any type of sexual activity or contact that a person does not consent to. Sexual assault may include 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 they are incapacitated.

Victims of rape and sexual assault include people of all genders. However, women and girls have the highest rates of being raped and sexually assaulted. The reported percentage of women who have been raped during their lifetime varies widely—from 2% to almost 30%. 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. Men who are raped are more likely than women to be physically injured, to be unwilling to report the assault, and to have several assailants.

Symptoms and Effects of Rape and Sexual Assault

Symptoms and complications of rape and sexual assault 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). Rape can also have long-term effects on physical health.

The psychologic effects of a sexual assault or rape are often more devastating than the physical.

Immediate effects

Immediately after a sexual assault, the victim's behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief to lack of emotion and stillness. 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.

Sexual assault 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

For most victims, symptoms lessen substantially over a period of months.

  • Continue for more than a month

  • Significantly interfere with a victim's social activities and work

  • Are not caused by another medical problem or drug use

Symptoms of PTSD include

  • Re-experiencing the trauma (for example, as flashbacks or intrusive and upsetting thoughts or images)

  • Avoiding situations, thoughts, and feelings related to the trauma

  • Having problems with thinking and mood (such as feeling responsible for the assault or not being able to have any positive feelings)

  • Being unable to remember significant parts of the event

  • Being excessively alert for signs of danger and being easily startled

  • Feeling extremely tense, agitated, or irritable and unable to relax

  • Having problems concentrating and sleeping

Risk of infection or pregnancy

After a rape, there is a risk of infections such as sexually transmitted infections (such as gonorrhea Gonorrhea Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, and throat or the membranes that cover... read more Gonorrhea , trichomoniasis Trichomoniasis Trichomoniasis is a sexually transmitted infection of the vagina or urethra that is caused by the protozoa Trichomonas vaginalis and that causes vaginal irritation and discharge and sometimes... read more , chlamydial infections Chlamydial and Other Nongonococcal Infections Chlamydial infections include sexually transmitted infections of the urethra, cervix, and rectum that are caused by the bacteria Chlamydia trachomatis. These bacteria can also infect... read more Chlamydial and Other Nongonococcal Infections , human papillomavirus infection, and syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Syphilis can occur in three stages of symptoms, separated by periods of apparent good health. It... read more Syphilis ), hepatitis B Hepatitis B, Acute Acute hepatitis B is inflammation of the liver that is caused by the hepatitis B virus and that lasts from a few weeks up to 6 months. Hepatitis B is spread through contact with blood or other... read more , hepatitis C Hepatitis C, Acute Acute hepatitis C is inflammation of the liver that is caused by the hepatitis C virus and that lasts from a few weeks up to 6 months. Hepatitis C is spread through contact with blood or other... read more , and bacterial vaginosis Bacterial Vaginosis (BV) Bacterial vaginosis is a vaginal infection that occurs when the balance of bacteria in the vagina is altered. Women who have a sexually transmitted infection, who have several sex partners,... read more . Infection with the human immunodeficiency virus Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more Human Immunodeficiency Virus (HIV) Infection (HIV) is a particular concern, but the chances of acquiring it in a single encounter are low.

A woman may also become pregnant.

Evaluation of Rape and Sexual Assault

  • A physical examination

  • If the victim consents, tests to collect evidence and check for sexually transmitted infections

  • A pregnancy test

If people have been a victim of rape, having a thorough medical evaluation is important. Whenever possible, people 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.

The sexual assault care team explains the procedures (physical examination and other tests) for collecting evidence that could allow eventual prosecution, and the victim decides whether to consent. Advantages and disadvantages of proceeding with such actions are explained. The victim should feel no pressure to consent.

If the victim chooses to proceed, health care practitioners 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. The medical team does everything possible to make the person feel comfortable and safe.

Before each step of the examination, the health care practitioner explains what will be done and asks the victim for permission to proceed. The victim should feel free to ask any questions about the examination and its purpose. The victim should also feel free to refuse any part of the examination.

The health care practitioner usually 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.

When the victim is able, the doctor asks the victim questions about the rape such as the following:

  • Which body parts were involved (vagina, mouth, and/or rectum)?

  • Did ejaculation (discharge of semen) occur?

  • Was a condom used?

  • Did the perpetrator threaten, use a weapon, or behave violently?

  • What did the perpetrator look like?

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. Colposcopy Colposcopy Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms. If women have symptoms related to the reproductive system (gynecologic... read more Colposcopy may be done to check for subtle genital injuries. For colposcopy, the vagina and cervix and/or anus are examined using a magnifying instrument.

Testing and evidence collection

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 and urine tests are done to check for infections, including HIV infection.

If the initial test results for pregnancy and sexually transmitted infections are negative or if the victim refused treatment for sexually transmitted infections, the victim is tested again:

  • At 1 week: Gonorrhea, chlamydial infections, and trichomoniasis

  • At 2 weeks: Pregnancy

  • At 4 to 6 weeks: Syphilis and HIV infection

  • At 3 months: Syphilis, hepatitis, and HIV infection

Usually, a pregnancy test Detecting and Dating a Pregnancy Pregnancy begins when an egg is fertilized by a sperm. For about 9 months, a pregnant woman’s body provides a protective, nourishing environment in which the fertilized egg can develop into... read more 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 2 weeks to check for pregnancy that may have resulted from the rape.

If the victim has amnesia for events around the time of rape, doctors may check for the date rape drug (flunitrazepam) and gamma hydroxybutyrate (a recreational drug) Gamma Hydroxybutyrate (GHB) Gamma hydroxybutyrate (GHB or "G") is taken by mouth, usually in liquid form. It is similar to ketamine or alcohol in its effects. (See also Drug Use and Abuse.) GHB produces feelings of relaxation... read more . Testing for recreational drugs and alcohol is controversial because evidence of intoxication may be used to discredit the victim.

If tears in the vagina are severe, especially in children, laparoscopy may be done. For laparoscopy, a flexible viewing tube is inserted into the vagina or other organs so that they can be directly examined.

Treatment of Rape and Sexual Assault

  • Treatment of any physical injuries

  • Drugs and sometimes vaccines to prevent infections, including HIV infection

  • Emergency contraception if the woman wants it

  • Psychologic support or intervention

After the examination, the victim is offered facilities to wash, change clothing, use mouthwash, and urinate and defecate if needed.

Any physical injuries are treated. Tears in the genitals or anus may need to be surgically repaired.

Providing psychologic support

Health care practitioners explain the psychologic reactions that commonly occur after a sexual assault (such as excessive anxiety or fear or guilt) to the victim. This information can help victims accept and deal with their reactions. Practitioners also reassure the victims that the assault was not their fault and provide general support.

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.

If victims continue to have symptoms after the rape, they 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 other negative 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 assault 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.

Preventing or treating infections

Sexually transmitted infections are treated with antibiotics.

Victims who have not been vaccinated against hepatitis B are given the vaccine, followed by two more doses, at 1 month and 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 Drug Treatment of Human Immunodeficiency Virus (HIV) Infection Antiretroviral drugs used to treat human immunodeficiency virus (HIV) infection aim to do the following: Reduce the amount of HIV RNA (viral load) in the blood to an undetectable amount Restore... read more is started immediately.

If test results for HIV are negative, the HIV test is repeated several times over the next several months.

Drugs 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. Risk may be higher if any of the following occurred:

  • Anal penetration

  • Bleeding (from the assailant or victim)

  • Male-male rape

  • Rape by several assailants (as may happen to men in prison)

  • Rape that occurs in areas where HIV infection is unusually common

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

Emergency contraception Emergency Contraception Emergency contraception is used after an act of unprotected sexual intercourse or after an occasion when a contraceptive method fails (for example, when a condom breaks). Emergency contraception... read more is provided if the woman wants it and has a negative pregnancy test. Usually, it consists of a high dose of a hormonal drug given immediately by mouth, then repeated 12 hours later.

Inserting an intrauterine device (IUD) within 5 days of the rape is also effective at preventing pregnancy.

If pregnancy results from the rape, doctors counsel women about their options, including continuing the pregnancy or abortion.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
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