Management of Rape
Victims
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Rape
Unwanted, forced penetration
(oral/vaginal/anal)
reported by 33 - 46% of women
who are physically abused
annual incidence 80/100,000
women
7% of all violent crimes
lifetime prevalence 10% - 25%
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Date Rape
40%
of college women
report forced sexual
contact, attempted rape, or
completed rape
independent of school
demographics
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Date Rape
25% of college males admit to
using sexually coercive behaviors
2/3 of college males report
engaging in unwanted sexual
intercourse
reasons: peer pressure, desire
to be liked
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Spousal Rape
10 - 15% of all marriages
more violent, less frequently reported
then non-spousal rape
not illegal in many U.S. states/other
countries
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High Risk Groups
Prostitutes
Military
Homeless
and runaways
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High Risk Perpetrators
Male
college athletes
Fraternity
Men
members
with restraining
orders
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Rape
5% chance of pregnancy
25% chance of acquiring STD
GC = 6 - 12%
Chlamydia = 4 - 17%
Syphilis = 0.5 - 3%
1 -2/1,000 odds of acquiring HIV
varies
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Rape
Underreported
Less than 1% of rapists convicted
Average prison time for those
convicted:
rape = 1 year
armed robbery = 3 - 5 years
murder = 8 years
Chemical Castration Laws
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The Physicians Duties in
Caring for Victims of Sexual
Assaults
Medical
medical history
evaluate and treat physical injuries
cultures
treat pre-existing infections
NEJM 1995; 332:234-7
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The Physicians Duties in
Caring for Victims of Sexual
Assaults
Medical
offer post-exposure HIV prophylaxis
offer post-coital contraception (vs. in
utero paternity testing f/b selective
abortion)
arrange medical followup
provide counseling
NEJM 1995; 332:234-7
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Physical Examination of
Sexual Assault Victims
Collection of clothing
External evaluation
abrasions, lacerations,
ecchymoses, bite marks
Oral cavity
secretions, injuries, cultures
NEJM 1995; 332:234-7
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Physical Examination of
Sexual Assault Victims
Genitalia
hair combing, hair sampling,
vaginal secretions, injuries,
cultures
Rectum
injuries, cultures
NEJM 1995; 332:234-7
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Prophylaxis for Adult
Victims of
Sexual Assault
Antibiotic Prophylaxis
Ceftriaxone (250 mg IM) or
Spectinomycin (2 g IM)
PLUS
Doxycycline (100 mg po bid x 7d) or
Azithromycin (1 g po x 1)
PLUS
Metronidazole ( 2 g po x 1)
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Prophylaxis for Adult
Victims of
Sexual Assault
Prevention of Pregnancy
2 OCP tablets (each with 50 mcg
ethinyl estradiol) po q12 x 2
OR
3 OCP tablets (each with 35 mcg
ethinyl estradiol) po q12 x 2
PLUS
Antiemetic
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HIV Post-Exposure
Prophylaxis for Adult
Victims of
Sexual
Assault
HIV Prophylaxis (studies ongoing)
Consult ID
start up to 72 after rape
Baseline
HIV test and referral to
experienced clinician within 72
hours of starting PEP
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Ensure Victims Safety
Social worker
involvement
Restraining order
Phone numbers of
shelters, hotlines
Safe place to go
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Domestic Violence Shelters
Availability poor
up to 70 - 80% of women and 80% of
children turned away on any given night
Woefully underfunded
Average length of stay = 14 days; most
allow 30 day max stay
Over 50% of all homeless women and
children are fleeing domestic violence
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Parveen Kumar Chadha with the vision
that nobody should suffer the way he
has suffered because of lack and
improper healthcare facilities in India.
We need lots of funds manpower etc.
to make this vision a reality please
contact us. Join us as a member for a
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