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Rape

Definition

Rape is defined as sexual intercourse forced on a person without his or her permission, either by threat of force or on someone who is unable to give consent.

Sexual intercourse may be vaginal, anal, or oral, and may involve the use of a body part or an object.

Alternative Names

Sex and rape; Date rape; Sexual assault

Information

According to most estimates, 80% - 90% of rapes are not reported to police. Current trends project that 1 in 3 American women will be sexually assaulted at some point during her life.

The typical rape victim is a 16 - 24-year-old woman. Anyone, however -- man or woman, adult or child -- can be the victim of rape. Other important facts about rape include:

  • Most commonly, the rapist is a 25 - 44-year-old man who plans his attack. He usually chooses a woman of the same race.
  • Nearly half the time, the victim knows the rapist from working or living near him.
  • Alcohol is involved in more than one out of three rapes.
  • Over one-half of rapes occur in the victim's home. The rapist breaks into the victim's home or gains access under false pretenses, such as asking to use the phone or posing as a repairman or salesman.

Date rape occurs when someone forces another person they are dating or spending time with to have sex. Date rape may involve the use of drugs such as flunitrazepam (Rohypnol).

Rape is a violent act, and is most often committed by a male upon a female. However, some cases of rape have been reported in which a woman has raped a man.

  • Rape also may occur between members of the same sex. This is more common in places such as prisons, military settings, and single-sex schools.
  • Those with physical or mental disabilities or limited language skills are also at higher risk, as are prostitutes.

The best response when being attacked may depend on both the victim and the situation. Attempting to get away and yelling for help is a good first step in most situations. Whether to fight back may depend on the size and behavior of the attacker, as well as whether he is armed.

AFTER A RAPE HAS OCCURRED

The victim may be acquainted or even live or work with a person who committed sexual assault. It is essential that rape victims be placed in an environment afterwards where they feel safe.

Victims of rape should be helped to understand that nothing about what happened was their fault. Nothing that they did should have allowed someone to have sex with them against their will. This includes dressing suggestively, or even kissing or performing other physically intimate activities with the person. Any fault or blame is solely on the rapist.

People who are raped may or may not be able to say that they were raped or seek help. Some may seek medical help for a different complaint, such as headaches, eating problems, pain, and sleep problems.

Emotional reactions differ greatly and may include:

  • Confusion or loss of emotional control
  • Crying or feeling numb
  • Fear, anger, and hostility
  • Nervousness or inappropriate laughter
  • Not eating or sleeping well
  • Tightly controlled behavior
  • Withdrawal from family or friends

Other physical problems are often present as well. Emergency room staff are specially trained to deal with all of these situations.

MEDICAL EXAMS AND TESTS AFTER RAPE

Seeking medical care after a rape is important. This should be done without changing clothes, showering, douching, or urinating.

Some people may wish to report the rape as a crime, while others may not want to report it. This can be a difficult decision, and no one should be forced into making a choice right away. Some people will change their minds about reporting the rape as a crime in the future.

In many cities, rape cases are referred to specific emergency rooms. This provides more specialized care, and assures that proper procedures are followed to maintain the "chain of evidence" necessary for a case that may go to trial. Most state laws require that the person be evaluated in the emergency room before the rape is officially reported.

While in the emergency room:

  • You will be cared for by a team that is trained in dealing with the emotional, physical, and legal issues faced by a person who was raped.
  • Trained rape counselors will likely be present to support you during the evaluation and to help you with your feelings. A counselor, friend, family member, or someone (such as a nurse) will stay with you throughout the interviews and examination.
  • You should be offered the choice of being interviewed in street clothes, rather than in a patient gown.
  • The examination and collection of specimens should be fully explained beforehand, and whenever possible, you should be given choices.

The health care providers will take a history in a supportive and nonjudgmental way. This will include the details of the attack:

  • The date and time of the rape
  • Where it occurred
  • What you have done since the attack (for example, showered and changed clothes or came directly to the hospital)

If possible, this interview should be done with both health care providers and police present. However, even if you at first think you do not want to report this crime, it is important to have this interview with the health care team at least, as you may feel differently after a period of time. The evidence, including the history of what happened, is most accurate when obtained right away.

Other medical history information that is taken includes:

  • Any possibility of pregnancy before the attack
  • Current medications
  • Gynecological history, including any previous sexual abuse or assault
  • The date of the last menstrual period
  • The presence of chronic illness or recent illness or injury

A complete physical examination should be done to document any signs of trauma. Pictures may be taken to note bruises, scrapes, or cuts. X-rays will be taken if the health care provider suspects fractures.

Many samples may be collected for evidence, including:

  • Clothing
  • Fingernail scrapings
  • Pubic hair samples (especially if there are foreign materials in it)
  • Vaginal samples for evidence of sperm and sexually transmitted diseases (mouth or anal samples may also be required)

Blood tests and cultures will be done to check for the chance of pregnancy, infections, and to see if you were given a rape drug.

TREATMENT

Treatment focuses on providing emotional support, while attempting to collect enough evidence to confirm the rape.

Treatment for the immediate physical and emotional trauma includes:

  • Addressing the possibility of pregnancy. See: Emergency contraception
  • Providing information about rape and sexual assault in a safe and supportive environment
  • Treating sexually transmitted infections

If there is a chance that the rapist is HIV-infected, the health care providers should explain and offer postexposure prophylaxis (PEP, a way to reduce the odds of infection immediately using antiretroviral medications).

Ongoing emotional support and therapy are key. Support groups, one-on-one talk therapy, or talk therapy groups can help a rape survivor work through his or her feelings and gain emotional strength. Victims often learn that talking about their memories and emotional pain is the best way to rebuild their lives.

Referral to a local rape crisis center may be helpful. These centers offer peer support and advice to help in recovery from the trauma.

See also:

OUTLOOK

Victims of rape struggle through a number of symptoms:

  • Anxiety
  • Depression
  • Dramatic life change (change of job, friends, residence)
  • Memories (flashbacks) of the event
  • Numbing of emotions
  • Recurrent nightmares
  • Social withdrawal

Many rape victims have difficulty in re-establishing relationships with spouses or partners or, if single, in re-entering the "dating scene."

Rape may worsen any pre-existing psychiatric disorders. Suicidal behaviors, depression, and substance abuse may develop or become more prominent.

However, working through these problems using therapy and support groups, rather than avoiding them, has been shown to be helpful in treating these symptoms and avoiding more chronic emotional problems.

RESOURCES:

References

Slaughter L. Sexual assault. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 64.

Lentz GM. Rape, incest, and domestic violence: Discovery, management, counseling. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 10.


Review Date: 3/30/2010
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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