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[Medical management of presumed sexual assault victims in Dakar, Senegal. Report of 25 cases].


 Between January 1989 and June 1992, interviews with and a medical examination of 25 rape victims (mean age, 12 years; range, 7-21 years) were conducted at the University Hospital in Dakar, Senegal. Females aged less than 18 represented 84% of cases, 25% of whom were less than 10 years old. None were married. Sexual abuse occurred during ovulation among 5 of the 11 victims who had reached menses, thus placing them at risk of pregnancy. Places where the rapes occurred were the dwelling of either the offender or the victim (56%), especially that of the victim (9/14 cases), or a public place (44%). The victim knew the presumed offender in 80% of cases. Known offenders included fathers, priests, employers, ex-boyfriends, and men living in the vicinity. In five cases the female was gang-raped. 18 victims waited 72 hours before seeking care; 2 females waited 3 weeks. The long delays compromised cytologic exams and findings. None of the victims had ever had a child. One case had nine weeks of amenorrhea and tested positive for pregnancy. The only extragenital lesion was a bruise on the thigh. Genital lesions included bruises or lacerations of the large and small labia, lacerated hymen (sometimes ruptured hymen), fossa triangularis, and vaginal lacerations. There was no evidence of anal penetration. 3 of 15 samples tested positive for pathogens (1 for Escherichia coli; 2 for Candida albicans). Sperm was found in only 1 case. In 7 cases, penetration had not occurred, probably due to immature genitals. It was not clear whether penetration had occurred or not in 3 other cases. Penetration clearly occurred in 15 cases. Physicians and allied health personnel should be sensitive and prepared to perform a complete physical exam so as to defend the interests of the victim and of society by obtaining proof to convict the sexual offender. Senegalese jurisprudence does not consider the distress of rape victims with an unwanted pregnancy. Legislation should include rape as a reason for legal abortion.
