women s health issues
Sexual Assault and Rape
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 may be done to check for subtle genital injuries. For colposcopy, the vagina and cervix and/or anus are examined using a magnifying instrument. 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 In women, a Papanicalaou (Pap) test is done to check for Human Papillomavirus (HPV) Infection after 6 weeks. Usually, a Detecting and Dating a Pregnancy 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 . 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. 