gynecology and obstetrics
Medical Examination of the Rape Victim
Symptoms and Signs of Rape
Rape may result in the following: Genital injury Extragenital injury Psychologic trauma Hepatitis Human Immunodeficiency Virus (HIV) Infection None Human papillomavirus infection Overview of Sexually Transmitted Infections (STIs—eg, syphilis, gonorrhea, chlamydial infection, trichomoniasis) Bacterial vaginosis Pregnancy Most physical injuries are relatively minor, but some lacerations of the upper vagina are severe. Additional injuries may result from physical violence that occurs during the sexual assault. Evidence indicates that a lifetime experience of rape is also related to long-term physical health problems; for example, risk of developing asthma, irritable bowel syndrome, frequent headaches, or chronic pain is higher for rape victims than for people who are not victims of rape ( Symptoms and signs reference ). Psychologic symptoms of rape are potentially the most prominent. In the short term, most patients experience fear, nightmares, sleep problems, anger, embarrassment, shame, guilt, or a combination. They may be unable to remember important parts of the event ( Dissociative Amnesia , which is a symptom of Immediately after an assault, patient behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief with dispassion or quiescence. The latter responses rarely indicate lack of concern; rather, they reflect avoidance reactions, physical exhaustion, or coping mechanisms that require control of emotion. Anger may be displaced onto hospital staff or family members. For acute stress disorder to be diagnosed, symptoms must be present for 3 days to 1 month after the assault. Friends, family members, and officials may be supportive or react judgmentally or in another negative way. Negative reactions can impede recovery after an assault. Long-range effects of rape may include PTSD, particularly among women. PTSD is a trauma-related disorder; symptoms of PTSD include Re-experiencing the trauma (eg, flashbacks, intrusive upsetting thoughts or images) Avoidance (eg, of trauma-related situations, thoughts, and feelings) Negative effects on cognition and mood (eg, persistent distorted blame of self or others, inability to experience positive emotions) Altered arousal and reactivity (eg, sleep difficulties, irritability, concentration problems) 1 month, must not be attributable to the physiologic effects of a substance or a medical disorder, and must significantly impair social and occupational functioning. Patients with PTSD often also have Depressive Disorders and/or other psychologic disorders (eg, 