gynecology and obstetrics
Medical Examination of the Rape Victim
Treatment of the Rape Victim
Psychologic support and/or crisis intervention When indicated, postexposure hepatitis B and human papillomavirus (HPV) vaccination Possibly HIV postexposure prophylaxis Possibly emergency contraception After the evaluation, the patient is provided with facilities to wash, change clothing, use mouthwash, and urinate or defecate if needed. A local rape crisis team can provide referrals for medical, psychologic, and legal support services. Physical injuries are treated conservatively. Prophylaxis for STIs as needed. Vaginal lacerations may require surgical repair. Sometimes examiners can use commonsense measures (eg, reassurance, general support, nonjudgmental attitude) to relieve strong emotions of guilt or anxiety. Possible psychologic and social effects of rape are explained, and the patient is introduced to a specialist trained in rape crisis intervention. Because the full psychologic effects cannot always be ascertained at the first examination, follow-up visits are scheduled at 2-week intervals. Severe psychologic effects (eg, persistent flashbacks, significant sleep disruption, fear leading to significant avoidance) or psychologic effects still present at follow-up visits warrant psychiatric or psychologic referral. Family members and friends can provide vital support (eg, gentle encouragement, reminders that the rape was not their fault), but they may need help from rape crisis specialists in handling their own negative reactions. Treatment can be effectively treated with psychotherapy and drug therapy. Routine empiric prophylaxis for STIsfor adults and adolescents consists of the following: Ceftriaxone500 mg IM in a single dose or for patients weighing ≥ 150 kg, 1 g ofceftriaxone(for gonorrhea and chlamydia infections) AND Doxycycline100 mg orally 2 times a day for 7 days (for chlamydial infection) For females,metronidazole500 mg orally twice a day for 7 days (for trichomoniasis and bacterial vaginosis) Forhepatitis B,the Centers for Disease Control and Prevention (CDC) recommends hepatitis B vaccination unless the patient has been previously vaccinated and has documented immunity. The vaccine is repeated 1 and 6 months after the first dose.Hepatitis B immune globulin(HBIG) is not given. HPV vaccinationis given to females and males aged 9 to 26 years if they are unvaccinated or incompletely vaccinated. The vaccine is repeated at 1 and 6 months after the first dose. A 2-dose schedule (at 0 and 6 to 12 months) is recommended for unvaccinated patients who are starting HPV vaccination before age 15 years. empiric Postexposure prophylaxis (PEP) None Anal penetration Bleeding (assailant or victim) Male-male rape Rape by multiple assailants (eg, male victims in prisons) Rape in areas with a high prevalence of HIV infection Prophylaxis for HIV infection is best begun<4 hours after penetration and should not be given after>72 hours. Emergency Contraception should be offered to all women with a negative pregnancy test. Usually, oral medications are used; if used If pregnancy results from rape, the patient should be counseled about options for obstetric care and elective termination. 1.Welch J, Mason F: Rape and sexual assault. BMJ 334 (7604): 1154–1158, 2017. doi: 10.1136/bmj.39211.403970.BE 