Prevention Book


Sexual Assault

Aka: Sexual Assault, Rape, Rape Management, Forcible Intercourse, Female Rape Victim, Date Rape, Alcohol and Drug Facilitated Sexual Assault, ADFSA
  1. See Also
    1. Sexual Assault of Male Victim
    2. Sexual Abuse in Children
    3. Rape Kit (Sexual Assault Kit)
    4. Date Rape Drug
  2. Definitions
    1. Alcohol and Drug Facilitated Sexual Assault (ADFSA)
      1. Forced (or surreptitious) ingestion of Alcohol or Date Rape Drug used by perpetrators to facilitate Sexual Assault
  3. Epidemiology
    1. Rape lifetime Incidence in women: 18%
    2. Most perpetrators are known to the victim (only 14% of rapes are by strangers)
  4. History
    1. Use the patient's exact words
    2. Use the phrase "alleged Sexual Assault"
      1. Avoid the word "Rape" (legal term, not a medical term)
    3. Document specific details
      1. Age and other identifying details about the assailant
      2. Date, time and location of assault
      3. Specific circumstances about the assault
        1. Include sexual contact
        2. Exposure to body fluids
      4. Restaints used by the assailant (e.g. weapons, drugs)
    4. Document any cleaning (bathing, douching) or clothes changing done by patient since the assault
    5. Obtain full gynecologic history
  5. Labs
    1. Forensic Evidence with Rape Kit
    2. Urine Pregnancy Test
    3. Vaginal and Endocervical Samples (consider repeating at 2 week)
      1. Gonorrhea PCR
      2. Chlamydia PCR
      3. Trichomonas
      4. Wet prep for sperm (motile for up to 6 hours)
      5. Consider Herpes Simplex Virus Testing to obtain baseline
    4. Serology initially and at 6, 12 and 24 weeks
      1. Hepatitis B Surface Antigen and Hepatitis B core IgM
      2. RPR for Syphilis Testing
      3. HIV Test
  6. Management
    1. Sexual Assault Nurse Examiners (SANE) perform these Sexual Assault forensic exams in most regions of the United States
    2. Emergency Contraception
      1. Levonorgestrel 1.5 mg for 1 dose (Plan B)
    3. STD Prevention (perform all measures)
      1. Ceftriaxone 250 mg IM for 1 dose
      2. Metronidazole 2 g orally for 1 dose
      3. Azithromycin 1 g orally for 1 dose (or Doxycycline 100 mg twice daily for 7 days)
      4. Hepatitis B Vaccine
      5. CDC as of 2010 guidelines does not recommend Valacyclovir for HSV prophylaxis (insufficient evidence)
    4. Consider HIV Prophylaxis in high risk exposure
      1. See HIV Postexposure Prophylaxis
      2. Assess HIV risk in assailant
        1. Vaginal intercourse risk: 0.1 to 0.2% HIV Transmission risk
        2. Rectal intercourse risk: 0.5 to 3% HIV Transmission risk
        3. Oral risk: Low HIV Transmission risk
      3. Assess for degree of mucosal Trauma, bleeding and other injuries associated with higher transmission risk
      4. Consider contacting National Clinician's Post-exposure Prophylaxis hotline (PEPline) at 888-448-4911
      5. Follow-up required in 7 days if prophylaxis started
  7. Associated Conditions: Following Assault
    1. Chronic Pelvic Pain
    2. Chronic back pain
    3. Fibromyalgia
    4. Headaches
    5. Irritable Bowel Syndrome
    6. Sexual Dysfunction
    7. Somatoform Disorder
    8. Alcohol Abuse
    9. Drug Abuse
    10. Anxiety Disorder
    11. Major Depression
    12. Eating Disorders
    13. Posttraumatic Stress Disorder
    14. Sleep disorder
  8. Resources
    1. Sexual Assault Forensic Examiner technical assistance
    2. Sexual Assault Nurse Examiners (SANE)
  9. Resources
    1. CDC Sexual Violence Data
  10. References
    1. Luce (2010) Am Fam Physician 81(4): 489-5 [PubMed]
    2. Petter (1998) Am Fam Physician 58(4): 920-30 [PubMed]
    3. Tayara (2006) Best Pract Res Clin Obstet 20(3): 395-408 [PubMed]
    4. Welch (2007) BMJ 334(7604): 1154-8 [PubMed]

Forcible intercourse (C0034668)

Definition (MSH) Unlawful sexual intercourse without consent of the victim.
Definition (CSP) unlawful sexual intercourse without consent of the victim.
Concepts Social Behavior (T054)
MSH D011902
ICD9 E960.1
SnomedCT 158087006, 22439003, 248111006
English Forcible intercourse, Rape, Rapes, rapes, raped, rape, Rape (intercourse), Rape - assault, Forcible intercourse (finding), Rape - assault (finding), Forcible intercourse (event), Rape - assault (event)
Spanish violación (evento), violación - agresión (evento), violación - agresión (hallazgo), violación (hallazgo), vejación, relación sexual forzada, violación - agresión, violación, Violación
Dutch verkrachting, Verkrachting
Portuguese Violação, Estupro
Japanese 強姦, ゴウカン
Swedish Våldtäkt
Czech znásilnění, Znásilnění, stuprum
Finnish Raiskaus
Polish Gwałt
Hungarian Megerőszakolás
Norwegian Voldtekt
French Viol
German Vergewaltigung
Italian Stupro
Derived from the NIH UMLS (Unified Medical Language System)

Sexual assault (C0237236)

Definition (MEDLINEPLUS)

Sexual assault is any sexual activity to which you haven't freely given your consent. This includes completed or attempted sex acts that are against your will. Sometimes it can involve a victim who is unable to consent. It also includes abusive sexual contact. It can happen to men, women or children.

The attacker can be anyone - a current or former partner, a family member, a person in position of power or trust, a friend, an acquaintance, or a stranger.

Sexual assault can affect your health in many ways. It can lead to long-term health and emotional problems. It is important to seek help if you have been assaulted. First, get to a safe place. Then dial 911 or go to a hospital for medical care. You may want to have counseling to deal with your feelings. The most important thing to know is that the assault was not your fault.

Centers for Disease Control and Prevention

Concepts Mental or Behavioral Dysfunction (T048)
SnomedCT 422608009, 219179003, 248110007
Spanish ataque sexual (evento), ataque sexual (hallazgo), agredido sexualmente, agredido sexualmente (hallazgo), Agresión sexual, ataque sexual
English Sexual assault (finding), Sexual assault, assaulted sexually, Attack(s);sexual, sexual assault, sexual assaults, assault sexual, assault sexually, Sexual Assault, Sexual assault (event)
French Assaut sexuel
Dutch seksuele aanranding
Portuguese Violência sexual
German sexueller Uebergriff
Italian Attacco sessuale
Japanese セイテキボウコウ, 性的暴行
Czech Pokus o znásilnění
Hungarian Nemi erőszak
Derived from the NIH UMLS (Unified Medical Language System)

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