- Intimate partner violence is a pattern of assaultive and coercive behavior that may include physical injury, psychological abuse, reproductive coercion, and/or sexual assault.
- Sexual assault is a crime of violence and aggression defined as attempted sexual touching of another person without their consent.
- Sexual abuse of children is defined as sexual activity for which a child cannot give consent, is unprepared for developmentally, or cannot comprehend, including noncontact abuse.
- Affects all communities:
- All genders
- All ages
- All sexual orientations
- Children from all social, cultural, and economic backgrounds
- Incidence is much higher in girls and women than in boys and men.
- Prevalence is difficult to document accurately.
- Worldwide estimate: 5%–25% of girls and 5%–9% of boys have been exposed to some type of sexual abuse.
- Often unreported because of:
- Fear of medical evaluation
- Shame and embarrassment
- Privacy concerns
- Approximately 1 in 3 women have experienced sexual assault during their lifetime.
- Approximately 1 in 5 women have experienced completed or attempted rape.
- 33% state that the assault occurred before age 17 years and 12% before age 10 years.
- 5% of girls who have been sexually assaulted have a STI.
- Prevalence during pregnancy is approximately 8%.
- Approximately 1 in 4 men have experienced sexual violence involving physical contact.
- Approximately 1 in 38 men have experienced completed or attempted rape.
- 25% state that the assault occurred before age 17 and 25% before age 10.
- Perpetrators (according to the Rape, Abuse & Incest National Network):
- Intimate partner: 33%
- Acquaintance: 39%
- Family member: 2.5%
- Stranger: 19.5%
- Special populations at increased risk:
- Developmentally delayed children
- Elderly patients with cognitive decline
- Patients institutionalized with mental health disorders
- Sexual and gender minority adolescents (gay, lesbian, bisexual, and transgender)
- Sexual abuse includes:
- Sexual intercourse (rape)
- Sodomy (oral–genital or anal–genital contact)
- Nonpenetrating sexual contact (fondling)
- Acquaintance rape/date rape: sexual assault committed by someone known to the victim
- Statutory rape: consensual sexual intercourse with an individual younger than a specific legal age
Clinical Presentation and Diagnosis
The patient should be approached in a nonjudgmental and respectful manner. In addition to psychological consequences, sexual assault can be associated with unintended pregnancy, STIs, and physical injury.
- Reluctance to talk is common.
- Children may present with behavioral changes (e.g., imitating sexual acts).
- Document the location, timing, duration, and type of force.
- Document other injuries or forms of abuse (e.g., physical abuse).
- Assess current safety and the presence of an emergency plan.
- Assess for suicidal ideation.
- Children may or may not have signs of abuse on physical exam.
- Vulvovaginitis in girls should elicit consideration for an evaluation of sexual abuse.
- May need photos for legal proceedings
- Anoscopy and colposcopy may be useful for visualizing injuries.
- Document findings:
- Hymen trauma or scarring
- Healed genital injuries (e.g., skin tags or granulation tissue)
- Vaginal or anal tears
- Signs of STIs, such as vesicles or condylomatous lesions
Patients who present with a report of sexual assault or abuse need proper examination, testing, and psychological support.
- Forensic evidence collection (rape kit) should be done within 72 hours.
- May be falsely positive if delayed
- Should always be done if there is bleeding or acute injury
- Specimens obtained for DNA analysis
- Report to police
- Offer emergency contraception, if indicated.
- Consider prophylactic STI treatment.
- Recommended lab tests:
- Chlamydia testing of the vagina and anus
- Gonorrhea testing of the pharynx, vagina, and anus
- Viral testing of lesions suspicious for herpes simplex
- Trichomonas and bacterial vaginosis testing
- HIV serology
- Hepatitis B and C
- Syphilis testing (rapid plasma reagin test)
- Evaluate psychosocial support system and refer as needed.
- Survivors of sexual abuse may need lifelong mental health care for:
- Substance abuse
- Major depressive disorder
- Distorted self-perception
- Panic disorder
- Bechtel, K., Bennett, B.L. (2021). Evaluation of sexual abuse in children and adolescents. UpToDate. Retrieved June 7, 2021, from https://www.uptodate.com/contents/evaluation-of-sexual-abuse-in-children-and-adolescents
- Sexual Assault Awareness. (2021). Centers for Disease Control and Prevention, Retrieved June 7, 2021, from https://www.cdc.gov/violenceprevention/sexualviolence/index.html
- Miller, E., Wiemann, C.M. (2020). Adolescent relationship abuse including physical and sexual teen dating violence. UpToDate. Retrieved June 7, 2021, from https://www.uptodate.com/contents/adolescent-relationship-abuse-including-physical-and-sexual-teen-dating-violence
- Rape, Abuse & Incest National Network (n.d.). Perpetrators of sexual violence: Statistics. Retrieved June 10, 2021, from https://www.rainn.org/statistics/perpetrators-sexual-violence
- Sackey, M., Murphy-Lavoie, H. (2018). Sexual assault. In Schlamovitz, G.Z. (Ed.), Medscape. Retrieved June 10, 2021, from https://emedicine.medscape.com/article/806120-overview