This document discusses various topics related to the management of rape victims. It provides statistics on the prevalence of different types of rape, including date rape and spousal rape. It outlines the medical duties of physicians in caring for victims, including evaluation, treatment, counseling and ensuring safety. It provides guidance on antibiotic and contraceptive prophylaxis. Risk groups and perpetrators are identified. Pregnancy and STI risks of rape are covered. Underreporting of rape and lenient punishment of convicted rapists are addressed.

1. Management of Rape VictimsManagement of Rape Victims
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2. RapeRape
 Unwanted, forced penetrationUnwanted, forced penetration
(oral/vaginal/anal)(oral/vaginal/anal)
 reported by 33 - 46% of women whoreported by 33 - 46% of women who
are physically abusedare physically abused
 annual incidenceannual incidence ≥≥ 80/100,00080/100,000
womenwomen
 7% of all violent crimes7% of all violent crimes
 lifetime prevalence 10% - 25%lifetime prevalence 10% - 25%
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3. Date RapeDate Rape
 40% of college women report40% of college women report
forced sexual contact,forced sexual contact,
attempted rape, or completedattempted rape, or completed
raperape
independent of schoolindependent of school
demographicsdemographics
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4. Date RapeDate Rape
 >>25% of college males admit to using25% of college males admit to using
sexually coercive behaviorssexually coercive behaviors
 2/3 of college males report engaging2/3 of college males report engaging
in unwanted sexual intercoursein unwanted sexual intercourse
 reasons: peer pressure, desire toreasons: peer pressure, desire to
be likedbe liked
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5. Spousal RapeSpousal Rape
 10 - 15% of all marriages10 - 15% of all marriages
 more violent, less frequently reported thenmore violent, less frequently reported then
non-spousal rapenon-spousal rape
 not illegal in many U.S. states/othernot illegal in many U.S. states/other
countriescountries
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6. High Risk GroupsHigh Risk Groups
 ProstitutesProstitutes
 MilitaryMilitary
 Homeless and runawaysHomeless and runaways
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7. ““High Risk” PerpetratorsHigh Risk” Perpetrators
Male college athletesMale college athletes
Fraternity membersFraternity members
Men with restraining ordersMen with restraining orders
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8. RapeRape
 5% chance of pregnancy5% chance of pregnancy
 25% chance of acquiring STD25% chance of acquiring STD
 GC = 6 - 12%GC = 6 - 12%
 Chlamydia = 4 - 17%Chlamydia = 4 - 17%
 Syphilis = 0.5 - 3%Syphilis = 0.5 - 3%
 1 -2/1,000 odds of acquiring HIV1 -2/1,000 odds of acquiring HIV
 variesvaries Brought to you by

9. RapeRape
 UnderreportedUnderreported
 Less than 1% of rapists convictedLess than 1% of rapists convicted
 Average prison time for thoseAverage prison time for those
convicted:convicted:
 rape = 1 yearrape = 1 year
 armed robbery = 3 - 5 yearsarmed robbery = 3 - 5 years
 murder = 8 yearsmurder = 8 years
 Chemical Castration LawsChemical Castration Laws
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10. The Physician’s Duties inThe Physician’s Duties in
Caring for Victims of SexualCaring for Victims of Sexual
AssaultsAssaults
 MedicalMedical
 medical historymedical history
 evaluate and treat physical injuriesevaluate and treat physical injuries
 culturescultures
 treat pre-existing infectionstreat pre-existing infections
NEJM 1995; 332:234-7NEJM 1995; 332:234-7
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11. The Physician’s Duties inThe Physician’s Duties in
Caring for Victims of SexualCaring for Victims of Sexual
AssaultsAssaults
 MedicalMedical
 offer post-exposure HIV prophylaxisoffer post-exposure HIV prophylaxis
 offer post-coital contraception (vs. inoffer post-coital contraception (vs. in
utero paternity testing f/b selectiveutero paternity testing f/b selective
abortion)abortion)
 arrange medical followuparrange medical followup
 provide counselingprovide counseling
NEJM 1995; 332:234-7NEJM 1995; 332:234-7
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12. Physical Examination ofPhysical Examination of
Sexual Assault VictimsSexual Assault Victims
 Collection of clothingCollection of clothing
 External evaluationExternal evaluation
 abrasions, lacerations, ecchymoses,abrasions, lacerations, ecchymoses,
bite marksbite marks
 Oral cavityOral cavity
 secretions, injuries, culturessecretions, injuries, cultures
NEJM 1995; 332:234-7NEJM 1995; 332:234-7
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13. Physical Examination ofPhysical Examination of
Sexual Assault VictimsSexual Assault Victims
 GenitaliaGenitalia
 hair combing, hair sampling, vaginalhair combing, hair sampling, vaginal
secretions, injuries, culturessecretions, injuries, cultures
 RectumRectum
 injuries, culturesinjuries, cultures
NEJM 1995; 332:234-7NEJM 1995; 332:234-7
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14. Prophylaxis for Adult VictimsProphylaxis for Adult Victims
ofof
Sexual AssaultSexual Assault
Antibiotic ProphylaxisAntibiotic Prophylaxis
 Ceftriaxone (250 mg IM) or SpectinomycinCeftriaxone (250 mg IM) or Spectinomycin
(2 g IM)(2 g IM)
PLUSPLUS
 Doxycycline (100 mg po bid x 7d) orDoxycycline (100 mg po bid x 7d) or
Azithromycin (1 g po x 1)Azithromycin (1 g po x 1)
PLUSPLUS
 Metronidazole ( 2 g po x 1)Metronidazole ( 2 g po x 1) Brought to you by

15. Prophylaxis for Adult VictimsProphylaxis for Adult Victims
ofof
Sexual AssaultSexual Assault
Prevention of PregnancyPrevention of Pregnancy
 2 OCP tablets (each with 50 mcg ethinyl2 OCP tablets (each with 50 mcg ethinyl
estradiol) po q12estradiol) po q12°° x 2x 2
OROR
 3 OCP tablets (each with 35 mcg ethinyl3 OCP tablets (each with 35 mcg ethinyl
estradiol) po q12estradiol) po q12 °° x 2x 2
PLUSPLUS
 AntiemeticAntiemetic Brought to you by

16. HIV Post-ExposureHIV Post-Exposure
Prophylaxis for Adult VictimsProphylaxis for Adult Victims
ofof
Sexual AssaultSexual Assault HIV Prophylaxis (studies ongoing)HIV Prophylaxis (studies ongoing)
 Consult IDConsult ID
 start up to 72start up to 72°° after rapeafter rape
 Baseline HIV test and referral toBaseline HIV test and referral to
experienced clinician within 72 hours ofexperienced clinician within 72 hours of
starting PEPstarting PEP
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17. Ensure Victim’s SafetyEnsure Victim’s Safety
 Social worker involvementSocial worker involvement
 Restraining orderRestraining order
 Phone numbers of shelters,Phone numbers of shelters,
hotlineshotlines
 Safe place to goSafe place to go
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18. Domestic Violence SheltersDomestic Violence Shelters
 Availability poorAvailability poor
 up to 70 - 80% of women and 80% of childrenup to 70 - 80% of women and 80% of children
turned away on any given nightturned away on any given night
 Woefully underfundedWoefully underfunded
 Average length of stay = 14 days; most allow 30Average length of stay = 14 days; most allow 30
day max stayday max stay
 Over 50% of all homeless women and childrenOver 50% of all homeless women and children
are fleeing domestic violenceare fleeing domestic violence
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