sexual health and sexual abuse

SEXUAL HEALTH during COVID19
Caring Victims of Sexual Abuse
Dr.Riaz.K.M, Assistant Professor,
Government College of Nursing, Thrissur
riazmarakkar@gmail.com

Definitions…………
Sex
Sex refers to the biological characteristics that define humans as
female or male.
Gender
Either of the two sexes (male and female), especially when
considered with reference to social and cultural differences rather
than biological ones.
(typically masculine, feminine, common, neuter)
Dr.Riaz.K.M, riazmarakkar@gmail.com. 2

Sexual health…
• …a state of physical, emotional, mental and social well-being in
relation to sexuality; it is not merely the absence of disease,
dysfunction or infirmity.
• Sexual health requires a positive and respectful approach to sexuality
and sexual relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of coercion,
discrimination and violence.
• For sexual health to be attained and maintained, the sexual rights of allDr.Riaz.K.M, riazmarakkar@gmail.com. 3

Sexuality
• Sexuality is experienced and expressed in
• Thoughts,
• Fantasies,
• Desires,
• Beliefs,
• Attitudes,
• Values,
• Behaviours,
• Practices,
• Roles and relationships.

Sexual rights
• “The fulfilment of sexual health is tied to the extent to which
human rights are respected, protected and fulfilled.
• Sexual rights embrace certain human rights that are already
recognized in international and regional human rights
documents and other consensus documents and in national
laws.

Rights to….
• Equality and non-discrimination
• Be free from torture or to cruel, inhumane or degrading treatment or
punishment
• Privacy
• The highest attainable standard of health (including sexual health) and
social security
• Marry and to found a family and enter into marriage with the free and
full consent of the intending spouses, and to equality in and at the
dissolution of marriage
• Decide the number and spacing of one's children
• Information, as well as education
• Freedom of opinion and expression
• An effective remedy for violations of fundamental rights.

Guiding principles in sexual health
1. Affirmative approach to sexuality
2. Autonomy and self-determination
3. Responsiveness to changing needs
4. Comprehensive understanding of sexuality
5. Confidentiality and privacy
6. Advocacy
7. Cultural diversity
8. Equity
9. Non-judgemental services and programmes
10. Accessible programmes and services

• Kāmasūtra is an ancient Indian Sanskrit text
on sexuality, eroticism and emotional
fulfillment in life.
• Attributed to Vātsyāyana,
• Kama Sutra is neither exclusively nor
predominantly a sex manual on sex
positions, but written as a guide to the
• Art of living well,
• Nature of love,
• Finding a life partner,
• Maintaining one's love life, and
• Pleasure-oriented faculties of human life

Why it is an issue…during pandemic
• Uncertainty
• Confusion
• Sense of urgency
• Comes in waves

Social isolation and sexual health.. impact
• Health risk behaviors prevails
• Obesity, substance abuse
• Psychosocial distress develops
• Anger, frustration

Social isolation .. Sexual health.. Strategies
• Culturally sensitive care
• Reduce unconscious biases
• Survivorship efforts
• Inform and avail all treatment services
• Cessation of unhealthy habits
• Substance use, poor nutrition, sedentary behaviours
• Initiation of healthy habits
• Nutrious diet, exercises, rest, positive social relationship
• Basic sex education
• Promote healthy behaviours

One in every two women and
one in five men have
experienced some form of
unwanted sexual contact or
violation

Criminal courts are often ill
equipped to provide remedies for
sexual assault victims

A prosecutor need to prove
beyond doubt that an assault
occurred
In case of no witness its very difficult to meet the standard

• Since the outbreak of COVID-19, emerging data and reports
from those on the front lines, have shown that all types of
violence against women and girls, particularly domestic
violence, has intensified

Sexual abuse
• is a sexual behavior or a sexual act forced upon a
woman, man or child without their consent.
• Sexual abuse includes abuse of a woman, man or
child by
• a man,
• a woman or
• a child.

Remember ……
• Act of violence on weaker groups
• For controlling and humiliating .
• Not always from an uncontrollable sex drive,
• Most victims of sexual violence are women
• More in patriarchal society.

Come-ons, Put-downs: They’re both
bad
• Sexual coercion and unwanted sexual attention are come-ons,
• Whereas gender harassment is a put-down.
• Still, they are all forms of sexual abuse and can all violate law,

Types of Sexual Assault
• Sexual assault – a term including all sexual offenses. Any action or
statement with a sexual nature and done without consent from both
sides.
• Rape – insertion of a bodily organ or an object into the sex organ of a
woman without her consent.
• Sodomy – insertion of a bodily organ or an object into a person's anus
or mouth without their consent.
• Attempted rape – attempted insertion of a bodily organ or an object
into the sex organ of a woman without her consent.
• Gang rape – rape carried out by more than one attacker.
• Serial rape – repeated incidents of rape carried out by the same
attacker over an extended period of time.
• Incest – Sexual abuse or assault at the hands of a family member.Dr.Riaz.K.M, riazmarakkar@gmail.com. 19

Types of Sexual Harassment
• Extortion when the act the person required to perform is of a sexual nature.
• An indecent act, i.e. an act performed to cause humiliation, stimulation or
sexual satisfaction.
• Repeated propositions that are of a sexual nature addressed to a person who
has previously demonstrated to the harasser that they are not interested in
said propositions.
• Repeated remarks relating to the person's sexuality when that person has
already shown the harasser that they are not interested in said remarks.
• Degrading or humiliating remarks relating to a person's sex or sexuality,
including their sexual orientation.
• Publishing a picture, video or recording of someone focusing on their
sexuality for the purpose of humiliating or degrading the person without their
consent.
• Propositions or remarks of a sexual nature when the harasser is aware that
their target is not interested due to circumstances of exploiting a working
relationship, dependency and other services.

Types of sexual abuse
Contact abuse (abuser makes physical contact with the victim)
• sexual touching of any part of body, whether they're clothed or not
using a body part or object to rape or penetrate
• forcing a victim to take part in sexual activities
• making a victim undress or touch someone else.
• Touching,
• Kissing
• Oral sex
(sexual abuse isn't just penetrative.)

Types of sexual abuse
Non-contact abuse (without being touched by the abuser)
• Exposing or flashing
• Showing pornography
• Exposing a victim to sexual acts
• Making them masturbate
• Forcing a victim to make, view or share abuse images or videos
Making, viewing or distributing abuse images or videos
• Forcing a victim to take part in sexual activities or conversations online
or through a smartphone.

What they said to have…
• Grief
• An assault is a profound loss and is characterized by intense
sadness.
• A survivor may feel her or his life has been shattered to such an
extent that she or he will never recover.
• A strong support system can help relieve this grief and move the
victim through the healing process

• Depression
• A deep feeling of emptiness, remorse, and unhappiness may set
in following a sexual assault.
• This reaction may result in survivors feeling hopeless,
immobilized, and unable to make decisions.
• Depression often makes survivors feel like everything is going
wrong and nothing will ever be resolved.

• Denial
• Some survivors respond to the trauma of an assault by minimizing
the experience, refusing to talk about the assault, or by blocking it
out of their consciousness altogether

• Anger and Irritability
• Sexual assault can result in tremendous rage. While anger is a
natural and healthy response, it may be misdirected towards family
members, the law enforcement official, attorneys, or others who
may be trying to offer assistance.
• Sometimes this anger is appropriately directed towards people
surrounding the survivor.
• A trained sexual assault advocate can help victims and loved ones
better understand this reaction and guide healthy, safe expression
of this anger.

• Feeling of Loss of Control
• Sexual assault, in itself, is a traumatic loss of control.
• During an assault, an individual’s right to make decisions about
their body and control the contact they have with another person is
destroyed.
• After the assault, this loss of control may result in difficulty in
making decisions or asserting feelings and needs

• Concern for the Perpetrator
• In some cases, a survivor may express concern about what will
happen to the perpetrator if the assault is reported to the police.
• The victim may know, care about, and/or be dependent upon the
offender (as in the case of an intimate partner).
• This is a valid reaction and while it may be confusing or frustrating,
a victim’s support system can be instrumental in understanding
those feelings while keeping them safe.

• Humiliation
• Many sexual assault survivors feel ashamed, embarrassed, and
humiliated.
• This sense may be heightened by misinformation that victims
should be able to protect themselves.

• Shame and Self-Blame
• Many survivors blame themselves for the assault – blame
themselves for something they did or didn’t do, for what they wore,
for not fighting back.
• This reaction is often an attempt to regain control. Remember, it is
not the victim’s fault.
• Only the perpetrator had the power to prevent the assault.

• Guilt
• Guilt comes from the sense that the individual could have and
should have done something more to protect themselves or to
prevent the assault.

• Fear of People
• Some sexual assault survivors thought they were going to lose their
lives during the assault and some may still be in the presence of, or
in close proximity to, her/his perpetrator, especially in small
communities (e.g., family, social groups, rural communities).
• Over time, the survivor may experience flashbacks that make
her/him feel intensely afraid or she/he may experience a less
intense, more prolonged sense fear

• Preoccupation with Disease, Pregnancy or Death
• Survivors may focus on the worst-case physical outcomes that may
accompany the sexual assault.
• HIV infection is a common concern, and survivors may react to the
assault by focusing on their potential mortality.
• It is important to take these concerns seriously.
• Some survivors may have still be in danger or may require medical
attention

• Risk of Suicide
• Some survivors of sexual assault may respond by contemplating
and/or threatening suicide.
• It is important to be aware of this risk and to take any signs of
suicide seriously.

Trauma survivors …problems
• Difficulty concentrating or paying attention
• Difficulty falling or staying asleep; severe nightmares
• Experiencing trauma memories, reminders, or flashbacks
• Reliving trauma memories, avoiding trauma reminders and struggling with
feeling fear and anger
• Feeling a lasting sense of terror, horror, vulnerability, and betrayal
• Feelings of intense anger and impulses that may be taken out on loved
ones
• Becoming overly dependent upon or overprotective of loved ones
• Loss of interest in social or sexual activities
contd..

Trauma survivors …problems
• Feeling distant from others and emotionally numb
• Unable to relax, socialize, or be intimate without being tense
• Turning to alcohol or drugs to cope
• Experiencing dissociation in which they go numb, leave their body, and do
not feel anything
• Feelings of depression, loss, sadness, and hopelessness
• Feelings of guilt for not having suffered as much as others
• Becoming aware of one’s own mortality and the possibility of one’s own
death
• Having anxiety, fear, and concern for their future safety
• Profound self-criticism over things done or not done during the incident
that created the trauma

Dynamics of sexual violence
• Sexual violence is an aggressive act. The underlying factors in many
sexually violent acts are power and control, (not, as is widely perceived, a
craving for sex.)
• Rarely is it a crime of passion. It is rather a violent, aggressive and hostile
act used as a means to degrade, dominate, humiliate, terrorize and
control women.
• The hostility, aggression and/or sadism displayed by the perpetrator are
intended to threaten the victim’s sense of self.
• Sexual violence violates a victim’s sense of privacy, safety and well-being

Risk factors
• Unaccompanied women
• Lone female heads of household
• Children and young adults
• Children in foster care
• Physically and mentally disabled men and women
• Individuals in prison or held in detention
• Individuals with drug or alcohol problems
• Individuals with a past history of rape or sexual abuse
• Individuals involved in prostitution
• Individuals in an abusive intimate or dependent relationship
• Victims of war or armed conflict situations
• Homeless or impoverished.

Service Priorities for victims
• Treatment of injuries,
• Assessment and management of pregnancy and sexually transmitted
infections (STIs)).
• Performing a forensic examination

Trauma-Informed Care
• Acknowledges the effect of trauma,
• Recognizes signs and symptoms of trauma,
• Responds by integrating knowledge about trauma into practices,
• Resist retraumatization.
• Ensuring physical and emotional safety,
• Maximizing trustworthiness,
• Prioritizing individual choice and control,
• Empowering individuals,
• Encouraging peer support

SAVE Model Protocol
• SCREEN all patients for sexual violence
• ASK direct questions in a nonjudgmental way
• VALIDATE the patient
• EVALUATE, educate, and refer

Sample Sexual Assault Screening
Questions
• Has anyone ever touched you against your will or without your
consent?
• Have you ever been forced or pressured to engage in sexual
activities when you did not want to?
• Have you ever had unwanted sex while under the influence of
alcohol or drugs?
• Do you feel that you have control over your sexual relationships
and will be listened to if you say “no” to sexual activities?
• Is your visit today because of a sexual experience you did not
want to happen?

SEXUAL ASSAULT AND RAPE-
PREVENTION STRATEGIES
• Adolescents need to be able to identify high-risk situations
• attending parties with unknown people,
• meeting people with whom they have had contact on the Internet,
• walking alone at night,
• allowing themselves to be photographed nude or in sexually explicit poses
or situations
• Seek medical care.
• “Buddying up,”
• Not drinking from anything that has been left unattended,
contd..

• Abstaining from or moderating alcohol intake,
• Not accepting drinks from strangers)
• Associated educational materials should be available and
distributed.
• Counsel their adolescent patients to avoid high-risk situations.
• Screening of adolescents for sexual victimization should be part of
visits for psychological problems, sexuality issues, contraception or
substance abuse, and health supervision.

• Anticipatory guidance with adolescents with and without
disabilities, tailored to cognitive abilities to understand.
• Adolescents should be asked direct questions without their parents
present regarding their past sexual experiences.
• explore age of first sexual experience, use of the Internet to find
romantic or sexual partners, and unwanted or forced sexual acts.
• Exploration of gender roles and relationship parameters (eg,
exploitative, nonconsensual versus healthy) are critical.
• Adolescents who have been sexually assaulted need the
opportunity to describe the experience at their own pace and in
their own words.

Assessment (Specifics of the incident: Document direct
quotes from the patient describing the incident)
a. Time, date, and place of the sexual assault or abuse
b. The patient’s ability to give consent to the reported sexual activity
c. Use of force, threats of force, weapons, coercion, or drugs and/or alcohol to
facilitate sexual assault
d. Types or means of assault
e. Number of assailants
f. The occurrence of penetration of any body part with a penis, finger, or other
object
g. Did the patient urinate, defecate, vomit, douche, remove/insert a tampon,
wipe/clean the genital area, bathe, shower, gargle, brush teeth, smoke, eat,
drink, chew gum, change clothes, or take medications after the incident?
h. Did the patient bite the perpetrator, or was the patient bitten?

Assessment
Medical history
a. Allergies
b. Medications
c. Immunization
d. Past medical history
e. Use of contraceptives and what type
f. Last menstrual period
g. Last consensual intercourse
h. Pregnancy status
i. History of anogenital surgery

Physical examination
1. Place a clean hospital sheet on the floor to be a barrier for the collection
paper
2. Allow the patient to remove and place each piece of clothing being
collected in a separate paper bag.
3. Handle all clothing with gloved hands to prevent contamination of
evidence
4. Simultaneously note the presence of any physical injury, biological
evidence, or foreign debris.
5. Photograph and recover any trace evidence, including sand, soil, leaves,
grass, and biological secretions.
6. Note the body location of the collection. Identify moist secretions.

Physical examination
7. Note all injuries by documenting the location, size, and complete
description of any trauma, including bite marks, strangulation
injuries, or areas of point tenderness, especially those
occurring around the mouth, breasts, thighs, wrists, upper arms,
legs, back, and anogenital region
8. Perform appropriate photodocumentation of collection sites and
injuries before evidence collection
9. Recover moist secretions with a dry swab. Dry secretions should
be moistened with a damp swab and then recovered with a dry
swab. Debris should be scraped onto a bindle.
10. Document the Tanner Stage of the patient and describe the level
of physical maturity

Laboratory and Radiographic Data
1. Serum or urine pregnancy test.
2. Cultures and syphilis testing: In cases where prophylaxis will be given and chronic
abuse is not suspected, cultures and syphilis testing are not necessary. This area
is very controversial.
3. Hepatitis B surface antibody: To check for the immune status in the previously
immunized patient. Hepatitis B testing is not indicated in the nonimmunized
patient.
4. Laboratory and radiographic studies as indicated.
5. HIV counseling and follow-up testing
6. Referral is strongly encouraged. Patients may be referred to the primary care
provider or to a center that provides confidential counseling and testing within
72 hours of the exposure to establish the HIV status at the time of the assault or
abuse.
7. HIV Risk Assessment and Screening: Patients should be assessed for risk of HIV
transmission following assault.

ABCs of Care

Appearance
• Remember to listen to, advocate for, and respect your patient
• Sexual assault patients don't always appear as expected.
• Physical trauma/“look fine” but report that they were raped.
• View the patient as a human being experiencing physical and
emotional trauma.
• Make sure to avoid asking what the patient was wearing at the
time of the assault
• Avoid adding additional trauma to the situation by carefully
monitoring your tone and actions, and avoid anything that may be
construed as victim blaming—holding the victim responsible for
the assault.

Avoid victim blaming…
build a professional relationship
• If the patient interprets your questions as being judgmental, not
only fail to obtain complete information and relationship with the
patient will be damaged, ability to fully care for the patient will
also be affected.
• Keep in mind that this is a crucial time for developing a trusting
relationship with the patient.

Behavior
• Although we may expect sexual assault patients to be crying,
hysterical, or shell-shocked, be careful to avoid judging the
veracity of the patient's claim by appearance or behavior.
• Some victims may be quiet and reserved or extremely talkative
and appear excited.
• Some may even laugh, tell jokes, or comfort their loved ones as a
way of coping with the assault.
• The nurses caring for sexual assault patients should carefully
document such behavior because juries may lack an
understanding of the complexities of victim response.

Behavior
• In a setting where nurses are busy, adhering to protocols and
efficiently performing tasks may be a priority.
• Advocate for the patient's needs above the needs of the
department.
• Providing a safe, comfortable environment may mean having
only one nurse caring for the patient and taking extra time with
him or her.

Behavior
• Also be mindful that asking the patient to undress may be a
harder task than with other types of patients and it may be
necessary to ease into the exam process, including basic
admission procedures such as vital signs.
• Be aware of facial expressions and body language because they
often convey as much meaning as any verbal communication.
• interaction with the patient should be guided by the three Cs.

3Cs (Control, Compassion and
Confidence)
• Using the three Cs will enable you to provide optimum care while
assisting the sexual assault patient to take the first steps toward
recovery or continue along their path of recovery.

Control, Compassion, and Confidence
• Empower the patient to regain some sense of control.
• Establishing a trusting relationship
• Instruct the patient that his or her permission will be obtained for every
part of the treatment, the treatment or exam will be stopped upon
request, and it's his or her choice to report the assault.
• Because the perpetrator took away control of the patient's body, this
step is vital in starting the patient down the path of recovery.
• For those patients whose assault occurred in the past, even distantly in
the past, performing medical procedures while giving the patient
control may avoid stimulating triggers.

• Be compassionate.
• Voice your regret that the attack occurred and your sincere
apology that the patient is enduring the situation.
• Allow your humanity to show while maintaining professionalism.
• This will reassure the patient that you aren't blaming the victim.

• Be confident.
• This confidence will convey to the patient that you believe his or her
story, are there to effectively care for the patient, and are skilled in
performing the exam.
• Communicates to the patient that you're confident in his or her ability
to survive and recover.
• Stress that the event is now in the past and praise the patient for
surviving it.
• Maintain an attitude of nonjudgmental acceptance.
• Believing the patient is especially important when he or she expresses
some degree of memory loss or loss of consciousness, which may
occur during a drug-facilitated assault.

In the ED
• The ED is the most probable environment in which you'll
encounter sexual assault patients who often present for a
forensic exam (rape kit) accompanied by a victim advocate
(someone trained to support the victim during the post assault
process).
• Providing care using best practices for sexual assault patients of
both sexes is achievable with careful planning and attention.
• The environment in which you care for these patients strongly
influences development of best practices.

In the ED
• If the victim is an adult with decision-making abilities, it's his or her
decision to report the assault to law enforcement.
• No nurse should make a report to law enforcement officials unless
initiated by the victim's desire to report.
• Mandatory reporting regulations only apply to sexual abuse and
assault of minors, the older adult, and those incapacitated or
incapable of making decisions.

In the ED
• Sexual assault nurse examiner (SANE), with specialized forensic
training may conduct the forensic exam to
• Collect any available evidence,
• Provide medical treatment,
• Dispense prophylactic medications for sexually transmitted infections
(STIs)
• Emergency contraception, such as “the morning after pill.”
• The timing of the assault is crucial in guiding further care because
most postexposure prophylaxis guidelines recommend that
treatment begin within 72 hours of the assault.
• For all patients, care must be individualized for their specific
needs and according to their medical histories.

In the ED
• For assaults perpetrated by an individual with unknown HIV
status, the CDC doesn't currently recommend the 28-day
antiretroviral treatment.
• Postexposure prophylaxis for STIs usually involves IM
ceftriaxone; oral metronidazole; and oral azithromycin or
doxycycline, twice daily for 7 days.
• Again, appropriate medications are prescribed on an individual
patient basis.

In the ED
• Until a SANE is available for the exam, regular ED staff should be
available to provide the patient with a private exam room and maintain
strict confidentiality of the patient's reason for presenting for care.
• Minimize the number of staff members who enter the patient's room.
• Regular ED staff to refrain from offering the patient anything to eat or
drink to preserve any evidence in the event of an oral assault until
directed to do differently by the SANE.
• If a SANE isn't available for the exam, a rape kit may be collected by
a regular ED nurse with the assistance of a physician for certain steps
of the exam.

Other care settings
• Patients, hospitalized for myriad reasons, may experience triggers
of past assault(s) during procedures such as urinary
catheterizations, enemas, those requiring application of temporary
restraints, and those requiring manipulation of the patient's genitals.
• Such triggers may be visual, olfactory, auditory, or tactile in nature.
• An I.V., a call light cord on the bed, oxygen tubing touching the face
and neck, and drains in place are things that we view as a normal
part of a hospital stay, but they may feel very threatening to the
patient.

Other care settings
• There may be things in the environment that we can't anticipate: a
smell, a sound, or the feel of equipment.
• Once triggered, the patient may experience flashbacks, especially
if he or she suffers some degree of PTSD from past assault(s).
• Flashbacks are common responses to psychological trauma and
may last for years.
• A common misperception is that a flashback is remembering or
recalling the event when, in fact, the individual is reliving the event
and may even temporarily lose touch with reality.
• During this time, be present and reassuring to the patient, and
understand that you may need to protect the patient from self-
harm.

Other care settings
• Obtaining a thorough history of past abuse and assault is
imperative when caring for such patients to avoid additional trauma
during medical procedures.
• Histories revealing chronic pain issues may be linked to sexual
assault history.
• Some patients speak of “body memories” in which the stress of the
memory is experienced as a physical complaint, such as chronic
pelvic pain, migraines, sleep disorders, gastrointestinal problems,
lightheadedness, dyspareunia (painful intercourse), and
autoimmune disorders.

Overcoming discomfort
• Sexual assault patients deserve the same high-quality care as all
patients.
• However, many nurses struggle to care for this patient population
because of their own discomfort with the situation.
• Overcoming personal discomfort and uncertainty when caring for
sexual assault patients is possible for all nurses to achieve using
some very simple steps.

• Avoid expectations about the stereotypical appearance of victims.
• Be aware that sexual assault patients don't all behave in a
predictable manner.
• This will positively influence your ability to develop a trusting,
therapeutic relationship with the patient.
• Provide care while giving patients control of their bodies, which is
vital to the recovery process.
• Use compassion and confidence to color your interactions and
avoid inflicting additional harm.
• Be aware that drug-facilitated sexual assault is a growing problem
and know the signs and symptoms of this assault component.

• Regardless of your practice environment, be prepared to
encounter patients of both sexes with sexual assault histories.
• Preparing yourself for such an encounter will enable a positive
healthcare experience for your patient and facilitate the patient's
recovery process.

Drug-facilitated sexual assault
• Drug-facilitated sexual assault has become a widespread problem.
• Substances used to facilitate sexual assault include alcohol,
flunitrazepam (also known as roofies or the date-rape drug),
gamma hydroxybutyrate or GHB, ketamine, MDMA (ecstasy), and
carisoprodol.
• Victims of drug-facilitated sexual assault may report periods of
memory loss, loss of consciousness, disorientation, or a feeling
“that something happened,” or have awakened in a state of
undress or misdress.

• These drugs are colorless, odorless, and tasteless, so reassure
patients that these substances are undetectable and they
shouldn't feel as if they “should have known.”
• It's imperative to obtain a thorough history, listen carefully to the
story that the patient shares, and remain nonjudgmental during
the telling.

• After listening to the patient's story, if you suspect drugs were used
to incapacitate or control the patient, draw blood and send it for
screening.
• Although many think that only women are victims of drug-facilitated
sexual assault, men can also be drugged by a perpetrator to
incapacitate them or alter their decision-making ability.

Rape kit
• Instructions
• Bags for evidence collection
• Swabs
• Comb
• Envelopes
• Blood collection devices
• Documentation forms.

Cognitively or physically impaired
individuals
• Increased risk for sexual assault.
• 83% of women with disabilities are assaulted in their lifetimes and more
than 50% of deaf individuals are sexually abused.
• Inability to defend themselves.
• Perpetrators may victimize individuals with communicating disabilities,
such as blindness or deafness, knowing that the individual's ability to
report the incident and identify the perpetrator is limited.
contd..

Cognitively or physically impaired
individuals
• Being confined to a bed or wheelchair makes an individual even more
vulnerable to abuse.
• Individuals who are dependent on a caregiver for food, clothing,
shelter, finances, medications, and medical care may also be victimized
by that caregiver and feel that they have no one to turn to for help.
• Be vigilant for signs of suspected abuse and refer these patients to
social services and law enforcement if appropriate.

Male victims
• Male victims of sexual assault are highly underreported, but
the CDC reports that 1 in 71 men have been raped.
• 6% of men have been sexually coerced at some time in their
lives.
• Sexual coercion or assault of men occurs for the same
reasons as assault of women: control, humiliation, and power
or authority.
• Male victims of sexual coercion, assault, or rape fall into
numerous categories; there's no “typical” victim.
Contd..

Male victims
• Large numbers of male victims come from military personnel and
prisons, and are assaulted by heterosexual men.
• One study reported that over 45,000 servicemen have reported
being sexually assaulted, usually by senior personnel.
• Within the male prisoner population, victims tend to be young,
White, and first-time offenders.
• Perpetrators may be prison guards, other personnel, or other
prisoners.

Sex trade workers
• Sex trade workers are at high risk for sexual assault.
• Although it's easy to assume that sex workers choose to work in
this high-risk industry, we must not forget that many of these
individuals are forced to sell their bodies to survive.
• Trapped and at the mercy of those who control their finances,
these individuals are constantly in danger and especially
vulnerable to violent sexual acts and exposure to alcohol, drugs,
and weapons.
contd..

Sex trade workers
• Members of this group range from underage young men and
women to middle-age adults, and include heterosexual,
homosexual, and transgender individuals.
• Many are unable to see a way out of their situation and are
reluctant to seek help from nurses or police out of fear of
prosecution and judgment.
• When encountering these individuals in various healthcare
settings, be especially careful to communicate in a nonjudgmental
manner and seize the opportunity to connect them with community
resources and services.

LGBTQ community
• LGBTQ individuals are at risk for sexual assault within
relationships, as well as from heterosexual individuals as a type
of hate crime.
• Transgender individuals may face the greatest risk of violence,
which seems to be dependent on the extent to which the
individual presents him or herself.

Contact: +91-11-26944880, +91-11-26944883
Email: complaintcell-ncw@nic.in
1. National Commission for Women

Guria India
Contact: 91-542-2504253
Email: info@guriaindia.org

3. Women Helpline (All India)- Women
in India
• Contact: 1091

4. The Pranjya Trust
• Contact: +914424811255
• Email: prajnyatrust@gmail.com

5. ActionAid India
• Contact: +91 80 25586293 (9 AM – 6 PM)
• Address: ActionAid India Head Office (Country Office) R 7,
Hauz Khas Enclave, New Delhi 110016

6. Snehalaya
• Contact: +91 0241 2778353
• Email: give@snehalaya.org

7. Majlis
Contact: 91-22-26662394 / 26661252
Email: majlislaw@gmail.com

8. Azad Foundation
• Contact: +91 11 4060 1878
• Email: azadfoundation@gmail.com

9. International Center for Research on
Women
• Contact: 011 4664 3333
• Email: info.india@icrw.org

10. Aasra
• Contact: +91-9820466726
• Email: aasrahelpline@yahoo.com

11. SNEHA
• Contact: +91 91675 35765
• Email: crisis@snehamumbai.org

riazmarakkar@gmail.com

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