Definitions of Sexual Assault Overview: A-Z Sexual Assault Cheryl Ann Graf ARNP, MSN, MBA Rape = forced sexual penetration (vaginal, oral, anal, digital, object) Attempted rape = uncompleted attempt at forced penetration Indecent Liberties = forced sexual contact (with breasts, buttocks, genital area) Nonconsenting Sex = unwanted sex while under the influence of alcohol or drugs and when unable to give or withhold consent Child Rape = non-forced sexual penetration when less than 16 years with a person more than five years older Child Molestation = non-forced sexual touching (of breasts, buttocks, or genital area) when less than 16 years by a person more than five years older Typologies of rape Blitz rape (stranger) Confidence rape previously known Offers ride home Controls victim by age or status Exploits someone unable to give consent Stress sex Initially consensual contact, becomes abusive and violent Occurrence of Rape How it is defined How data is collected Sexual violence data comes from: Police Clinical settings Nongovernmental organizations Survey research Sexual assault is common and it is under reported Sexual assault is a tragedy of youth
Age at SA Experience 80 % < 18 years old Of adult assault experience, 50% occurred between 18 and 21 years Younger women report higher rates 44% of adult victims were also assaulted as a child Some women are victimized more than others Sexual assault keeps company with other difficult life events Offender Relationship Adult victim Stranger rape is uncommon % Stranger 11 Relative 1 Intimate 20 partner Acquaintance 68 Harborview data 1997-1999 819 patients 15 83 years old Body trauma 51% Increased frequency of body trauma Strangers Intimate partners Weapon use Choking or anal assault Genital-anal trauma 26% Increased frequency of genital trauma Young (15 to 20 years old) Older (50 and older) Some assaults are more violent than others Genital injury is less common than body injury
Help Seeking Tell Someone 56% See Doctor 19% Sexual assault may have long-lasting adverse life consequences See Therapist 31% Report to Police 18% Mental health SA Hx No SA Hx Total PTSD Lifetime 35% 7% 17% PTSD-Current 8% 0.8% 3% Depression - lifetime Depression - current 32% 10% 18% 6% 2% 3% Somatic symptoms Dysparunia Childbirth trauma Chronic pelvic pain Irritable bowel syndrome Increased use of medical resources Sexual assault of males Risk factors for victimization 16% of adult men report experience of sexual assault Usually by males Often in childhood/young adolescence More often out of family Alcohol use Other substance use Mental illness depression, bipolar illness Domestic violence Prior victimization
Medical Purposes of the exam Identify and treat injuries Assess risk of pregnancy and sexually transmitted diseases Provide prophylaxis for STDs and pregnancy, when indicated Triage Immediate treatment of life threatening injuries Systematic approach Objective evidence collection Consistent techniques Standard protocols Refer/Report Refer for follow-up medical care Refer for advocacy or counseling Report to law enforcement as requested by patient, or in the case of minors to Child Protective Services (CPS) or law enforcement Social/Psychological Crisis management Purposes of the exam (2) Provide information about typical reactions and fearreduction coping strategies Explain reporting process, Crime Victims Compensation, and resources for advocacy and counseling Legal Document history Document medical findings Collect forensic evidence, maintain chain of custody, and transfer to law enforcement To provide Overview: The road map Objective documentation of findings, statements, and injuries Compassionate care and attention to medical and psychological needs Advocacy for legal referral and for safety Where to start.. 1. Obtain consent 2. Assess patient s concerns 3. Relevant history of event 4. Head-to-toe exam 5. Photograph and draw injuries 6. Collect evidence, package and store 7. Offer and administer preventive medicine 8. Discharge with a follow-up plan The Consequences Introduce yourself Physical Psychological Social Health Behaviors Groups at risk Victimization Perpetration I am a nurse who.. Role of the SANE Remain unbiased Identify injury or lack of Understand consensual intercourse as well as sexual assault injury of lack of Consider colposcopy What to do if you need additional support or help for your patient
First things first. Preparation is key Consent for exam Evidence kit Labels Camera Medications Documentation forms What History of the event The Facts Please Type of physical contact / number of assailants Orifices penetrated Ejaculation / condom use Type of force, coercion, restraint Activity after assault douche, bathe, etc Voluntary or suspected drugs Where and Why??? When Who When it happened and where Risk of STD, HIV, physical and emotional trauma Acquaintance, partner, stranger, risk factors of assailant, safety Vital signs What goes in a Head to Toe Exam anyway??? Pulse BP Respirations Weight Are you hurting anywhere? Bleeding Long term illness Regular medications Allergies to meds Screening Exam History Inspection Palpation Movement Active Passive LOC Strangulation Kicked/punched Thrown Twisted arms/legs Amnesia ETOH or Drugs What happened? Past medical history Chronic illness Disability Psychiatric illness, including substance use Usual contraception Any missed pills in cycle Depo last dose Last menstrual period Often known Relationship between Victim and Perpetrator Husbands and intimate partners Sexual coercion Vulnerability factors Protective factors
Refer Advocacy Mental health Follow-up medical Police