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Management of Rape Victims

Management of Rape Victims. Martin Donohoe This presentation was last updated in the early 2000s – I recommend consulting more contemporary medical references. Rape. Unwanted, forced penetration (oral/vaginal/anal) reported by 33 - 46% of women who are physically abused

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Management of Rape Victims

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  1. Management of Rape Victims Martin Donohoe This presentation was last updated in the early 2000s – I recommend consulting more contemporary medical references

  2. Rape • Unwanted, forced penetration (oral/vaginal/anal) • reported by 33 - 46% of women who are physically abused • annual incidence ³ 80/100,000 women • 7% of all violent crimes • lifetime prevalence 10% - 25%

  3. Date Rape • 40% of college women report forced sexual contact, attempted rape, or completed rape • independent of school demographics

  4. Date Rape • >25% of college males admit to using sexually coercive behaviors • 2/3 of college males report engaging in unwanted sexual intercourse • reasons: peer pressure, desire to be liked

  5. Spousal Rape • 10 - 15% of all marriages • more violent, less frequently reported then non-spousal rape • not illegal in many U.S. states/other countries

  6. High Risk Groups • Prostitutes • Military • Homeless and runaways

  7. “High Risk” Perpetrators • Male college athletes • Fraternity members • Men with restraining orders

  8. Rape • 5% chance of pregnancy • 25% chance of acquiring STD • GC = 6 - 12% • Chlamydia = 4 - 17% • Syphilis = 0.5 - 3% • 1 -2/1,000 odds of acquiring HIV • varies

  9. Rape • Underreported • Less than 1% of rapists convicted • Average prison time for those convicted: • rape = 1 year • armed robbery = 3 - 5 years • murder = 8 years • Chemical Castration Laws

  10. The Physician’s Duties in Caring for Victims of Sexual Assaults • Medical • medical history • evaluate and treat physical injuries • cultures • treat pre-existing infections NEJM 1995; 332:234-7

  11. The Physician’s Duties in Caring for Victims of Sexual Assaults • Medical • offer post-exposure HIV prophylaxis • offer post-coital contraception (vs. in utero paternity testing f/b selective abortion) • arrange medical followup • provide counseling NEJM 1995; 332:234-7

  12. Physical Examination ofSexual Assault Victims • Collection of clothing • External evaluation • abrasions, lacerations, ecchymoses, bite marks • Oral cavity • secretions, injuries, cultures NEJM 1995; 332:234-7

  13. Physical Examination ofSexual Assault Victims • Genitalia • hair combing, hair sampling, vaginal secretions, injuries, cultures • Rectum • injuries, cultures NEJM 1995; 332:234-7

  14. Prophylaxis for Adult Victims ofSexual AssaultAntibiotic Prophylaxis • Ceftriaxone (250 mg IM) or Spectinomycin (2 g IM) PLUS • Doxycycline (100 mg po bid x 7d) or Azithromycin (1 g po x 1) PLUS • Metronidazole ( 2 g po x 1)

  15. Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy • 2 OCP tablets (each with 50 mcg ethinyl estradiol) po q12° x 2 OR • 3 OCP tablets (each with 35 mcg ethinyl estradiol) po q12 ° x 2 PLUS • Antiemetic

  16. HIV Post-Exposure Prophylaxis for Adult Victims ofSexual Assault • HIV Prophylaxis (studies ongoing) • Consult ID • start up to 72° after rape • Baseline HIV test and referral to experienced clinician within 72 hours of starting PEP

  17. Ensure Victim’s Safety • Social worker involvement • Restraining order • Phone numbers of shelters, hotlines • Safe place to go

  18. Domestic Violence Shelters • Availability poor • up to 70 - 80% of women and 80% of children turned away on any given night • Woefully underfunded • Average length of stay = 14 days; most allow 30 day max stay • Over 50% of all homeless women and children are fleeing domestic violence

  19. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org

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