SEXUAL ASSAULT and ABUSE

1. SEXUAL ASSAULT and ABUSE Presented by: Mrs. Mary Elizabeth Pacuska, M.S.N.

2. Definitions • Rape: “forced sexual intercourse (vaginal, anal, & oral), including both psychological coercion and physical force.” • Sexual Assault: “completed or attempted attacks involving unwanted sexual contact, includes such acts as grabbing, fondling or verbal threats.”

3. Long Term Consequences • Effects vary according to: Age Severity Frequency Relationship to Perpetrator Number of Perpetrators

4. Child Sexual Abuse • Reported up to 80,000 times a year, but the number of unreported instances is far greater, because the children are afraid to tell anyone what has happened • Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger. • No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is "wrong," will develop problems resulting from the inability to cope with the over stimulation.

5. inappropriate sexual knowledge sexually aggressive behavior sex play with other children Depression, anxiety substance abuse dissociation sexual dysfunction revictimization risk of HIV, STD Long Term Symptoms of Sexual Abuse

6. Intimacy/Sexuality • Incident of abuse often first sexual experience • given confusing messages by perpetrator • confusing/conflicting emotions

7. Physiologic Effects of Sexual Abuse • Deregulation of stress system • increased cortisol • decreased testosterone • increased sexual behaviors • early onset of puberty • Physical consequences; injury, infection, STD

8. High Risk Behaviors • less likely to use contraceptives • pregnancy • STD • prostitution • Substance use/abuse

9. Consensual Sex • To regain: self-esteem, attention, power control • Unable to resist request

10. Family Background • Dysfunctional/disrupted family • Multiple types of abuse; sexual, physical, psychological

11. Revictimization • History of childhood CSA - increases likelihood of adult abuse/assault • High risk behavior • Impaired social skills • Personality characteristics abuser looks for • Stronger reaction to adult abuse • trouble communicating with partners • emotional attachment • sexual problems (desire, arousal, orgasm) • anxiety and guilt about sex • Degree of dysfunction correlated with degree of abuse

12. Male Victims • Impact on sexuality: sexual acting out, sexual identity confusion, STDs, dangerous sexual behaviors - e.g., auto-erotic asphyxiation • sexual functioning: low libido, premature ejaculation, erectile failure, inability to ejaculate

13. Male Victims: Reporting Sexual Abuse • Men less likely than women, especially if abuse committed by a woman • Feelings of shame, helplessness, and emasculation • Fear of being labeled homosexual • Interpreting the event as favorable, harmless

14. Survivors as Perpetrators • All abusers have been abused, however not all abused become abusers

15. Real rapes are only committed by strangers. Women who are raped were just asking for it. Unless a weapon is used it isn't rape. If he bought dinner she "owes" him sex. If a woman doesn't fight against her attack it isn't really rape. Husbands can't rape their wives. It's her duty. Women cry rape because they had sex and changed their minds. If it is really rape then the victim will report it immediately. She really wanted to have sex so it was ok to get rough. Rape only happens to women. Rape only happens to women who are on the streets late at night. I don't know anyone who's ever been raped. Rape Myths

16. Types of Rape • Date rape & Acquaintance rape • Stranger Rape • Marital rape • Male rape

17. Types of Rapists • Anger Rapist • Power Rapist • Sadistic Rapist

18. Incidence and Prevalence • Every 2 minutes in US • 1 out of 6 American women • 9 out of 10 victims are women • 44% under 18 • Although 80% white, minorities more likely • Ages 12-34 highest risk years • Average age of rapist is 31 • In 1 out of 3, perpetrator intoxicated • 98% of males who raped boys report that they are heterosexual

19. Statistics • 62% of female rape victims knew their assailant • 43% are raped by a friend or acquaintance, 34% by a stranger, 17% by an intimate, 2% by a relative

20. Rape: Long Term Consequences • physical injury • STDs • long-term psychological consequences • eating and sleep disorders • depression • problems establishing trust in relationships • Post traumatic stress disorder (PTSD)

21. PTSD • Following exposure to an extreme trauma for one month or more: • persistent re-experiencing of trauma • persistent avoidance of stimuli associated with trauma ornumbing persistent increased arousal

22. Date And Acquaintance Rape • Acquaintance rape: nonconsensual sex between two individuals who know one another • Date rape: nonconsensual sex occurs between two people who are in a romantic relationship

23. Date Rape Statistics • 25% of college women victims of rape or attempted rape • 85% of rapes on campuses are acquaintance/date rapes • 73% do not recognize their experience as rape • Alcohol involved in 90% of campus rapes • 70% college students admit to sexual activity as a result of being intoxicated • 42% of college women raped do not tell • 84% of college men who committed rape claimed definitely NOT rape

24. Safety Tips • Know your own feelings about sex • Communicate your feelings and sexual intentions clearly • Do not allow yourself to be isolated • Protest LOUDLY!! • Be smart and aware of your surroundings • Drink responsibly • Have an alternative mode of transportation • Pay your own way

25. Date Rape Drugs • Alcohol • Rohypnol • Gamma Hydroxybutyrate (GHB) • Ketamine • Any drug that causes drowsiness

26. Begin in 10-30 minutes Abnormally sleepy, dizzy, confused, and intoxicated Very drunk with very little alcohol Loss of memory and judgment Maximum effect in 1-2 hours May last up to 24 hours Memory gaps and blackouts Wake up feeling violated Waking in strange places May notice bruises on their bodies Symptoms of Date Rape Drugs

27. Dangers of Date Rape Drugs • Respiratory depression • Aspiration • Death

28. Protect Yourself from Date Rape Drugs • Do not let someone push drinks on you • Do not accept a drink from anyone you would not “put your life in their hands” • NEVER leave a drink unattended • If you feel sick or drunk go to someone you KNOW and TRUST • Never leave alone!!! • Call 911

29. Marital Rape • History - Rape: "sexual intercourse with a female not his wife without her consent" Sir Matthew Hale, Chief Justice in 17th century England "The husband cannot be guilty of a rape committed by himself upon his lawful wife, for by their mutual matrimonial consent and contract, the wife hath given herself in kind unto the husband which she cannot retract." • 1970s: challenged by women’s rights movement July 5, 1993 - marital rape a crime in all 50 states

30. Marital Rape • Higher incidence for women: 7.7 % men • Domestic violence • Risk factors: pregnancy, illness, attempting to leave partner, drug and alcohol abuse by perpetrator, previous experience of abuse

31. Marital Rape • Effects: physical injury • STDs long-term psychological consequences disordered eating sleep problems depression problems establishing trust in relationships PTSD

32. Disorganization: Immediate impact Emotional Reactions Physical Reactions Social Responses Sexual Disturbances Reorganization: Psychological Physical Problems Social Responses Sexual Relationships Rape Trauma Syndrome

33. Personality type Support systems Relationship with offender Degree of violence Type of sexual assault Perception of the assault Social/cultural influences Previous experiences with stress Success in coping with previous crisis Immediate personal contacts after assault Factors Influencing Recovery

34. Rape is about power, control and anger!!!!! • The truth is: • Rape is an act of violence • Rape can happen to anyone • Rapists can be anyone • Rapists commit rape again and again until caught

35. Protect Yourself • Use your head • Be alert! Walk with confidence and purpose • Be aware of your surroundings • Don’t let alcohol or drugs cloud your judgment • Trust your instincts

36. When the unthinkable happens • Surviving is your goal! • Try to escape. Scream. Be rude. Make noise. • Talk, stall for time, assess your options • If weapon, do what ever it takes to survive

37. Find a safe environment... away from the attacker Have a friend stay with you for moral supportKeep the evidence of the attack... don't bathe, douche or brush your teeth Write down details of the attacker and attack to recall at a later time for the police Call a rape crisis center near you or RAINN @ 1-800-656-HOPE Get medical attention even if you have no physical injuries due to the risk of   STD's and  pregnancy and to preserve forensic evidence. Report the rape to law enforcement (Hospital must notify police, victim does not have to talk to them) Remember it wasn't your fault!!! Give yourself the time you need to heal... it may take a while Surviving the rape

38. If someone you know is raped • Believe her or him • Don’t blame the victim!!! • Offer support, patience, and compassion

39. PHYSICAL EXAM and EVIDENCE GATHERING • SAFE/SANE: Sexual Assault Forensic Examiner/ Sexual Assault Nurse Examiner • SART: Sexual Assault Response Team

40. REGISTRATION • Registration: Insurance • Victims Compensation Program $500/exam $100 for medication

41. Medical Treatment for Minors • Emancipated: can give consent for medical treatment 1. 18 or older 2. High school grad 3. married or been married 4. pregnant or has been pregnant Any minor can give consent for treatment of STD’s

42. Physical Exam • Possible injuries • External genitalia • Internal examination • Anal orifice and mouth • Cultures of mouth, throat, cervix and rectum • Rape Kit : Chain of Evidence

43. Medical Issues • Trauma • Drug Induced Rapes • STD’s • Prganancy

44. Psychological and Emotional Support • VRC • Private Counseling