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Sexual Assault

Sexual Assault. Max Brinsmead PhD FRANZCOG July 2011. This Talk. Overview of the Problem Definitions Incidence Potential Consequences Principles of management of the victim of rape The forensic examination will not be covered in detail Follow the protocol Resources

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Sexual Assault

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  1. Sexual Assault Max Brinsmead PhD FRANZCOG July 2011

  2. This Talk • Overview of the Problem • Definitions • Incidence • Potential Consequences • Principles of management of the victim of rape • The forensic examination will not be covered in detail • Follow the protocol • Resources • O’Connor and Kovacs “Obstetrics, Gynaecology and Women’s Health” 2003 • Miriam O’Connor’s material for PEmO Courses

  3. Sexual Assault • A universal problem • Most victims are women or girls and most perpetrators are men or adolescent males • Encompasses a range of activities that includes... • Physical violence with a sexual component • Domestic abuse • Sexual harrassment • Paedophilia • Incest • Each is defined under law

  4. Rape – Legal Definition • Conviction requires 3 components: • Sexual Penetration • Lack of Consent • Intent of the accused to penetrate without consent • Sexual Penetration: • Penile penetration of the vagina, anus or mouth • Penetration of the vagina or anus by any object • Lack of Consent includes... • Submission because of harm or threat • Asleep, unconscious or affected by drugs • Incapable of understanding • Mistaken about the nature of the event or the identity of the person

  5. Rape – Incidence • Difficult to measure because most is unreported • Official crime statistics just the tip of the iceberg • Up to 33% of women report a lifetime incidence of unwanted sexual penetration • This means that most is perpetrated by partners, friends, acquaintances or family members • Vulnerable groups: • Minorities • Adolescents • Sex workers • Intellectually or Psychiatrically impaired

  6. Consequences of Sexual Assault • Physical harm • May be minimal or life-threatening • STD or Pregnancy • Psychological harm • Depression (guilt, anger and loss of self esteem) • Suicide • Post traumatic stress disorder • Sexual dysfunction • Chronic Pelvic Pain • Obstetric dysfunction

  7. Your Responsibilities • First and foremost is the physical and psychological care of your patient • It is important to remain professional • And not be judgemental or emotional • Secondary considerations include... • Assist the police in the identification and conviction of the perpetrator • And protection of the community • Assist the patient by explaining her options and then respecting her choices

  8. Good Practice during a Forensic Evaluation • Be kind, gentle, considerate & slow • Seek consent for every step of the process • Don’t forget that history precedes examination • Use support person as a chaperone • But this also requires patient consent • Remember that lack of physical evidence for injury does not exclude the event • You are not the judge and jury

  9. Tips for Competency during the Forensic Evaluation • Make sure that you have enough time • Triage other commitments • Get everything ready before you start • Read the protocol before you start • Needs meticulous records • Observe legal protocols • For example, the chain of custody • You may need • STD rapid testing and pregnancy tests • STD prophylaxis including that for HIV • Emergency contraception • Some examinations require GA

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