Management of Rape Victims

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Title: Slide 1 Author: Owner Last modified by: Owner Created Date: 11/10/2005 7:12:16 PM Document presentation format: On-screen Show (4:3) Other titles
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Title: Management of Rape Victims 1 Management of Rape Victims
  • Martin Donohoe
  • Information within does not constitute clinical advice regarding treatment I recommend consulting contemporary medical references
  • 2 Rape
  • Unwanted, forced penetration (oral/vaginal/anal)
  • Reported by 33 -46 of women who are physically abused
  • 3 Rape
  • Annual incidence ³ 80/100,000 women
  • 7 of all violent crimes
  • Lifetime prevalence up to 25
  • 1/3 Native Americans/Alaskan Natives victims of attempted rape or rape
  • Migrants, those in war zones and refugee camps at high risk
  • 4 Rape
  • Annual incidence of at least 300,000 women in US
  • Forcible rape every 6.2 seconds (FBI)
  • 7 of all violent crimes
  • Additional 3.7 million confronted with unwanted sexual activity
  • Lifetime prevalence 13-39 in women 3 in men
  • 5 Epidemiology of VAW
  • 2011 CDC study
  • 18 of women have been raped 1.4 of men
  • Women 52 by partner 41 by acquaintance
  • Men 52 by acquaintance 15 by stranger
  • 6 Date Rape
  • 40 of college women report forced sexual contact, attempted rape, or completed rape
  • independent of school demographics
  • 7 Date Rape
  • gt25 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
  • 8 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
  • 9 High Risk Groups
  • Prostitutes
  • Military
  • See the Womens Health and War and Peace pages of the Public Health and Social Justice website for other slide shows and articles covering
  • Violence against women in the military
  • War, rape and genocide
  • Homeless and runaways
  • 10 High Risk Groups
  • Gays, lesbians, bisexuals, transgendered
  • Alcohol and drug users
  • College students
  • Persons under age 24
  • 11 High Risk Perpetrators
  • Male college athletes
  • Fraternity members
  • Men with restraining orders
  • 12 Rape
  • 5 chance of pregnancy
  • 25 chance of acquiring STD
  • GC 6 - 12
  • Chlamydia 4 - 17
  • Syphilis 0.5 - 3
  • 13 Rape
  • 5 chance of pregnancy
  • 25 chance of acquiring STD
  • GC 6 - 12
  • Chlamydia 4 - 17
  • Syphilis 0.5 - 3
  • 14 Rape and HIV
  • 1 -2/1,000 odds of acquiring HIV from HIV rapist
  • 1-2/100,000 overall risk of HIV from vaginal penetration
  • 2-3/10,000 from anal penetration
  • 15 Rape and Pregnancy
  • Noninvasive prenatal genetic testing through amplification of fetal alleles from maternal blood very accurate for identifying father
  • Can be performed at 8-14 weeks gestation
  • vs. amniocentesis and chorionic villus sampling (10-15 weeks, risks to mother and fetus)
  • May assist mothers decision to carry vs. terminate pregnancy
  • 16 Rape
  • Underreported (16-38 notify law enforcement 17-43 present for medical evaluation)
  • Fewer than ½ of rape cases successfully prosecuted as few as 1 of rapists convicted
  • 17 Rape
  • Large backlog of untested rape kits (over 180,000)
  • H.R. 4114 and S.B 2736 (Justice for Survivors of Sexual Assault) bills pending in Congress
  • 18 Rape
  • Average prison time for those convicted
  • rape 1 year
  • armed robbery 3 - 5 years
  • murder 8 years
  • Chemical Castration Laws
  • 19 The Physicians Duties in Caring for Victims of Sexual Assaults
  • Medical
  • medical history
  • evaluate and treat physical injuries
  • cultures
  • treat pre-existing infections
  • NEJM 1995 332234-7 and NEJM 2011365834-41
  • 20 The Physicians 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 332234-7 and NEJM 2011365834-41
  • 21 Physical Examination ofSexual Assault Victims
  • Collection of clothing
  • External/internal evaluation
  • abrasions, lacerations, ecchymoses, bite marks colposcopy, toluidine blue staining
  • Oral cavity
  • secretions, injuries, cultures
  • Note time limits for evidence collection vary by state (72-120 hrs)
  • NEJM 1995 332234-7 and NEJM 2011365834-41
  • 22 Physical Examination ofSexual Assault Victims
  • Genitalia
  • hair combing, hair sampling, vaginal secretions, injuries, cultures
  • Rectum
  • injuries, cultures
  • NEJM 1995 332234-7 and NEJM 2011365834-41
  • 23 Prophylaxis for Adult Victims ofSexual AssaultAntibiotic Prophylaxis
  • Ceftriaxone (250 mg IM) or cefixime (2 g po)
  • PLUS
  • Doxycycline (100 mg po bid x 7d) or Azithromycin (1 g po x 1)
  • PLUS
  • Metronidazole ( 2 g po x 1)
  • 24 Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy
  • Most effective oral regimen 1 dose of 30 mg ulipristal or 1.5 mg levonorgestrel within 120 hours of unprotected intercourse (ulipristal twice as effective 0.9 pregnancy rate vs 1.7)
  • 25 Prophylaxis for Adult Victims ofSexual AssaultPrevention of Pregnancy
  • Alternate regimen 2 doses of 100 mcg ethinyl estradiol plus 0.5 mg levonorgestrel taken 12 hours apart (plus prn antiemetic)
  • Most effective IUD implanted within 5 days
  • Nearly 100 effective
  • 26 HIV Post-Exposure Prophylaxis for Adult Victims ofSexual Assault
  • HIV Prophylaxis
  • Consult ID
  • start up to 72 after rape
  • Baseline HIV test and referral to experienced clinician within 72 hours of starting PEP
  • 27 Hepatitis B Post-Exposure Prophylaxis for Adult Victims ofSexual Assault
  • Offender HBsAg-positive administer Hep B vaccine and HBIG
  • Offenders HBsAg status unknown administer Hep B vaccine
  • Rx ideally within 24 hrs, but may be effective up to 14 days
  • Complete Hep B vaccine series
  • Tetanus booster if indicated
  • 28 Ensure Victims Safety
  • Social worker involvement
  • Restraining order
  • Phone numbers of shelters, hotlines
  • Safe place to go
  • 29 Domestic Violence Shelters
  • Availability poor
  • up to 70 - 80 of women and 80 of children turned away on any given night
  • 4 times as many animal shelters as domestic violence shelters in U.S.
  • 30 Domestic Violence Shelters
  • 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
  • 31 Contact Information
  • Public Health and Social Justice Website
  • http//www.phsj.org
  • martindonohoe_at_phsj.org
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