An important topic in medical education: Multidisciplinary approach to a sexual assault case in the emergency clinic (original) (raw)
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Sexual Assaults and Medical Approach
International Journal of Medical and Biomedical Studies, 2019
Sexual abuse can be accompanied with physical force, threatening, horrifying, drugging and / or misuse of the consents such as the unable ones to give consent because of their underage and / or mental disease. It is a major problem in all over the world as well as our country. Most of the sexual assault victims are actually also child abuse cases. This study aims to contribute to the solution of these abuses and assaults as well as to increase the awareness of the clinical examiners. We designed this study to present the data and increase the benefit for to prevent these abuses. 154 cases had been evaluated at our department in between the dates of October 2012 and January 2014. The ages varied as in groups such as 0-12, 12-15, 15-18 and over the age of 18. The majority of the cases (46.7%) were in the 12 – 15 age group. 25.9% were aged as 15 – 18 and 15.6% were over the age of 18. Only 11.8% were under 12 years of age. The youngest victim was seven years old while the oldest one...
Ethiopian Journal of Health Sciences, 2014
BACKGROUND: Sexual assault affects one out of every five women, and it is a substantial public health and human rights problem in developing countries including Ethiopia. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to assess the pattern of sexual assault and related complications in cases which were treated at Jimma University Specialized Hospital from November 1, 2011-October 31, 2012. METHODS: A hospital based cross-sectional descriptive study was conducted with the aim of assessing sexual assault patterns and related complications on 99 sexual assault cases which were managed at the Gynecology Outpatient Department of the Hospital. Data on circumstances of sexual assault, survivor specific demographic characteristics and information on complications and interventions provided were collected by trained third year residents in obstetrics and gynecology using pretested questionnaire after respondent consent was taken. The collected data was cleaned, edited, fed into computer and analyzed using SPSS for windows version 16.0. RESULTS: The mean (±SD) of the survivors' age was 14 (±5) years; 57.5% of the survivors were children and 68.7% were from rural areas. Three percent of the clients visited the Gynecology Outpatient Department for sexual assault where rape accounted for 78.8%. The majority (76.8%) of the assailants was known to the survivors, 91% were assaulted by one assailant and 5.1% of the rape cases were gang rape. The mean time of presentation after sexual assault to the hospital was 15 days. Survivors had pregnancy test, HIV test and screening for sexually transmitted infections in 76.8%, 99%, 93% respectively of which 17.1%, 5.1%, 14.1% tested positive for pregnancy, HIV, and some STIs respectively. All HIV positive survivors were children under fifteen years of age. Forty percent of the survivors were provided with emergency contraception. In addition, 60.5%, 63%, and 91.9% of them were provided with post-exposure prophylaxis for HIV, STIs prophylaxis and were given counseling respectively. CONCLUSION: It has been revealed that sexual assault is a major problem of women and children of less than fifteen years. There were gaps in providing and receiving packages of care and justice system to protect survivors indicating the needs for community intervention and providing quality of care by health care staff.
The Importance of Clinical Approach to Aggravated Sexual Abuse: Case Report
Turkish Journal of Trauma and Emergency Surgery, 2018
The reported rate of sex crimes, some of the most severe acts of violence that can be perpetrated against an individual, is increasing across all societies, regardless of gender or age of the victim. Sexual abuse has been defined, in part, as the involvement of a child in sexual activity for which they are incapable of giving consent, that they cannot fully comprehend, or for which they are developmentally immature. Molestation of the anorectal region is frequently encountered when the victim of sexual abuse is a male child. Tenderness around the anus, ecchymosis, and detachment in the anal sphincter and rectum mucosa may be observed in the acute examination of children who have been subjected to aggravated sexual abuse; however, injuries related to the anus or the rectum may also occur as a result of an accident. An 11-year-old male patient was referred from another health center with a report of being at risk of death. The injury that was said to be the result of accidentally sitting on a knife. An examination in the lithotomy position revealed perianal ecchymosis, a superficial laceration at 1 and 6 o'clock, and a deep laceration at 7 o'clock. Based upon a suspicion of sexual abuse, anal and rectal swab specimens were obtained. The pediatric surgery department performed a primary repair of the lacerations. The microscopic examination of the swab specimens revealed cells showing sperm morphology, and therefore the appropriate forensic statements were made and the swab specimens were sent to the judicial authority for genetic analysis. This report emphasizes the importance of the awareness of physicians regarding the prompt collection and submission of potentially evidential biological samples in a case of suspected sexual abuse though it may be presented as an accident.
Medicolegal Examination of Sexual Assault Cases. A Retrospective Study
Zagazig Journal of Forensic Medicine
Background: Sexual assault is any sexual action submitted against someone without their assent or against people who cannot give a legitimate assent. Sexual assaults can happen to anybody at whatever age, at any place, whenever. Aim of the work: to assess sexual assaults within Fayoum governorate, Egypt, and know the elements of this significant public health concern. Methods: This is a retrospective study of sexual assault cases examined by the forensic medicine authority, Fayoum governorate, Egypt, from January 2013 to December 2017. Sociodemographic data of the victim and assailants and information about the assault were recorded. Results: The study recorded 164 cases. The victim's age was commonly presented in the second decade of life as 45%. Females were higher than males. The perpetrator's age was widely shown in the third decade of life as 44%. A known person to the victim, either friend or neighbour, was the widely presented form of the relation of the perpetrator to the victim (53.7%). Anal sexual assaults or sodomy was the dominant form of assault (53.7%), followed by vaginal assaults or rape (41.5%). The time of examination of the victim after the assault was commonly one week (58.5%). At the same time, 41.5% of victims were examined for more than one week. The local genital examination findings were positive in (51.2%) of the victims. A highly significant difference was found between the victims' age and victims' gender, type of sexual assault, perpetrator age, and type of penetration. Conclusion: Most assaulted males were in their first decade of life, while most assaulted females were in the second and third decades. The results conclude that our sons and daughters could not be secure even among their most treasured ones.
The Psychiatric Consequences of Child and Adolescent Sexual Abuse: A Report of 590 Cases in Turkey
Noro Psikiyatri Arsivi, 2015
Introduction: The purpose of this study was to investigate the psychiatric consequences of sexual abuse and its associated factors in children and adolescents referred to our child and adolescent psychiatry clinic from official medico-legal units. Methods: All victims of sexual abuse (n=590) aged 1-18 (mean: 13.56±3.38) referred from forensic units to Ondokuz Mayis University Child and Adolescent Psychiatry Clinic over a period of 2 years [boys: 83 (14.1%); girls: 507 (85.9%)] were included. Child and adolescent psychiatry and forensic medicine specialists evaluated all the cases. The Wechsler Intelligence Scale for Children-Revised Form (WISC-R) and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T) were applied. Results: Abuse-related psychiatric diagnoses (of which 45.9% were major depressive disorder and 31.7% were post-traumatic stress disorder cases) were made in 75.2% of the cases. In 80.3% of the cases, the perpetrators were known to their victims [incest, n=91 (15.1%)], and intercourse took place in 48.8%. Although gender and age were not significantly associated with the appearance of any psychiatric disorders, severity of abuse (e.g., intercourse; p=.006), additional physical assault (p<.001), and incest (p<.001) had a significant correlation with psychiatric disorders. To explore the predictive value of multiple factors in the appearance of any sexual assault-related psychiatric disorder, a logistic regression model was used to determine the best linear combination of age, gender, abuse severity, incest, involvement of any other victim, additional physical assault, and length of time from first abuse to first psychiatric evaluation. This combination of variables (occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation) significantly predicted the appearance of a psychiatric disorder of any kind (χ 2 =55.42; df=7; n=522; p<.001). Conclusion: Our findings reveal that the occurrence of incest, additional physical assault, and a long duration from first abuse to first psychiatric evaluation predict higher rates of sexual abuse-related psychiatric disorders.
Sexual assault: examination of the victim
Medicine, 2010
While rape and sexual assault are common, most offences remain unreported. These crimes are associated with acute and chronic physical and psychological morbidity and may be linked to substance misuse, healthcare neglect, 'risky' sexual behaviour and eating disorders. Early interventions may reduce serious psychological morbidity in some individuals. Most research focuses on the impact of sexual violence on women, but the principles of management apply to both male and female complainants.
Child Sexual Abuse in Turkey: An Analysis of 1002 Cases
This study investigated the characteristics of abuse suffered by children, the dimensions of the psychiatric effects associated with abuse, and the factors affecting these. One thousand two cases aged under 18, exposed to sexual abuse, and referred over a 7-year period were assessed. Girls represented 80.8% of cases, and the numbers rose with age. The aggressors were all male, and 88.2% were known to their victim. Approximately half the children were exposed to sexual abuse involving penetration. Psychological pathology was identified in 62.1%. Female gender, the presence of penetration, physical violence, and incest significantly increased the development of psychological pathology. Levels of awareness in people close to and trusted by the child must be raised to minimize the adverse effects of trauma in the long term, preventive measures must be taken, and medical and social support units from which victims can receive assistance need to be established.
Management of acute adult sexual assault
The Medical journal of Australia, 2003
An estimated 13% of women and 3% of men worldwide report sexual assault in their lifetime. Although managing sexual assault may appear daunting, some victims want medical care only. After disclosure, discuss forensic assessment. If a complaint to the police is possible, give the first dose of emergency contraception if required, and refer for forensic assessment. If medical care only is desired, determine the timing and type of assault and current contraception, manage general and genital injuries and perform relevant tests. After unprotected vaginal rape, offer emergency contraception, chlamydia prophylaxis and vaccination against hepatitis B virus. Counselling is important for all victims of sexual assault, as psychosocial consequences are more common than physical injuries. Management by a sympathetic, non-judgmental health practitioner helps the victim to regain control.
Therapeutic Drug Monitoring, 2008
Sexual assault is defined as any undesired physical contact of a sexual nature perpetrated against another person and is a prevalent problem presenting at emergency departments, emergency forensic medicine units, and rape crisis centres worldwide. Drug-facilitated sexual assault (DFSA) is a complex problem that is encountered with increasing frequency. But this problem is often underrepresented because most DFSAs are not reported by the frightened victims or are diagnosed as an acute drug or alcohol intoxication, thereby bypassing sexual abuse diagnosis and appropriate care. Proper care must be taken to ensure the chain of custody. Emergency physicians need to be aware of the phenomenon and work together with reference emergency forensic medicine units and rape crisis centres, which are capable of taking care of the male and female victims of sexual abuse. If no attention is given to the risk of DFSA, then toxicological samples (urine, blood, hair) and other biologic evidence may remain unidentified and semen, vaginal secretions, and vaginal epithelial cells cannot be genetically typed by a crime laboratory. This article reports the main clinical aspects of DFSA encountered in emergency departments at the beginning of the 21st century and the experience of an emergency forensic medicine unit based at a hospital (Compiègne, France). Guidelines are proposed for clinical examination of DFSA victims, clinical forensic medical examination, and accurate samplings for further toxicological and biological evidence.