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Not all individuals who are sexually assaulted sustain an injury. Lack of injury does not mean that an assault did not occur. Often the perpetrator is known to the assault survivor.

Intimate partner violence and abuse is defined as a pattern of assaultive behavior that may include physical injury, sexual assault, psychological abuse, stalking, deprivation, intimidation, and threats. Intimate partner violence and abuse occurs in every race, ethnicity, culture, geographic region, and religious affiliation and occurs in gay, lesbian, and heterosexual relationships.


Elements of the sexual assault history are listed in Table 188-1. The history for intimate partner violence and abuse can be more difficult to obtain. Risk factors for intimate partner violence and abuse include female sex, age between 18 and 24 years, low socioeconomic status, separated relationship status, and residence in rental housing. Injuries inconsistent with the patient's history, multiple injuries in various stages of healing, delay in the time of injury occurrence and presentation, a visit for vague complaints without evidence of injury, or suicide attempts should trigger suspicions of intimate partner violence and abuse. Patients may complain initially of chronic pain syndromes, gynecologic or psychiatric difficulties, and alcohol and substance abuse. The patient also may appear frightened when the partner is present or the partner may be hostile, defensive, aggressive, or overly solicitous. Recent and remote abuse, including dates, locations, details of abuse, and witnesses, should be documented. Patients need to be asked about any suicidal or homicidal ideation and plans and get appropriate, immediate evaluation.

Table 188-1

Assault History

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