Sexual assault is defined as forced sexual contact without consent. Sexual assault involves the threat of force, the use of force, or a person’s inability or refusal to give consent (e.g., children, dementia, and unconsciousness).1 The exact legal definition of sexual assault varies from state to state. Nonconsensual sexual contact involves a continuum ranging from unwanted touching and fondling to forced penetration (i.e., anal, oral, or vaginal). Fingers or objects (e.g., bottles, broomsticks, or knives) could be used instead of or in addition to a penis as a weapon of choice. Drugs (e.g., alcohol, gamma-hydroxybutyric acid [GHB], ketamine, and Rohypnol [flunitrazepam]) are commonly used as “date rape” drugs.2-4 These agents can be used to disable the victim prior to a sexual assault. Alcohol remains the most common intoxicant involved in a sexual assault.5
Approximately 300,000 to 700,000 adult women are victims of sexual assault annually in the United States.6 The lifetime prevalence of sexual assault for women is 18% to 19% and 2% to 3% for men.6,7 The prevalence may be grossly underestimated with only 10% to 15% of all assaults being reported.6 Vulnerable populations (e.g., homeless, institutionalized, or sheltered) are not included in most large studies looking at the incidence or prevalence.8
Sexual assault is not generally a crime committed by strangers. Most women (78% to 82%) are sexually assaulted by someone known to them.6,9 The assailant may be an acquaintance, coworker, family member, neighbor, significant other, or spouse. More than 50% of rape victims over the age of 30 are sexually assaulted by an intimate partner.9 Even fewer women report assault when it is committed by someone they know.
Victims do not fit a specific profile. Adolescent girls and young women face particularly high rates of sexual assault.10 Victims have been reported in all age groups. Sexual assault occurs across all ethnic backgrounds, racial backgrounds, and socioeconomic groups. Up to 39% of women will be raped more than once during their lifetime.6
Some victims will not identify themselves as victims of sexual assault.1 They may be ashamed or fearful to disclose what happened. They may be experiencing the rape trauma syndrome which is a special category of posttraumatic stress disorder. The use of screening questions and a high index of suspicion are necessary to identify these patients. It is clear there is a significant increase in the utilization of medical resources after a sexual assault and early identification of potential victims may be useful.11
The Emergency Department visit of a sexual assault victim is vital in assuring evidence collection and proper medical treatment.5,12 Proper follow-up plans, medical appointments, and referrals to local rape crisis centers and/or hotlines are crucial for the mental and physical recovery of victims. The likelihood that the patient will seek follow-up ...