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 20 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 ||Download (.pdf)
Table 188-1 Assault History
| Did the assault survivor know the assailant?|
| Was it a single assailant or multiple assailants?|
| What were the assailant's identity and race? (Document in the medical records.)|
| Was the patient physically assaulted?|
| With what (eg, gun, bat, or fist) and where?|
| Was there actual or attempted vaginal, anal, or oral penetration?|
| Did ejaculation occur? If so, where?|
| Was a foreign object used?|
| Was a condom used?|
| When did the assault occur?|
| (Emergency contraception is most effective when started within 72 h of the assault.)|
| Where did the assault occur?|
| (Corroborating evidence may be found based on the location of the assault.)|
|Suspicion of drug-facilitated rape|
| Was there a period of amnesia?|
| Is there a history of being out drinking and then suddenly feeling very intoxicated?|
| Is there a history of waking up naked or with genital soreness?|
|Douche, shower, or change of clothing|
| Did the patient douche, shower, or change clothing after the assault? (Performing any of these activities prior to seeking medical attention may decrease the probability of sperm or acid phosphatase recovery, as well as recovery of other bits of trace evidence.)|
Perform a general medical examination including vital signs, appearance and demeanor. Focus head-to-toe inspection on defensive injury areas, such as the ...