The exact legal definition of sexual assault varies from state to state. Sexual assault is defined as forced sexual contact without consent. Nonconsensual sexual contact involves a continuum ranging from unwanted touching and fondling of sex organs to forced penetration (oral, anal, or vaginal). Fingers or objects (such as broomsticks, bottles, or knives) could be used instead of, or in addition to, a penis as a weapon of choice. Drugs such as gamma-hydroxybutyric acid (GHB), Rohypnol (flunitrazepam), ketamine, and alcohol are commonly used as “date rape” or “club drugs.” These agents are used to disable the victim prior to a sexual assault.
Large studies have shown that 13% to 39% of women and 3% of men have experienced an attempted or completed sexual assault in their lifetime.1,2 FBI and crime statistics grossly underestimate the incidence since only 16% of sexual assaults are reported to police.1,2 In addition, the vulnerable populations such as homeless, sheltered, or institutionalized persons are not included in most large studies.3 Approximately 300,000 to 700,000 adult women are victims of sexual assault annually in the United States, with 40,000 victims treated in Emergency Departments.1,4
Sexual assault is not generally a crime committed by strangers. Most women (78% to 82%) are sexually assaulted by someone known to them.1,4–6 The assailant may include a spouse, boyfriend, family member, coworker, or neighbor. More than 50% of rape victims over the age of 30 are sexually assaulted by an intimate partner.7 An acquaintance such as a contractor or package delivery person may be the perpetrator.
There is not a typical profile of a victim. Adolescent girls and young women face particularly high rates of sexual assault.8 However, victims have been reported in all age groups. Sexual assault occurs across all socioeconomic groups, all racial backgrounds, and all ethnic backgrounds. Up to 39% of women will be sexually assaulted more than once during their lifetime.1
Some victims will not identify themselves as victims of sexual assault. They may be ashamed or fearful to disclose what happened. They also may be experiencing the rape trauma syndrome, a special category of posttraumatic stress disorder. The use of screening questions, as used for domestic violence, and a high index of suspicion are necessary to identify these patients. There is a significant increase in the utilization of medical resources after a sexual assault.9
The Emergency Department visit of a sexual assault victim is vital in assuring proper medical care, evidence collection, and treatment. 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 care and pursue the case through legal avenues is strongly influenced by his or her initial experience in the Emergency Department. It is ...