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Management of rape victimsppt - Public Health and Social Justice

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									Management of Rape Victims

                Martin Donohoe
   This presentation was last updated in the
  early 2000s – I recommend consulting more
        contemporary medical references
                 Rape
   Unwanted, forced penetration
    (oral/vaginal/anal)
   reported by 33 - 46% of women
    who are physically abused
   annual incidence  80/100,000
    women
      7% of all violent crimes

   lifetime prevalence 10% - 25%
          Date Rape

 40%  of college women report
 forced sexual contact,
 attempted rape, or completed
 rape
  independent of school
   demographics
             Date Rape

 >25% of college males admit to using
  sexually coercive behaviors
 2/3 of college males report engaging
  in unwanted sexual intercourse
    reasons: peer pressure, desire to
     be liked
               Spousal Rape

   10 - 15% of all marriages

   more violent, less frequently reported then
    non-spousal rape

   not illegal in many U.S. states/other
    countries
        High Risk Groups

 Prostitutes



 Military



 Homeless   and runaways
“High Risk” Perpetrators

  Male   college athletes

  Fraternity   members

  Men    with restraining orders
          Rape

 5% chance of pregnancy
 25% chance of acquiring STD

    GC = 6 - 12%

    Chlamydia = 4 - 17%

    Syphilis = 0.5 - 3%

 1 -2/1,000 odds of acquiring HIV

    varies
              Rape

   Underreported
   Less than 1% of rapists convicted
   Average prison time for those
    convicted:
      rape = 1 year

      armed robbery = 3 - 5 years

      murder = 8 years

   Chemical Castration Laws
The Physician’s Duties in Caring
 for Victims of Sexual Assaults
   Medical
     medical history

     evaluate and treat physical injuries

     cultures

     treat pre-existing infections

                       NEJM 1995; 332:234-7
The Physician’s Duties in Caring
 for Victims of Sexual Assaults
   Medical
     offer post-exposure HIV prophylaxis

     offer post-coital contraception (vs. in
      utero paternity testing f/b selective
      abortion)
     arrange medical followup

     provide counseling

                         NEJM 1995; 332:234-7
    Physical Examination of
     Sexual Assault Victims
 Collection of clothing
 External evaluation

    abrasions, lacerations, ecchymoses,
     bite marks
 Oral cavity

    secretions, injuries, cultures

               NEJM 1995; 332:234-7
       Physical Examination of
        Sexual Assault Victims
   Genitalia
     hair combing, hair sampling, vaginal
      secretions, injuries, cultures
   Rectum
     injuries, cultures

                  NEJM 1995; 332:234-7
    Prophylaxis for Adult Victims
                 of
          Sexual Assault
          Antibiotic Prophylaxis
 Ceftriaxone (250 mg IM) or Spectinomycin
  (2 g IM)
  PLUS
 Doxycycline (100 mg po bid x 7d) or
  Azithromycin (1 g po x 1)
  PLUS
 Metronidazole ( 2 g po x 1)
    Prophylaxis for Adult Victims
                 of
          Sexual Assault
         Prevention of Pregnancy
 2 OCP tablets (each with 50 mcg ethinyl
  estradiol) po q12 x 2
  OR
 3 OCP tablets (each with 35 mcg ethinyl
  estradiol) po q12  x 2
  PLUS
 Antiemetic
HIV Post-Exposure Prophylaxis
     for Adult Victims of
       Sexual Assault
     HIV Prophylaxis (studies ongoing)
       Consult ID

       start up to 72 after rape
       Baseline HIV test and referral to
       experienced clinician within 72 hours of
       starting PEP
Ensure Victim’s Safety

 Social worker involvement
 Restraining order

 Phone numbers of shelters,
  hotlines
 Safe place to go
     Domestic Violence Shelters

   Availability poor
      up to 70 - 80% of women and 80% of
       children turned away on any given night
   Woefully underfunded
   Average length of stay = 14 days; most allow 30
    day max stay
   Over 50% of all homeless women and children
    are fleeing domestic violence
    Contact Information

Public Health and Social Justice
             Website

    http://www.phsj.org
   martindonohoe@phsj.org


								
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