Sexual Assault of Women
Editor's Note: This article has been updated to reflect new guidance from the Centers for Disease Control and Prevention on the treatment of gonococcal infection.
Am Fam Physician. 2021 Feb 1;103(3):168-176.
Patient information: See related handout on sexual assault of women, written by the authors of this article.
Author disclosure: No relevant financial affiliations.
Sexual violence is a major public health and human rights issue affecting more than 40% of women in the United States during their lifetimes. Although men and women experience sexual assault, women are at greatest risk. Populations uniquely impacted by sexual assault include adolescents; lesbian, gay, bisexual, transgender, and queer people; and active-duty military service members. Health consequences of sexual assault include sexually transmitted infections, risk of unintended pregnancy, high rates of mental health conditions (e.g., posttraumatic stress disorder), and development of chronic medical conditions (e.g., chronic pelvic pain). Family physicians care for sexual assault survivors at the time of the assault and years after, and care should follow a survivor-centered and trauma-informed framework. Multiple organizations recommend screening all women for a history of sexual violence; however, the U.S. Preventive Services Task Force recommends only universal intimate partner violence screening in women of reproductive age. A validated tool, such as the Two-Question Screening Tool, can be implemented. Initial care should include treatment of physical injuries, prophylaxis for sexually transmitted infections, immunizations, and the sensitive management of psychological issues. Clinicians must comply with state and local requirements for the use of evidence-gathering kits. Many hospitals have developed collection protocols and employ certified Sexual Assault Nurse Examiners or Sexual Assault Forensic Examiners. Prevention of sexual violence requires a comprehensive approach to address individual, relational, community, and societal factors.
Definitions and Epidemiology
Sexual violence is a broad term that encompasses all sexual acts, committed or attempted, without consent or that occur when the person is unable to consent.1 The World Health Organization recognizes sexual violence as a global public health and human rights issue with far-reaching health consequences.2 Sexual assault is a crime involving nonconsensual sexual contact or behavior, which includes rape or attempted rape, unwanted touching, and sexual coercion.1 In 2012, the Federal Bureau of Investigation developed a comprehensive definition of rape, including any penetration (i.e., with a sexual organ or object) of a body orifice (e.g., vagina, anus, mouth) without consent.3 State laws related to sex crimes differ, and state-specific information is available in the Rape, Abuse and Incest National Network database (https://apps.rainn.org/policy/).
WHAT'S NEW ON THIS TOPIC
Sexual Assault of Women
The National Intimate Partner and Sexual Violence Survey revealed that 43.6% of women experienced sexual violence in their lifetimes, with one in five women experiencing rape or attempted rape.
Approximately 6% of women in the active-duty military reported experiencing sexual assault in the past year.
Among survivors of rape, 16% to 38% report the crime to law enforcement, with similar percentages presenting for medical evaluation.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
A survivor-centered and trauma-informed approach should be used when caring for a survivor of sexual assault.25,26 | C | Expert opinion |
Clinicians who provide care for sexual assault survivors in the acute setting should adhere to medical and legal standards for examination, evidence collection, and documentation.26,36 | C | Expert opinion and legal standards |
All sexual assault survivors of childbearing potential with a negative pregnancy test result should be offered emergency contraception within the appropriate time frame.38 | C | Expert opinion |
All sexual assault survivors should be treated for the prevention of sexually transmitted infections.19 | C | Expert opinion and consensus guideline |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
A survivor-centered and trauma-informed approach should be used when caring for a survivor of sexual assault.25,26 | C | Expert opinion |
Clinicians who provide care for sexual assault survivors in the acute setting should adhere to medical and legal standards for examination, evidence collection, and documentation.26,36 | C | Expert opinion and legal standards |
References
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