In an educational bulletin published in the October 1998 issue of Obstetrics and Gynecology, the American College of Obstetricians and Gynecologists (ACOG) discusses the management of adolescent victims of sexual assault (ACOG Educational Bulletin No. 252). The report covers definitions, prevalence, adolescent perceptions of violence, identification of the adolescent sexual assault victim, and intervention and prevention.

The National Institute of Justice reports that, each year, 1 million women in the United States become new victims of rape. ACOG points out that many of these victims are adolescent females and children. One study mentioned in the report provided evidence that 74 percent of women who had sex before the age of 14 years and 60 percent of women who had sex before the age of 15 years had sex involuntarily at some time earlier in their lives. ACOG believes that these data suggest routine screening is warranted for adolescent victims of sexual assault so that they may receive appropriate counseling.

ACOG recommends that physicians who evaluate victims of acute sexual assault should provide counseling as well as medical treatment, talk to the victim about her rights, direct her to obtain legal assistance and discuss preventive strategies for future problems with victimization. However, ACOG recognizes that physicians may be faced with the challenging responsibility of identifying adolescent victims of sexual assault and providing effective interventional and preventive counseling. It is important for physicians to recognize the behavioral symptoms that may suggest a history of sexual assault. In the report, ACOG lists the following behavioral and psychologic symptoms that may help identify an adolescent who has been sexually assaulted in the past: teenage pregnancy, poor contraceptive use, substance abuse, risky health behaviors associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome, prostitution, multiple sexual partners, sexual dysfunction, problems with interpersonal and sexual relations, poor self-esteem, depression, somatization, eating disorders/obesity, insomnia and nightmares, suicide attempts, psychiatric admissions, post-traumatic stress disorder, anxiety and school failure.

The following physical health problems that may suggest a history of sexual assault are listed in the ACOG report:

• Chronic abdominal pain

• Gastrointestinal tract symptoms (e.g., irritable bowel syndrome)

• Chronic pelvic pain

• Vulvodynia and dyspareunia

• Breast pain

• Gynecologic infections

• Sexual transmissible infections

• Chronic headache

• Musculoskeletal complaints

• Multiple physical complaints

The ACOG document also discusses the physician's responsibility for reporting child abuse to child protective services and various effective counseling techniques. Suggestions for prevention messages for adolescents are also included.

The address for ACOG is 409 12th St., S.W., P.O. Box 96920, Washington, D.C. 20090-6920.