Sexual Assault

By: Dejene Edosa (BSc, MSc in CMw)

July 2021
 Sexual Assault
• Defined as any sexual act performed by one person
on another without consent. Eg: Attempted rape,
unwanted sexual touching, use of force, the threat of
force, or from the victim's inability or refusal to give
consent.
• RAPE: is type of sexual assault usually involving
sexual intercourse or other forms of sexual
penetration without consent.

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 EVALUATION
 The assessment of sexual assault victims includes
several domains:
• Assessment and Rx of physical injury with special
focus on the genitalia.
• Psychological assessment and support.
• Pregnancy assessment and prevention.
• Evaluation, treatment, and prevention of STIs.

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 History
• The following details of the history should be obtained:
• Circumstances of the assault: date, time, location, use of
weapons, force, or threats.
• Whether or not the victim - loss of consciousness or
memory loss.
• The assailant's physical description - use of drugs or
alcohol.
• Specifics regarding oral, vaginal, or ano-rectal contact
or penetration along ejaculation or not, condom use.

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 …..
• Areas of trauma should be ascertained focusing
especially upon victim's mouth, breasts, Vx, & rectum.

• Bleeding on the part of either assailant or victim - risk of

hepatitis or HIV transmission.

• The source of genital bleeding must be ascertained as it

can be life threatening.

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 Physical examination
• The pt should undress for the exam with a sheet beneath
them to capture any falling debris for medical evidence.
• The physical exam should describe pt's emotional state.
• The examiner should document any evidence of trauma.
• If possible, photographs of injuries should be taken, with
the patient's consent.
• Extragenital trauma may be more common than
anogenital trauma (70.4% versus 26.8 %)- abrasions, or
erythema on the thigh, upper arm, face or neck.

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 …..
• In women, the breasts, external genitalia, vagina, anus,
and rectum should be carefully examined.

• Common sites of genital injury include the posterior

fourchette and the labia minora.

• As compared to women who have had consensual

sex(with consent), assaulted women are more likely to
have genital trauma lesions to multiple areas.

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 …..
• Suggested terminology for describing examination
findings includes the TEARS categorization: 

• Tears (defined as any break in tissue including fissures

& lacerations), Ecchymoses, Abrasions, Redness,
and Swelling.

• Colposcopic examination can enhance detection of

areas of milder genital trauma.

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 ……
• In male victims, close attention should be paid to the
penis & scrotum, evaluating for erythema, ecchymosis,
excoriation, laceration, or suction marks.

• Penile exam should focus particularly on the glans and

frenulum, and should also assess for urethral discharge.

• Rectal examination should be considered and performed

if there was anal penetration.

• The prostate should be assessed for tenderness.

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 Laboratory testing & diagnostic imaging
•  Laboratory evaluation is focused on testing for STIs,
and pregnancy testing.
• Radiographic imaging is guided by the history and
physical examination.
• Serum testing for HIV, hepatitis B, and syphilis are
recommended.
• Pregnancy testing should be performed for women of
childbearing age.
 

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 TREATMENT
• Initial therapy - Fractures, soft tissue injuries, and
other traumatic injuries should be treated appropriately.

• After urgent attention to trauma, the remainder of the

initial Rx regimen should focus upon STIs (including
hepatitis B and HIV), Px, and psychosocial issues

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 …
• Hepatitis B virus infection  - CDC recommends post
exposure hepatitis B vaccination without hepatitis B
immune globulin (HBIG).
• If the assailant is known to be hepatitis B infected,
hepatitis B immune globulin (HBIG) is recommended.
• Follow-up doses of hepatitis B vaccine should be
administered one and six months after the first dose.
• Vaccination is not necessary if the patient has had
previous hepatitis B vaccine.

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 .
• HIV infection — Prophylactic Rx with antiretroviral
drugs for HIV following sexual assault should be
addressed with every patient.
• Generalizing from the model of occupational HIV
exposure, it is thought that antiretroviral drugs are best
started within 4 hours of assault, and
• Should not be prescribed if more than 72 hours has
passed.

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 ….

• Options for prophylactic regimens used in post exposure

prophylaxis (PEP) for healthcare workers are suitable
for patients who choose to take HIV prophylactic Rx
following sexual assault.

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• The risk may be increased…..
by certain aspects of the
assault:
• Male on male rapists might be expected to have a
higher prevalence of HIV infection.
• Sexual assault in a region or country with a high
background prevalence of HIV.
• Multiple assailants presumably increase the risk.
• Anal sexual assault may be more likely to transmit HIV.

• Sexual assault where either the assailant or the victim

has trauma, bleeding, or genital lesions may increase
the likelihood of transmission.
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 ..
• Pregnancy -Although the risk of pregnancy after a
single episode of Vx intercourse varies during the
menstrual cycle:
• 3 days before ovulation-15%,
• 1 or 2 days before ovulation-30%,
• day of ovulation-12%,
• 1 or 2 days after ovulation-zero).
• post-coital emergency contraception should be offered
without regard to the menstrual cycle, given the
uncertainty in the timing of ovulation.

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04/25/2023 17