RAPE AND SEXUAL

VIOLENCE
Terminology
 Sexual violence- any sexual act, attempt to
obtain sexual act, unwanted sexual comments or
advances, or acts to traffic women’s sexuality,
using coercion, threats of harm or physical force,
by any person regardless of relationship to the
survivor in any setting
 Rape- an act done which causes penetration of
one person’s genital organs with the genital
organs of another without their consent or where
the consent is obtained by force, threats, or
intimidation
Cont
 Penetration- partial or complete insertion of the
genital organs of a person or an object into the
genital organs of another person
 Indecent act- any unlawful act which causes:
I. Any contact between the genital organs of a
person, his or her breasts and buttocks with
that of another person
II. Exposure or display of any pornographic
material to any person against his or her will,
but without penetration
Cont
 Defilement- an act which causes penetration of a
child’s genital organs
 Sexualassault- one unlawfully penetrating the
organs of another person with:
I. Any part of the body or another person or
II. An object manipulated by another person or that
person except where it is done for professional
hygienic or medical purposes
III. Manipulating any part of one’s body or the body of
another person so as to cause penetration of the
genital organ into or by any part of the other
person’s body
Epidemiology
 Globally,
14% of girls and 7% of boys
experience sexual violence
 One third of the girls end up being pregnant
 Therapist is frequently a man with
aggressive behavior
 Motivation
usually relates to expressions of
power or anger, not sexual satisfaction
 Anexcessive amount of alcohol intake is
associated with the aggressive behavior
Forms of sexual violence
 Rape
 Child sexual abuse
 Defilement
 Incest
 Sexual exploitation
 Forced prostitution
Rape trauma syndrome

 Rape victims demonstrate emotional and

physical symptoms that constitute rape
trauma syndrome. The symptoms occur in
two stages:
1. Disorganization
2. Reorganization
Assessment
Disorganization phase:
 Lasts about 3 days
 Victimsfeel humiliation, shame and guilt,
embarrassment, anger, and vengefulness
 Victimmay tremble from fear or be in great pain
from perineal lacerations
 May be startled visibly at the sound of anyone
approaching or touching them
 May have nightmares of the attack occurring again
Cont
Reorganization phase:
 May last months or years
 Victims report recurring nightmares
 Continuing inability to relate to men
 Inabilityto face new and surprising
situations
 May change residence
Medical management of sexual
violence
 A clinician offers physical, forensic, and psychological
care to survivor
General considerations:
 History taking and examination- immediately, in a safe
and trusting environment
 Explain all the procedures and rationale to the survivor
 Allow the survivor to have a family member or friend
present throughout the examination, if he/she wishes
 Collect medical and forensic specimens during the course
of the examination
Cont
Consent:
 Survivor fills informed consent form
 Inform survivor information may be released to a
third party
History taking:
 Be empathetic and nonjudgmental
 Use calm tone of voice
 General health, PMSHx, allergies, current Rx
 Gynecologic hx- LMP, sexual hx, pregnancies,
contraception, current sexual partner, last
consensual sex
Cont
Head-to-toe examination:
 General demeanor and appearance
 Vital signs
 Scalp- palpate for tenderness
 Inspect eyes, ears, and face
 Neck- bruises
 Upper arms and armpits- bruises
 Hand- signs of injury
 Wrist- signs of ligatures
 Forearms- presence of defense injuries
Cont
 Abdomen- palpate to exclude internal injuries and
pregnancy
 Back of legs- collect any biological evidence with
moistened swab (blood, semen, saliva) or tweezers
(hair, fibers, grass, soil)
 Inspect vulva for signs of bruising, scratching, tearing
 Take swabs of external genitalia
 Inspect walls of vagina- abrasions, lacerations, bruises
 Collect any trace evidence- hair, foreign bodies
 Suture tears if needed
 Do warm saline vaginal washout
Investigations
Basic investigations for clinical management of
survivor:
 Urinalysis
 Pregnancy test
 HIV test
 Hb
 VDRL
 LFTs

Forensic investigations:
 Urinalysis- epithelial cells
 High vaginal swab- spermatozoa
Management of physical injuries
 Cleaning and dressing lacerations
 Stitching
 Laparotomy- for perforations, intraabdominal
injuries
 Analgesics
 Tetanus toxoid
 PEP (post exposure prophylaxis)- within 72 hours
 Emergency contraception- within 120 hours
 Prophylaxisfor STIs- within 24 hours; Amoxil and
erythromycin in children
Psychological care
Trauma counseling and psychoeducation:
 Explore feelings
 Normalize feelings of guilt, shame, low self-esteem
 Teachcoping mechanisms, avoidance of risky
circumstances
Other counseling:
Contraception
PEP
Forensic management of sexual
violence
Collection and handling of specimen:
Avoid contamination
Early collection
Dry blood on gauze and store
Protect from direct light
Label accurately
Cont
 Handleappropriately- packaging, storage,
transport
 Urine is refrigerated
 Pack biological evidence in paper envelopes
 Ensure security and record transfer
 Document collection
Documentation

 Post-rape form (PRF) care form

 Kenya police medical examination P3 form
Summary of specimen
 Mouth swab- DNA
 Urine of survivor and victim- alcohol and drug test
 Pubic/scalp hair- DNA transfer evidence
 Foreign fibers, grass, soil- transfer evidence
analysis
 Semen- secretor, blood group of assailant, DNA
 Finger nail, scrapping, clippings- DNA
 Blood stained clothes- DNA, alcohol, drugs
 Bite marks (on plasticine)- dental impressions
THE END

ANY QUESTIONS?