Sexual Assault: By: Dejene Edosa (BSC, MSC in CMW) July 2021
Sexual Assault: By: Dejene Edosa (BSC, MSC in CMW) July 2021
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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.
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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.
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• Suggested terminology for describing examination
findings includes the TEARS categorization:
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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.
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TREATMENT
• Initial therapy - Fractures, soft tissue injuries, and
other traumatic injuries should be treated appropriately.
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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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….
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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.
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