Rape

Introduction

• Women neither secretly want to be raped nor do they expect, encourage, or enjoy rape.
• Rape is always a terrifying experience in which most victims fear for their lives.
• The rapist is usually a hostile man who uses sexual intercourse to terrorize and humiliate a woman.

General Considerations

Rape, or sexual assault, is legally defined in different ways in various jurisdictions. Clinicians and emergency room personnel who deal with rape victims should be familiar with the laws pertaining to sexual assault in their own state. From a medical and psychologic viewpoint, it is essential that persons treating rape victims recognize the nonconsensual and violent nature of the crime. About 95% of reported rape victims are women. Penetration may be vaginal, anal, or oral and may be by the penis, hand, or a foreign object. The absence of genital injury does not imply consent by the victim. The assailant may be unknown to the victim or, more frequently, may be an acquaintance or even the spouse.

"Unlawful sexual intercourse," or statutory rape, is intercourse with a female before the age of majority even with her consent.

Rape represents an expression of anger, power, and sexuality on the part of the rapist. The rapist is usually a hostile man who uses sexual intercourse to terrorize and humiliate a woman. Women neither secretly want to be raped nor do they expect, encourage, or enjoy rape.

Rape involves severe physical injury in 5-10% of cases and is always a terrifying experience in which most victims fear for their lives. Consequently, all victims suffer some psychologic aftermath. Moreover, some rape victims may acquire sexually transmissible disease or become pregnant.

Because rape is a personal crisis, each patient will react differently. The rape trauma syndrome comprises two principal phases. (1) Immediate or acute: Shaking, sobbing, and restless activity may last from a few days to a few weeks. The patient may experience anger, guilt, or shame or may repress these emotions. Reactions vary depending on the victim's personality and the circumstances of the attack. (2) Late or chronic: Problems related to the attack may develop weeks or months later. The lifestyle and work patterns of the individual may change. Sleep disorders or phobias often develop. Loss of self-esteem can rarely lead to suicide.

Clinicians and emergency room personnel who deal with rape victims should work with community rape crisis centers whenever possible to provide ongoing support and counseling.

General Office Procedures

The clinician who first sees the alleged rape victim should be empathetic. Begin with a statement such as, "This is a terrible thing that has happened to you. I want to help."