ACM sexual assult

relationship of victim to offender

22% by stranger, 9% by husband or ex husband, 11% by fathers/step fathers, 10% by boyfriend or ex, 16% by other relative, 29% by non relative such as friend or neighbor

child abuse

3 million reports a year, 1 million verified risk factors: low incomes of family, disabilities, irritable temperament

treatments

STD testing, culture, wet mount for trich, blood for syphilis, hep B, HIV ( get baseline then again in 3-6 weeks) refer to counseling for PTSD

categories of rape

acquaintance rape/date rape, marital rape, gang rape, incest, child sexual assault, male rape

Drug and ETOH

alcohol is the #1 drug used in rapes date rape drugs: gamma-hydroxybutrate, GHB, Xyrem- muscle builder, Rohypnol

violence on campus

alcohol is the #1 facilitator of sexual assault. 1 in 4 college students will be sexually assaulted while in college

definition of sexual assult

any type of sexual activity to which the victim does not consent, ranges form inappropriate touching to penetration, can occur verbally over the phone or internet, being forced into prostitution, pornography, can include children, older adults, women, men

history

assault history in their words. oral,anal vaginal penetration, medical history- LMP, BC, last consensual intercourse, allergies, and PMHx prior sexual assault

emergency contraception

baseline urine pregnancy test, emergency hormonal contraception within 72 hrs

common myths

boys and men cant be victims, most sexual abuse of boys is by homosexuals, if a victim experience sexual arousal or orgasm from abuse, this means they were a will participant and enjoyed it, boys are less traumatized by rape than girls, boys abused by males will become homosexual

definition of sexual abuse

causing another person to engage in sexual activity by threatening or placing that person in fear, or the person is incapable of declining or expressing unwillingness, abusive sexual conduct- no penetration, committed by a person responsible for care of child or related to child

evidence collection

collect clothing of pt, fingernail scraping/clippings, pulled hair- 25, oral swabs- 2 and 1 smear slide, comb and pubic combing, genital swabbing, vaginal swabs -4 and 2 smear slides, 2 anal swabs and 1 smear slide, pulled pubic hair- 20, bode buccal swab- no blood

offenders

drug facilitated sexual assault- know it is illegal but no not feel it is wrong by their own morality antisocial personality disorder impulsive sex offender

more definition of rape

forced sexual intercourse, including both psychological coercion and physical force, includes incidents where the penetration is form a foreign object such as a bottle, includes attempted rapes, male and female victims, and heterosexual and homosexual rape.

federal mandates

healthy people 2020- reduction of violence and injuries WHO 2002, Join commission- mandates screening

statutory rape definition

illegal sexual activity bn two people when it would otherwise be legal if not for their age sexual penetration by a person >18 with a person under the age of consent. the age of consent varies from state to state, some states require reporting even if consensual, definitions of penetration vary by state.

payment

in PA the state (PA crime commission) pays up to $1000 per exam, pt may request that their insurance not be billed for the evidence collection kit

important tips

never leave the room once exam begins, maintain the chain of evidence, make sure kit is in a locked cabinet and that is gets to the lab properly

definition of rape

nonconsensual vaginal, anal, or oral penetration obtained by force or by threat of bodily harm or when a person is incapable of giving consent, contact bn the penis and the vulva or the penis and the anus involving penetration, however slight contact bn the mouth and penis, vulva or anus; or penetration of the anal or genital opening of another person by hand, finger or other object not a sexual crime but one of control and power

violence in our lives

popular tv shows, movies, news, neighborhoods, schools

theories of violence

power and control, violence according to walters and parke is culterally determined some people mean to harm others but based on their cultural backgrounds and beliefs, do not perceive their acts as violent

background

rape is the second most frequently committed violent crime, >1 million females/yr, approximately 30% are reported to police, 50% tell no one, only 5% visit a rape center, NVAW estimates that 14.8% of women have been rape at some time in their lives

how do we protect ourselves from violence?

recognize that we are victims, respond to others who are victims, teach the young how to protect themselves, break the cycle

children

referral- mandatory reporting for all healthcare workers. call local child protective services, hospital policy,

incest

sexual activity bn two close relatives irrespective of consent that is illegal or socially taboo, step relatives/parental figures in the home, most common is father-daughter and sibling to sibling

when presenting to healthcare setting

sexual assault forensic exam (SAFE), provide privacy, establish trust, attend to boundaries, may present differently, examine for major injuries

forensic lab evaluation

sperm viability- detection depends on time lapse bn the rape and PE, if assailant is azoospermic, if victim douched, if assailant ejaculated, loss of sperm motility is 2-3 hrs, survival or non motile sperm is 24 hrs, in vagina and rectum and several days in cervical mucus, in mouth sperm destroyed in hrs, semen stains on clothing or bedding

what to do if we are a victim or know someone that is?

talk, listen, advocate, most victims feel as if they are the only ones, prevent depression/anxiety

exam

trained rape counselor present, body map of trauma, full exam including pelvic, must consent for evidence collection, sexual assault evidence collection kit

what is america's number 1 public health issue

violence