Description

Definitions (vary by jurisdiction on local, state, and national levels):

• Rape (a legal term), sexual assault (a medical term), or sexual violence (a general term): any form of sexual activity that occurs without consent between a victim and perpetrator(s)/suspect(s)
• Rape/sexual assault/sexual violence: may be associated with the use of force and/or threats, alcohol, and/or illicit and/or prescription drugs
• Rape crisis syndrome is historical term that has previously been utilized to define what is now known as an acute stress reaction (ASR), acute stress disorder (ASD), and/or a posttraumatic stress disorder (PTSD) in persons exposed to sexual violence.
  • Psychological responses to sexual violence range from transient to chronic and debilitating.
  • The neurobiology and traumatic impact of sexual violence on victims is complex. It is associated with a profound flight, fight, and/or freeze-related fear response as well as a hormonal cascade (involving catecholamines, cortisol, opiates, and oxytocin), and the use of primitive brain structures (e.g., the prefrontal cortex, amygdala, and hippocampus) and can trigger the development of numerous posttraumatic psychological, emotional, physical, and social effects.

Epidemiology

• In the United States, 33% of women and 25% of men have reported experiencing sexual violence during their lifetime.
• Around 1.5 million women and 834,700 men are victims of sexual violence annually in the United States.
• The following populations are especially vulnerable to sexual violence:
  • Adolescents and young children
  • Persons with disabilities
  • Elderly adults
  • Those with a low socioeconomic status and/or that are homeless
  • Sex workers and persons being trafficked
  • People living in institutions/areas of conflict/training environments
• The incidence of sexual violence peaks in those 11 to 24 years of age.
• 33% of female victims first experienced sexual violence before age 18; 13% first experienced it before age 10
• 25% of male victims first experienced sexual violence before age 18; 25% first experienced it before age 10
• Only 16–38% of victims of sexual violence report to law enforcement, and 17–43% of victims obtain a medical evaluation.
• 33% of victims of sexual violence never report it to their primary care providers.

Risk Factors

• History of sexual violence, psychological aggression, physical violence, trafficking, and/or stalking
• Early initiation of sexual activity
• Engagement in high-risk sexual behavior
• Exposure to familial and/or environmental violence
• Consumption of alcohol/use of illicit drugs
• Belief in traditional gender roles

General Prevention

• Primary prevention: Promoting gender equality, teaching skills to prevent sexual violence, empowering and supporting females, and creating protective environments decrease the occurrence of sexual violence perpetration.
• Secondary prevention: The United States Preventive Services Task Force recommends screening all women of childbearing age for intimate partner violence (IPV) and referring women who screen positive for interventional services.
  • The HARK screening tool, which includes questions that assess if a patient has felt humiliated (H) and/or afraid (A) and been raped (R) and/or kicked (K) within the past year, is 81% sensitive and 95% specific for IPV, as well as clinically useful (1).