Rape Crisis Syndrome

Rape Crisis Syndrome is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Definitions (legal definitions vary from state to state)
    • Rape (which is a legal term, physicians should use the phrase “alleged sexual assault”): any sexual penetration, however slight, using force or coercion against the person’s will
    • Rape is separated into three types: completed forced penetration, attempted forced penetration, and competed alcohol- or drug-facilitated penetration.
    • In a female, rape is forced oral, vaginal, or anal penetration. In a male, rape is forced penetration of the anus with any object in a male.
    • Sexual coercion: unwanted sexual penetration without the use of force
    • Sexual imposition: similar to rape but without penetration or the use of force (i.e., nonconsensual sexual contact, stalking)
    • Gross sexual imposition: nonconsensual sexual contact with the use of force
    • Corruption of a minor: sexual conduct by an individual age ≥18 years with an individual <16 years of age
    • Rape crisis syndrome/rape trauma syndrome is the response of a survivor to rape.
  • Most states have expanded rape statutes to include marital rape, date rape, and rape shield laws.
  • System(s) affected: nervous; reproductive; GI

Epidemiology

  • In the United States, 25% of women and 7.6% of men report being target of the definition of rape crisis syndrome listed above. Annually, rape costs the United States $127 billion (the most of any crime).
  • Anyone can be sexually assaulted, but some populations are especially vulnerable.
    • Adolescents and young children
    • People with disabilities
    • Elderly
    • Low socioeconomic status and homeless people
    • Sex workers
    • Those living in institutions/areas of conflict
  • Predominant age
    • The incidence of sexual assault peaks in those 16 to 19 years of age, with the mean occurring at 20 years of age.
      • Adolescent sexual assault has a greater frequency of anogenital injuries.
  • Predominant sex: female > male
    • For males
      • 69% of male victims were first raped before age 18 years.
      • 41% of male victims were raped before age 12 years.
  • Only 16–38% of rape survivors report to law enforcement and only 17–43% present for medical evaluation after rape.

Incidence
  • In the United States, approximately 1.5 million women and 834,700 men are sexually assaulted annually.
  • Approximately 18% of U.S. women have experienced rape or attempted rape.
  • Approximately 1–2% of U.S. men have experienced rape or attempted rape.
  • Most rape survivors either know or have some acquaintance with their attacker.
  • Rape of females and males were predominantly perpetrated by male assailants.

Risk Factors

  • Children living in a household of sexual assault are at increased risk of maltreatment and lifelong poor health.
  • Early sexual initiation
  • Sexual risk-taking behavior
  • Exposure to parental violence
  • Alcohol consumption is estimated to be involved in 1/2 of sexual assault.
  • Illicit drug may also contribute to sexual assault.

General Prevention

  • Primary prevention: Evidence suggests that promotion of gender equality decreases sexual violence perpetration—strategies include mobilizing men and boys as allies and empowering/supporting girls and women through economic supports and increasing leadership opportunities.
  • Secondary prevention: The USPSTF recommends screening women of childbearing age for intimate partner violence and refer women who screen positive to intervention services; HARK screening tool is 81% sensitive and 95% specific (1)[B].
  • Tertiary prevention: Support survivors through victim-centered services (refer to “Patient Education” section) and medical treatment.

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