Rape trauma syndrome
The term rape refers to illicit sexual intercourse without consent. It’s a violent assault in which sex is used as a weapon. Rape inflicts varying degrees of physical and psychological trauma.
Rape trauma syndrome occurs after the rape or attempted rape. It refers to the victim’s short-term and long-term reactions and to the methods she uses to cope with this trauma.
Incidence of reported rape is highest in large cities and is rising. However, more than 90% of assaults may still go unreported.
Known victims of rape range from age 2 months to 97 years. The age-group most affected is 10- to 19-year-olds; the average victim’s age is 13½. About one out of seven reported rapes involves a prepubertal child.
More than 50% of rapes occur in the home; about one-third of these involve a male intruder who forces his way into the home. About half the time the victim has some casual acquaintance with the attacker. Most rapists are between ages 15 and 24. Usually, the attack is planned.
Usually, the rapist is a man and the victim is a woman. However, rapes do occur between persons of the same sex, especially in prisons, schools, hospitals, and other institutions.
Children are also often victims of rape; most of the time these cases involve manual, oral, or genital contact with the child’s genitalia. Usually, the rapist is a member of the child’s family. In rare instances, a man or child is sexually abused by a woman.
Causes
Cultural, sociologic, and psychological factors that contribute to rape include increasing exposure to sex, permissiveness, cynicism about relationships, feelings of anger, and powerlessness amid social pressures.
A rapist usually has feelings of violence or hatred toward women or sexual problems, such as impotence or premature ejaculation. He may feel socially isolated and unable to form warm, loving relationships. Some rapists may be psychopaths who need violence for physical pleasure, no matter how it affects their victims; others rape to satisfy a need for power. Some were abused as children.
Signs and symptoms
A physical examination (including a pelvic examination by a gynecologist) will probably show signs of physical trauma, especially if the assault was prolonged. Depending on specific body areas attacked, a patient may have a sore throat, mouth irritation, difficulty swallowing, ecchymoses, or rectal pain and bleeding.
If additional physical violence accompanied the rape, the victim may have hematomas, lacerations, bleeding, severe internal injuries, or hemorrhage, and if the rape occurred outdoors, she may suffer from exposure. X-rays may reveal fractures. The patient may have injuries severe enough to require hospitalization.
Assessment
When a rape victim arrives in the emergency department, assess her physical injuries. If she isn’t seriously injured, allow her to remain clothed and take her to a private room where she can talk with you or a counselor before the necessary physical examination.
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