CME Accreditation Page and Author Disclosure

Abstract

Sexual assault is a crime of violence, often motivated by aggression and rage, with the assailant using sexual contact as a weapon for power and control. Sexual assault can include a range of coercive behaviors ranging from kissing, fondling, and molestation, to rape or attempted rape. For the purposes of this review, sexual assault is defined as “an event that occurred without the victim's consent, involved the use of force, or the threat of the use of force, and involved actual or attempted penetration of the victim's vagina, mouth, or rectum.”18 According to recent statistics, one out of eight women will be raped during her lifetime, and 39% will be sexually assaulted more than once.18 Many rapes are unreported, either because of feelings of shame and guilt, or because the victim does not define the event as rape (e.g., spousal and date rape). Well-known sequelae of rape, whether reported or not, include isolation, depression, anxiety, somatic symptoms, suicide attempts, and post-traumatic stress disorder (PTSD). The experience of rape has a strong effect on the subsequent health of victim/survivors and has thus become a major public health issue. Sexual assault victims often present to the emergency department (ED) for initial evaluation, evidence collection, treatment, and crisis intervention. Although some cities have model sexual assault centers or use specially trained sexual assault nurse examiners (SANE), the emergency physician (EP) is responsible for the initial evaluation and management in most EDs. It is, therefore, imperative that the EP be familiar with complex array of reactions (emotional and physical), common injuries, and elements of proper evaluation and treatment of sexual assault victims.