Epidemiological and Clinical aspects of the management of victims of sexual abuse in the Obstetrics and Gynecology Department of Hospital Principal Dakar

Abstract

Introduction: Sexual abuse or sexual assault, a major public health problem, is defined as any sexual violation committed with violence, coercion, threat or surprise on the person of another. This worldwide societal tragedy has dramatic repercussions on the physical and psychological health and social well-being of victims. The objective of this study was to determine the epidemiological and clinical profile and to evaluate the management of sexual violence at Hospital Principal Dakar. Patients and methods: This was a retrospective study of all cases of alleged sexual assault received at the maternity ward of the Hôpital Principal de Dakar during the period from 1 January 2018 to 15 April 2022, i.e. 4 years. Results: During this period, 57 assault cases out of 77 were collated which represent 75% of medico-legal cases and 0.35% of admissions. The patients were immediately referred with a judicial requisition (91.2%) and were accompanied by their relatives in 90.7% of cases. The average consultation time after the attack was 17 days, with extremes ranging from 5 hours to 3 years. The epidemiological profile of the victim was that of an adolescent girl aged on average 15 years, a student (75%), nulligest (96.4%) and living in an urban area (51.9%). The sexual assault took place during the day (82.6%), at the victim's home (15.7%) or that of the alleged perpetrator (35.3%), and was perpetrated by an adult (81.6%) belonging to the victim's entourage in 78.6% of cases (parents, spiritual guide, teacher, driver, roommate, family friend). The mode of sexual abuse was genital contact in 62.3% of cases. The examination most often revealed hymenal trauma (78.5%), three quarters of which were old lesions, with no sign of physical violence in 91.1%. In almost all of the presumed victims, the psychological impact was not assessed on admission. Five pregnancies were recorded; emergency contraception was prescribed for 23.1% of patients. An infectious disease assessment, antibiotic prophylaxis, ARV prophylaxis and a psychological consultation were prescribed in 90%, 85.7%, 78.5% and 54.9% of cases respectively. Only 14.8% of the victims had been followed up. Conclusion: Sexual abuse, the scourge of our time, is a disturbing reality. The real prevalence of this growing phenomenon is poorly known because of the many taboos and patriarchy. Optimal care for victims inevitably involves raising awareness among the population in order to break the silence, setting up specialised structures and collaboration between the various actors to condemn these crimes and, above all, to provide medical and psychological assistance and safe social reintegration for victims.