SPEAK OUT

GUIDELINES FOR DOCTORS
SEXUAL ASSAULT

Traditional Criteria:

1. A female victim, not the wife of the assailant.
2. Penetration of the vagina by the penis.
3. Lack of consent.
4. Assailant must use force.

Aggravated sexual assault:

1. Use or display of a weapon.
2. Life is endangered or threatened.
3. Victim physically handicapped or retarded or >60 yrs.
4. Bodily harm to victim.
5. Another felony is committed.
6. Force if used through physical violence or displays of rage and power

Myth:

1. No woman is raped who does not want to be.
2. Provoked by sexual desires of men who must be satisfied.
3. The victim's non verbal behaviour or appearance invite rape and are more important than the version she reports to the police and court about what happened.
4. Strangers are the only perpetrators of rape.

Doctors duties:

1. Treat injuries.
2. Detect, prevent, and treat sexually transmitted disease.
3. Detect and offer options to prevent pregnancy.
4. Conform to the law.
5. Assist transition from victim to survivor.

History:

1. Who was assailant.
2. What happened.
3. When was the assault,
4. Where did the assault occur.
5. Last menstrual period.
6. Gynaecological history.(Contraception, STD)
7. Last consensual intercourse.
8. Medical history.
9. Prior sexual assault.
10. Any activities which will decrease recovery of evidence.

Risks:

1. Sexually transmitted disease.

Gonorrhoea 6% - 12%
Chlamydia 4% - 17%
Syphilis 0.1%
HIV >1% (80% if genital ulcer disease) (these stats are from the USA, the risk of HIV is considerably higher in South Africa were 40% of those in the most common age category of rapists carry HIV, plus 75% of rape in SA is gang rape and the risk increases with each rape by an infected person, in addition sub- Saharan Africa, SA carries the most virulent and infectious AIDS virus in the world, sub-type C. Because there is a higher incidence of STD's in SA, the risk from STDs and other infections are also higher. In the USA they also do not test for Hepatitis, it is imperative to do this in South Africa - Speak Out)

2. Pregnancy 1%
3. Major injury 1%
4. Death 0.1% (40% higher risk in SA)

Treatment STD prophylaxis, pregnancy prophylaxis, Tetanus, Hepatitis B vaccine. Collection of hair (pubic and hair on head), semen, DNA profile, Mandarory reporting, Pregnancy testing, STD as evidence for severity of sentencing in USA (not applicable in SA), HIV test to ascertain whether patient HIV+ on day of rape, if positive DO NOT give HIV prophylaxis HIV prophylaxis needs to be administered no later than 72 hours after first incident of rape. Social support is essential for recovery.

RAPE TRAUMA SYNDROME:

a. Shock, disbelief, despair.
b. Denial and non specific anxiety. Psycho-somatic complaints
c. Pseudo adjustment phase Depression and Anger, 50% of survivors lose their jobs, 80% end primary relationships within 1 year. High incidence of suicide years later, functional limitation, battering, phobias, Criteria of recovery. Control of memory, no flashbacks, (drawn from SA Gynaecological Association, US medical journals and Speak Out)