Friday, March 29, 2024

Sexual Assault

Practice Essentials

Sexual assaults are distinguished from other assaults by forcible, inappropriate sexual behavior upon a person without consent. In the course of a sexual assault, any injury may be inflicted on the victim, up to and including life-threatening multiorgan system trauma.

Signs and symptoms

Signs of sexual assault include evidence of the use of force such as the following:

Presence of blood and/or sperm

Contusions

Lacerations

Abdominal trauma

Joint dislocation

Mechanical back pain

Abruptio placentae

Lesions caused by forceful genital penetration

In addition to the physical trauma, sexual assault can result in significant mental suffering for victims and lead to posttraumatic stress disorder (PTSD). It can also result in unwanted pregnancy and victims may also be exposed to sexually transmitted diseases (STDs).

See Clinical Presentation for more detail.

Diagnosis

Laboratory studies

Urine or serum pregnancy tests should be obtained in women of childbearing age. Baseline testing for STDs, although controversial, may be carried out, including the following:

Serologic tests for syphilis, hepatitis B, and HIV

Cultures of exposed body sites, as appropriate, to evaluate for STDs (eg, oral, throat, vaginal, and rectal)

Wet mount and culture of a vaginal swab specimen to evaluate for Trichomonas vaginalis, bacterial vaginosis, and candidiasis

Procedures

Colposcopy, where available, may have considerable value in documentation, because it allows photographic recording of injuries, including lesions caused by forceful genital penetration. Anoscopy may be performed in male victims and may be combined with colposcopy in female victims.

See Workup for more detail.

Management

Emergency department care

Medical intervention in sexual assault is focused on prevention of unwanted pregnancy and STDs. This includes the administration of antibiotics (eg, ceftriaxone, metronidazole, and azithromycin) as prophylaxis against diseases such as gonorrhea and chlamydia.

Emergency contraception is offered if the patient’s pregnancy test results are negative. Additional treatment for sexual assault includes updating the patient’s tetanus status, if necessary, and administration of hepatitis B vaccine if the patient has not previously been vaccinated. Follow-up doses of the vaccine are administered over the next few months.

Counseling

If available, a consultation with a sexual assault counselor should be offered in the emergency department. The patient should also be referred to a sexual assault center for aftercare and community resources. Given the long-term emotional and psychosocial impact of sexual assault on the victim, aftercare is vital.

See Treatment and Medication for more detail.

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