Sexual Assault
The month of April is dedicated to many health awareness issues such as National Donate Life Month, National Autism Awareness Month and Irritable Bowel Syndrome (IBS) Awareness Month. Although each of these conditions deserves recognition, the one that applies most to our patients is Sexual Assault Awareness Month.
In women’s health there are many discussions surrounding sexual activity. Patients are typically willing to discuss at what point they became sexually active, what protection they use to prevent sexually transmitted diseases, methods of contraception, and even libido concerns. Unfortunately women are not as comfortable discussing a history of sexual assault and even worse, often times health care providers are just as uncomfortable discussing these events.
It is estimated anywhere between 1 in 3 to 1 in 6 women will experience some form of sexual assault in their lifetime. Sexual assault is defined as any nonconsensual contact in a sexual manner. It is not limited to vaginal or anal intercourse, it may be as “benign” as someone touching another’s chest or butt, even if the person meant it as a “joke” or didn’t mean for it to be a threatening action. Both men and women are victims of sexual assault, but women are more commonly the recipient of such actions. Females are often victimized by someone they know, including a current partner or ex-partner. Unfortunately a majority of the times the actions are not as simple as the actions mentioned above.
Only about 30-40% of victims will actually be evaluated by a health care professional. This is a major health concern for our society because of the multiple implications that follow a sexual assault. Not surprisingly, many studies show an increase in unintended pregnancies, future fertility issues, sexually transmitted diseases (STD), other infections of the lower pelvis such as pelvic inflammatory disease (PID) and urinary tract infections (UTI). Emotional status of the victim is also obviously affected, leading to increased rate of depression and even post traumatic stress disorder (PTSD).
The less identified risks to the health of victims include an increased in overall poor health, they are less likely to access preventative care which in turn increases the risk of developing high blood pressure, high cholesterol and obesity as well as diabetes as a sequelae from those conditions. It is even linked to an increase in female cancers such as cervical and vaginal as a result of possible exposure to HPV and to uterine cancer.
Women are urged to seek medical attention as soon as possible following an assault. The most important time is within the first 3-5 days when emergency contraception (EC) can be given to prevent unintended pregnancy and antibiotic therapy can be initiated to treat potential STDs and prevent long-term effects. Although emergency contraception is preferred to be given within the first 3 days, there is still a proven benefit to receiving EC up to 5 days afterwards.
We realize that seeking medical attention following such traumatic experience may seem even more intrusive which may cause you to not be evaluated. Our office is always a safe place to turn for help. For some patients it may be more comfortable to come to an office with a provider you are already familiar with, while other women may be too “embarrassed” or “ashamed” due to a fear of judgment. Although none of the staff at Women’s Care Specialists LLC would ever pass judgment on a patient who has been assaulted and we are capable of providing the medical attention you would need… there are actually facilities in the area that have specially trained nurses that are available 24/7. At the conclusion of this blog entry will be a list of such facilities and other resources. These nurses have undergone an intense training program to not only be able to perform medical-forensic exams, but to also be your advocate throughout the entire evaluation, get the appropriate mental health care desired and to even facilitate involvement with law enforcement if the victim desires to pursue charges. There is no requirement or expectation to press charges but having a Sexual Assault Nurse Examiner (SANE) nurse collect the rape kit there are fewer errors if future litigation is sought.
Listed above are some more common concerns and deterrents for victims to seek medical attention following an assault but one other significant one is cost. Many people are struggling with finances and don’t want to add any other bills. As of August 2011 federal law mandates that sexual assault victims be exempt from paying anything out of pocket for evaluation following an assault. This is to allow victims to receive the appropriate evaluation without regard to money.
Below is a list of helpful resources that have been obtained from The Journal for Nurse Practitioners June 2012 edition:
- International Association of Forensic Nurses (iafn.org)- list of local SANE organizations.
- Race, Abuse and Incest National Network (www.rainn.org)- 24-hour resource that directs victims to the nearest rape crisis center.
- 1-800-799-SAFE- toll-free number that provides assistance to callers as well as phone numbers for local shelters
- Office for Victims of Crime (www.ojp.gov)- Directory of services and victims’ rights
- YWCA (www.ywca.org)- website that is full of resources for women of domestic violence, rape, incest, and racial discrimination. They offer counseling and support for all women.
APR