Sexual Assault

Clinical description

Sexual assault is defined as a non-consensual sexual act.

The clinician should complete the history, examination and management in a non-judgmental manner.

Record the chain of evidence, what was collected, and where it went.

If the patient is unable to consent to the exam, then the next of kin or 2 doctors may consent.

Signs and symptoms

History Record details of the events before and after the assault, drugs taken voluntarily or involuntarily, force and/or weapons used, condom use, timing and sequence of events, specific events of the assault, and post assault hygiene.

• Ask about LMP, current hormonal contraception and previous intercourse.

Exam Visualize entire body to draw a detailed body map.

• Mark abnormalities (i.e. contusions, bites, ligature marks, old and new trauma), distinguishing features (i.e.

tattoos, piercings, scars) and areas where swabs were obtained.

• Include pertinent negatives.
• For the pelvic exam, visualize before using a speculum.
• Other common areas of injury include head/neck and anus/rectum.
• Note tenderness, tears, ecchymosis, abrasions, erythema and oedema.
• Lack of findings does not mean that the exam is inconsistent with history of sexual assault.

Investigations Time-dependent specimens include sperm/semen, foreign material, swabs of body secretions and fingernail scrapings.

• Blood and hair from the head or pubic area are NOT time-dependent.
• Also do the following:
• HIV test
• UPT

Treatment

Step 1:

• Assess and treat serious injuries first
• Obtain verbal consent to conduct physical examination
• Take full history and document all findings
• Conduct full physical examination and document all findings
• Document all facts regarding the assault

Step 2:

• Manage physical effects of the assault such as wounds and bruises – includingantibiotics to prevent wound

infection, tetanus booster if required,medication for pain relief or anxiety Step 3:

• Provide emergency contraception if the victim has started menarche andpresents within 5 days post-assault
• Postinor-2: take 2 pills in a single dose, or 1 pill followed by the second pill after 12 hours
• Microgynon:take 4 pills, to be repeated after 12 hours

Step 4:

• Treat presumptively for STIs (or conduct laboratory investigations if available):