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Sexual Assault Medical Issues

It is important for survivors to seek medical attention immediately following the assault, even if there are no visible physical injuries. Medical tests can detect pregnancy, physical injuries or sexually transmitted diseases that would otherwise remain undetected and possibly cause complications later. The presence of sedating substances or "rape drugs" can be detected by a urine test or a free drug test from Hoffman-LaRoche drug company (call 1-800-608-6540). In addition, prompt collection of evidence may aid in the arrest and conviction of the assailant if the case is heard in court. An exam is most effective if administered within 24 hours of the assault. Little or no valid evidence can be collected after 48 to 72 hours. Regardless of the time span, it is recommended that all survivors seek medical care.

Many hospitals have staff who are specifically trained to work with a survivor of rape or sexual assault. Most also offer survivors privacy during any waiting period prior to an examination. Survivors are treated as quickly as possible and second only to others who are involved in life threatening situations. Hospital staff are required to report the assault, but reporting is different than prosecuting. See the Legal Issues web page for more information. A survivor may want to inquire about Hospital Advocacy programs in the emergency room or by contacting the local rape crisis center or police. An advocate will support the survivor and help explain procedures.

It helps to preserve evidence if survivors do not bathe, douche, urinate, defecate, or change clothes. If possible, survivors should bring a change of clothes to the hospital, since it may be necessary for the hospital to forward the clothes worn during the crime to legal authorities. Some hospitals may provide clothing.

The Examination

In the examination room, a nurse will take a brief medical history. At this time, the survivor needs to give information on any past illnesses or injuries; if there was vaginal, oral or anal penetration during the assault; and if there are any medication allergies. It is not necessary to share the details of the assault, but the doctor will need to know some of what happened in order to provide appropriate medical care. The survivor will also be checked for scratches, bruises, red marks, cuts, etc., and these will be noted (and often photographed) for evidence.

The examination will include a thorough physical including a pelvic exam. It is helpful to tell the doctor if the survivor has never had a pelvic exam. The medical staff will also collect evidence throughout the exam which is necessary for prosecution. Evidence collection includes taking samples of substances from the clothing, vagina, rectum, mouth and any other opening that was penetrated; combings and samples from your head and pubic hair; and material from beneath your fingernails. These samples will be used to detect the assailant's sperm, saliva, hair and skin cells and can help indicate a recent attack and identify the attacker. Eighty percent of individuals can be genetically typed from saliva that is used for blood typing. In addition, active sperm can indicate a recent attack and provide genetic material for DNA profiling. Sperm can remain active in the vagina up to 24 hours and even longer in the cervical area and anal cavity.

Sexually Transmitted Infections (STIs)

Sexually Transmitted Infections are transmitted during oral, anal or vaginal intercourse. There are over 40 STIs that can be contracted during sexual activity. The most common are: chlamydia, genital warts, gonorrhea, herpes, and syphilis. The most dangerous is the Human Immunodeficiency Virus (HIV), which is the virus that causes AIDS, Acquired Immunodeficiency Syndrome. There are a few treatments for HIV infection, but there is no cure for AIDS. The Centers for Disease Control & Prevention caution that the risk for acquiring HIV infection through sexual assault is low in most cases.

Many STIs can be detected and even avoided if treated as soon as possible following the assault. During medical treatment the survivor should be tested for STIs using a blood sample and bacterial cultures, but this test will only determine if you were infected BEFORE the assault. STIs which may have been contracted during the assault WILL NOT show up on tests until weeks later, because STI incubation periods vary. Therefore, it is strongly recommended that the survivor get STI tests two, four and six weeks after the sexual assault and again in six months for HIV. Ruling out pre-existing STIs can also be important if legal charges are pursued. Testing establishes a baseline against which follow-up results can be compared in order to document the possibility that the assailant infected the patient with an STI during the assault. HIV testing is recommended only if it is anonymous; HIV testing at a hospital would be confidential but NOT anonymous. Most STIs can be treated easily through doses of penicillin or other antibiotics. The survivor should notify the physician of any allergies and be aware of the name, dosage, purpose and possible side effects of any drugs prescribed.

Survivors should inquire about the confidentiality policy of the hospital or clinic. In Ohio, survivors have the right to know the HIV status of an assailant after a charge has been filed. Contact the victim assistance personnel in your local prosecuting attorney's office for more information.

Pregnancy

If the survivor is female, she should discuss with hospital personnel any possibility of current pregnancy (pregnancy prior to the assault). It is also important to discuss any type of birth control currently being used and any recent consensual sexual activity. Statistics indicate that the chances of becoming pregnant as a result of sexual assault are less than 10%. If the patient is not pregnant and can provide reliable information about her last period, the physician can approximate the likelihood of impregnation during the assault. Otherwise, an accurate pregnancy test cannot be given until six weeks after one's last menstrual period. There is preventive pregnancy medication, such as the "morning after pill" (Ovral Postcoital Contraceptive), available in most hospitals which can be given at the time of the exam. To be effective, pregnancy medication must be given within 24 hours of the assault. Also, stress, tension and worry can cause a survivor to have a late period; this happens to many sexual assault survivors. Having a late menstrual period does not necessarily mean that one is pregnant. Follow-up testing is the most reliable way to determine whether a female survivor is pregnant.

The Medical Bill

By law, the municipality in which the crime occurred must pay for the medical costs related to the collection of evidence. The survivor is entitled to receive compensation for the additional expenses not covered by insurance. See the Legal Issues web page for compensation information.

**Additional information can be obtained by contacting OCOSA at (614) 268-3322, RAINN at 1-800-656-HOPE, or your local rape crisis center.