Rape (sexual assault) - overview

Information

According to most estimates, 80 - 90% of rapes are not reported to police. Current trends project that 1 in 3 American women will be sexually assaulted at some point during their lives.

The typical rape victim is a 16- to 24-year-old woman. Anyone, however -- man or woman, adult or child -- can be the victim of rape. In most cases, the victim knows the rapist. 

Other important facts about rape include:

• Most commonly, the rapist is a 25- to 44-year-old man who plans his attack. He usually chooses a woman of the same race.
• Alcohol is involved in more than one out of three rapes.
• Rape may occur between members of the same sex. This is more common in places such as prisons, military settings, and single-sex schools.
• People with physical or mental disabilities or limited language skills are also at higher risk. Prostitutes are at higher risk too.
• Over one-half of rapes occur in the victim's home.

Date rape occurs when someone forces another person they are dating or spending time with to have sex. Date rape may involve the use of drugs such as flunitrazepam (Rohypnol).

The best response when being attacked may depend on the victim, the attacker, and the situation. Trying to get away and yelling for help are good first steps in most situations. Whether to fight back may depend on the size and behavior of the attacker, as well as whether a weapon is involved.

AFTER A RAPE HAS OCCURRED

The victim may know, or even live or work with a person who sexually assaulted them. It is essential that rape victims get help to find an environment where they feel safe after the attack.

People who are raped may not be able to say they were raped or seek help. Some may get medical help for a different complaint, such as headaches, eating problems, pain, or sleep problems.

Emotional reactions can be very different in each person, and may include:

• Anger or hostility
• Confusion
• Crying or feeling numb
• Fear
• Loss of emotional control
• Nervousness or inappropriate laughter
• Not eating or sleeping well
• Tightly controlled behavior
• Withdrawal from family or friends

Victims of rape should be helped to understand that nothing about what happened was their fault. Nothing that they did should have allowed someone to have sex with them against their will. This includes dressing suggestively, or even kissing or performing other physically intimate activities. Any fault or blame is solely on the rapist.

TREATMENT

Most state laws require that the person be evaluated in the emergency room before the rape is officially reported. In many cities, rape cases are referred to specific emergency rooms where staff are trained to:

• Know how to approach and support a victim of sexual assault
• Follow the proper procedures to maintain the "chain of evidence" needed for a case that may go to trial

If a woman who is raped might be pregnant, health care providers will discuss methods of emergency contraception.

If there is a chance that the rapist is HIV-infected, the health care providers should explain ways to reduce the odds of HIV infection. This may involve the immediate use of medicines used to treat HIV, called antiretrovirals. This process is called post exposure prophylaxis (PEP).

The person who was raped may also need to be treated for other sexually transmitted infections.

Most importantly, the person needs support and information to begin the process of healing after a sexual assault.

• Information about rape and sexual assault should be provided in a safe and supportive environment.
• Ongoing emotional support is key, and talk therapy can be very helpful.

RESOURCES:

• Rape, Abuse & Incest National Network - www.rainn.org

Alternative Names

Sex and rape; Date rape; Sexual assault

References

Slaughter L. Sexual assault. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 64.

Lentz GM. Rape, incest, and domestic violence: Discovery, management, counseling. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 10.

Linden JA. Care of the adult patient after sexual assault. N Engl J Med. 2011;365:834-841.

Centers for Disease Control and Prevention (CDC). Sexual assault and STDs. In: Sexually transmitted diseases treatment guidelines. 2010. MMWR Recomm Rep. 2010:17(59)(RR-12):90-95.

Update Date: 1/28/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.