Rape and sexual assault

Definition

Rape and sexual assault are crimes that involve the use of threats, fear tactics, and/or physical violence to force a child or adolescent to submit to sexual intercourse or to engage in other sexual activity (e.g., oral sex, anal sex).

Description

Rape and sexual assault are violent crimes, and children and adolescents constitute a large number of the victims of these crimes. Rape and sexual assault are defined according to the degree of sexual interaction. Rape and sexual assault can involve contact between the penis and vagina or penis and anus that involves penetration; contact between the mouth and genitals or anus; penetration of the vagina or anus with an object; or direct touching (not through clothing). Sexual assault is defined as intentional touching of the genitals, breasts, buttocks, anus, inner thigh, or groin with no sexual penetration that is forced upon the victim. Rape and sexual assault that recurs is considered sexual abuse. When the perpetrator is a family member, these crimes are also referred to as incest.

Rape and sexual assault are especially traumatic for children and adolescents, who often do not fully understand normal sexual activity. Studies and statistics have shown that adolescence is the riskiest life stage for sexual assault, and the time when the most psychological trauma can result.

Demographics

The 2000 Victim, Incident, and Offender Characteristics, published by the National Center for Juvenile Justice (NCJJ), analyzed sexual assault data collected by law enforcement agencies over a five-year span. The following characteristics were found to be significant among victims of sexual assault:

• Age: Over two-thirds of reported victims of sexual assault were juveniles under the age of 18. Adolescents aged 12 to 18 years represented the largest group of victims at 33 percent; 20 percent were between the ages of six and 11; children younger than five years old and adults between 18 and 24 years of age each constituted 14 percent of victims. One out of every seven victims surveyed in the study was under the age of six.
• Gender: Females were more than six times more likely to be a victim of sexual assault than males; more than 86 percent of victims were females. The great majority (99%) of the victims of forcible rapes were women, while men constituted the majority (54%) of the victims of forcible sodomy (oral or anal intercourse). Females are most likely to be the victim of sexual assault at age 14, while males are at most risk at age four.
• Location: The residence of the victim was the most commonly noted location of sexual assault (70%). Other common locations included schools, hotels/motels, fields, woods, parking lots, roadways, and commercial/office buildings.

Similar statistics were gathered by the NCJJ regarding the perpetrators of rape and sexual assault. These characteristics included the following:

• Age: Over 23 percent of offenders were under the age of 18; juveniles were more likely to be perpetrators of forcible sodomy and fondling. The remaining 77 percent of offenders were adults and were responsible for 67 percent of juvenile victims. For younger juvenile victims (under the age of 12), juvenile offenders were responsible for approximately 40 percent of assaults.
• Gender: The great majority of all reported offenders were male (96%). The number of female offenders rose for victims under the age of six (12%), in contrast to 6 percent for victims aged six through 12, 3 percent for victims aged 12 through 17, and 1 percent for adult victims.
• Relationship with offender: Approximately 59 percent of offenders were acquaintances of their victims, compared to family members (27%) or strangers (14%). Family members were more likely to be perpetrators against juveniles (34%) than against adults (12%). In contrast, strangers accounted for 27 percent of adult victims and 7 percent of juveniles.
• Past offenses: In 19 percent of juvenile cases, the victim was not the only individual to be assaulted by the offender, compared to only 4 percent of adult cases.

Of particular importance are the number of rapes and sexual assaults that go unreported, especially in adolescents. Although one in five sexual assault reports occurs for adolescents between 12 and 17 years of age, and adolescents between ages 16 and 19 years have the highest rate of reported sexual assault, anonymous school surveys have revealed that only 5 percent of sexually assaulted adolescents actually report the crime to law enforcement.

When to call the doctor

Many children and adolescents are reluctant to report rape and sexual assault for a number of reasons. Often the victim fears retaliation from the offender. He or she may be afraid that family, friends, the community, or the media may learn about the offense. There may be a concern about being judged or blamed by others. The victim may think that no one will believe the assault occurred or that they were somehow at fault. Unreported rape and sexual assault are especially common when the offender is known to the victim, such as a family member or respected member of the community (e.g., clergy, teacher).

Parents who suspect that their child or adolescent has been raped or sexually assaulted should take the child to see a doctor and psychologist or psychiatrist. Signs that a child or adolescent may have been raped or sexually assaulted include shying away from physical affection, unexplained bleeding from the rectum and/or vagina, bruising around the breasts and genitals, and hiding or throwing away undergarments. Any child or adolescent who is raped or sexually assaulted should be taken to an emergency room immediately so that evidence against the perpetrator can be gathered, and medical treatment can be given.

Diagnosis

Rape and sexual assault are diagnosed by interviewing the patient and parents, physical and gynecological examination, and laboratory tests for the presence of seminal fluid. In many cases, children or adolescents do not report the rape or sexual assault, but they do show obvious signs of physical violence. When rape is suspected, diagnosis may be made by a psychiatrist or psychologist based on sessions with the victim. In cases where obvious signs of the crime are not visible, and immediate treatment is not received, the victim may develop post-traumatic stress disorder (PTSD), also known as rape trauma syndrome, which is a mental health disorder that describes a range of symptoms often experienced by someone who has undergone a severely traumatic event. In such cases, diagnosis of rape or sexual assault is revealed through therapy sessions for PTSD.

Approximately 31 percent of rape victims develop PTSD as a result of their assault. The symptoms of PTSD include:

• recurrent memories or flashbacks of the incident
• nightmares
• insomnia
• mood swings
• difficulty concentrating
• panic attacks
• emotional numbness
• depression
• anxiety

Treatment

Once a victim of rape or sexual assault reports the crime to local authorities, calls a rape crisis hotline, or arrives at the emergency room to be treated for injuries, a multidisciplinary team is often formed to address his or her physical, psychological, and judicial needs. This team usually includes law enforcement officers, physicians, nurses, mental health professionals, victim advocates, and/or prosecutors.

The victim may continue to feel fear and anxiety for some time after the incident, and in some instances this may significantly impact his or her personal and academic life. Follow-up counseling should, therefore, be provided for the victim, particularly if symptoms of PTSD become evident.

Forensic medical examination

Because rape is a crime, there are certain requirements for medical evaluation of the patient and for record keeping. The forensic medical examination is an invaluable tool for collecting evidence against a perpetrator that may be admissible in court. Since the great majority of victims know their assailant, the purpose of the medical examination is often not to establish identity but to establish nonconsensual sexual contact. The Sexual Assault Nurse Examiner program is an effective model that is used in many U.S. hospitals and clinics to collect and document evidence, evaluate and treat for sexually transmitted diseases (STDs) and pregnancy, and refer victims to follow-up medical care and counseling. Many nurse examiners are specially trained to handle cases that involve children and adolescents. The "Sexual Assault Nurse Examiner Development and Operation Guide," prepared by the Sexual Assault Resource Service, describes the ideal protocol for collecting evidence from a sexual assault victim. This protocol includes the following:

• performing the medical examination within 72 hours of the assault
• taking a history of the assault
• documenting the general health of the victim, including menstrual cycle, potential allergies , and pregnancy status
• assessing for trauma and taking photographic evidence of injuries
• taking fingernail clippings or scrapings
• taking samples for sperm or seminal fluid
• combing head/pubic hair for foreign hairs, fibers, and other substances
• collecting bloody, torn, or stained clothing
• taking samples for blood typing and DNA screening

After evidence is collected, rape victims are treated with appropriate medical care for their injuries. In female children and adolescents, vaginal tears and injuries may require suturing; in male children and adolescents, anal tears and injuries are common and may require suturing and other treatment.

Prognosis

Children and adolescents who have been raped or sexually assaulted are three times more likely to experience another rape in adulthood. Victims of rape and sexual assault who report their attack greater than one month afterwards are more likely to suffer from PTSD, mood swings, and major depression than victims who report their attack immediately, most likely because victims who report their attacks immediately receive appropriate interventional care, particularly mental health support and counseling. For adolescents, untreated rape and sexual assault can result in serious long-term psychological effects. One in 10 sexually assaulted adolescents attempt suicide , and about 50 percent are diagnosed with phobias , depression, substance abuse, and other psychological disorders. Compared to those who have never been victimized, rape victims are three times more likely to have a major depressive episode, four times more likely to have contemplated suicide, 13 times more likely to develop alcohol dependency problems, and 26 times more likely to develop substance abuse problems. In addition, school performance in many sexually assaulted adolescents declines, and many eventually fail academically. Even when treated, rape and sexual assault can cause poor self-esteem , sexual dysfunction and impaired sexual and personal relations, insomnia, anxiety, eating disorders, and other psychological symptoms that last into adulthood.

Lasting psychological trauma is especially serious in male children and adolescents who are raped or sexually assaulted. Young boys may be more reluctant to discuss their attack and may harbor feelings of resentment and anxiety over potential homosexuality . Assaulted young boys may, in turn, commit sexual assault themselves in the future. Appropriate psychological therapy is necessary for improved long-term outcomes.

Prevention

Usually, rape and sexual assault cannot be prevented, and it is important that children and adolescents, who often think they are at fault after an attack, be told that there was nothing they could have done to prevent the attack. However, measures to reduce the likelihood of a rape or sexual assault and to increase the chances of an assailant being caught can be taken:

• Children and adolescents can be instructed on safety and strangers and inappropriate touching, and the importance of telling parents about any uncomfortable situation.
• Parents can monitor social activities, particularly for older adolescents, who may attend events (e.g., parties with no adult supervision) without their parents' knowledge.
• Adolescents can be educated about "date-rape" drugs and methods to prevent their consumption (e.g., never leaving drinks unattended at a party). And they can be informed about the dangers of alcohol consumption.
• Parents can encourage open communication regarding normal sexual development and activity and emphasize the importance of saying no in compromising or uncomfortable situations.

Sexually transmitted disease (STD) prevention

STDs are a source of concern for many victims of sexual assault. The most commonly transmitted diseases are gonorrhea, chlamydia, genital warts , and acquired immunodeficiency syndrome (AIDS)/human immunodeficiency virus (HIV). STDs are transmitted in up to 30 percent of rapes. Treatment involves antibiotics and antiviral medications, depending on the STD. In some instances, cultures may be taken during the medical examination and at time point afterward to test for gonorrhea or chlamydia. It is important that the victim receive information regarding the symptoms of STDs and be counseled to return for further examination if any of these symptoms occur.

Pregnancy prevention

Female adolescents at risk of becoming pregnant after an assault should be counseled on the availability of emergency contraception . According to the Food and Drug Administration (FDA), emergency contraception (in the form of a course of pills) is not effective if there is a pregnancy but works to prevent pregnancy from occurring by delaying or preventing ovulation, by affecting the transport of sperm, and/or by thinning the inner layer of the uterus (endometrium) so that implantation is prevented.

Parental concerns

Parents of children and adolescents who are raped or sexually assaulted are understandably upset, angry, and even violent toward perpetrators. For the best mental health of the victim, parents should strive to listen to their children, use healthy coping strategies, and reassure the victim that he/she was not at fault. Parents should resist letting anger toward the assailant take precedence over attention to their child or adolescent.

Because rape and sexual assault cause long-term psychological trauma, parents should be aware of symptoms of PTSD, depression, substance abuse, high-risk behaviors, and anxiety in their children. Long-term therapy with a counselor experienced in rape and sexual assault trauma can benefit both the victim and parents.

Parents should also be aware that PTSD and other psychological effects of rape can manifest as poor school performance. Impaired concentration, acting out in school, diminished energy, embarrassment, and frustration may all occur in traumatized children and adolescents. School officials and counselors should be contacted to help students with academic problems; temporary homebound instruction or day therapy programs may be necessary.

Resources

BOOKS

Matsakis, Aphrodite. The Rape Recovery Handbook: Step-by-Step Help for Survivors of Sexual Assault. Oakland, CA: New Harbinger Publications, 2003.

PERIODICALS

Kawsar, M., et al. "Prevalence of Sexually Transmitted Infections and Mental Health Needs of Female Child and Adolescent Survivors of Rape and Sexual Assault Attending a Specialist Clinic." Sexually Transmitted Infections 80 (April 2004): 138–141.

Pharris, Margaret D., and Sarah S. Nafstad. "Nursing Care of Adolescents Who Have Been Sexually Assaulted." Nursing Clinics of North America 37 (2002): 475–97.

Ruggiero, Kenneth J., et al. "Is Disclosure of Childhood Rape Associated with Mental Health Outcome? Results from the National Women's Study." Child Maltreatment 9 (February 2004): 62–77.

ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090–6920. Web site: http://www.acog.org/.

Rape, Abuse, and Incest National Network (RAINN). 635-B Pennsylvania Ave. SE, Washington, DC 20003. National Sexual Assault Hotline: 1–800–656-HOPE. Web site: http://www.rainn.org/.

WEB SITES

"Adolescent Update: Drugs and Date Rape." American College of Emergency Physicians. Available online at http://www.acep.org/webportal/MemberCenter/SectionsofMembership/PediatricEmergencyMedicine/NewsletterArticles/AdolescentUpdateDrugsDateRape.htm (accessed November 3, 2004).

Jennifer E. Sisk, M.A.