Merck Manual

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Rape

By

Erin G. Clifton

, PhD, Department of Psychiatry, University of Michigan

Last full review/revision Apr 2020| Content last modified Apr 2020
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Rape refers to penetration of the vagina, anus, or mouth that involves threats or force against a person who is unwilling or incapacitated (because of mental or physical disability or intoxication).

  • Victims may have tears in the vagina or anus, cuts and bruises, upsetting emotions, and difficulty sleeping.

  • Sexually transmitted diseases, infection with the HIV (human immunodeficiency virus), and pregnancy are risks.

  • Women or men who are raped should be thoroughly evaluated in a center staffed by specially trained people (rape center).

  • Treatment of physical injuries, antibiotics to prevent infections, emergency contraception, and counseling or psychotherapy are often needed.

  • If possible, family members and close friends should meet with a member of the rape crisis team to discuss how to support the rape victim.

Rape is typically considered to be penetration of the another person's vagina, anus, or mouth when it is unwanted and/or the person does not or cannot consent to it (called nonconsensual), including when the person is incapacitated (that is, mentally or physically disabled or intoxicated). In people younger than the age of consent, penetration of the vagina, anus, or mouth—whether wanted or not—is considered rape (statutory rape).

Sexual assault is a broader term, including the use of force and threats to coerce any sexual contact. The victim is a person who does not consent or who cannot consent because they are incapacitated. Sexual assault also includes seduction of a child through offers of affection or bribes and unwanted touching, grabbing, or kissing.

The reported percentage of women who have been raped during their lifetime varies widely—from 2% to almost 30%. The reported percentage of children who are sexually abused is similarly high. Reported percentages are probably lower than the actual percentages because rape and sexual abuse are less likely to be reported to the police than are other crimes.

Typically, rape is an expression of aggression, anger, or the need for power and control rather than being sexually motivated. Many women who are raped are also physically beaten and/or injured.

Men are also raped. The perpetrator is often another man. Rape is common in the prisons. Men are more likely than women to be physically injured, to be unwilling to report the rape, and to have several assailants.

Symptoms

Symptoms and complications of rape can include

  • Physical injuries

  • Psychologic effects

  • Sexually transmitted diseases

  • Pregnancy

Physical injuries resulting from a rape may include injuries of the anus or genitals, such as tears in the upper part of the vagina, and injuries to other parts of the body, such as bruises, black eyes, cuts, and scratches. Rape can also have long-term effects. on physical health. Evidence suggests that rape increases the risk of developing asthma, irritable bowel syndrome, frequent headaches, and chronic pain. The risk of having difficulty sleeping and overall poor physical health is also increased.

The psychologic effects of a rape are often more devastating than the physical.

Immediate effects

Immediately after a rape, the victim's behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief to lack of emotion, stillness, and smiling. Lack of emotion rarely indicates lack of concern. Rather it is probably a way to avoid thinking about what has happened or to keep emotions under control. Or the victim may show little or no emotion because of physical exhaustion or emotional numbness.

Rape victims typically also feel fearful, anxious, and irritable. They may feel angry, depressed, embarrassed, ashamed, or guilty (wondering whether they may have done something to provoke the rape or could have done something to avoid it). Their anger may be directed at themselves or misdirected at hospital staff or family members.

Difficulty sleeping and nightmares are common.

Victims may develop symptoms of stress (called acute stress disorder). Acute stress disorder may be diagnosed when symptoms are present for 3 days to 1 month after the rape.

Posttraumatic stress disorder

For most victims, symptoms lessen substantially over a period of months.

Some victims develop posttraumatic stress disorder (PTSD). It is diagnosed when symptoms of PTSD do the following:

  • Continue for more than a month

  • Significantly interfere with a victim's social activities and work

  • Are not caused by another medical problem or drug use

Symptoms of PTSD include

  • Re-experiencing the trauma (for example, as flashbacks or intrusive and upsetting thoughts or images)

  • Avoiding situations, thoughts, and feelings related to the trauma

  • Having problems with thinking and mood (such as feeling responsible for the rape or not being able to have any positive feelings)

  • Being unable to remember significant parts of the event

  • Being excessively alert for signs of danger and being easily startled

  • Feeling extremely tense, agitated, or irritable and unable to relax

  • Having problems concentrating and sleeping

Many victims who develop PTSD also develop depression and/or other mental health disorders, such as a substance use disorder.

Risk of infection or pregnancy

After a rape, there is a risk of infections such as sexually transmitted diseases (such as gonorrhea, trichomoniasis, chlamydial infection, and syphilis), hepatitis B, hepatitis C, and bacterial vaginosis. Infection with the human immunodeficiency virus (HIV) is a particular concern, even though the chances of acquiring it in a single encounter are low.

A woman may also become pregnant.

Evaluation

  • A physical examination

  • If the victim consents, tests to collect evidence and check for sexually transmitted diseases

  • A pregnancy test

Having a thorough medical evaluation after a rape is important. Whenever possible, women who have been raped or sexually assaulted are taken to a sexual assault center that is staffed by trained, concerned support personnel, such as sexual assault nurse examiners (SANE). The center may be a hospital emergency department or a separate facility. Some areas have a sexual assault response team (SART), which includes people who work in health care, forensics, the local rape crisis center, law enforcement, and the prosecutor's office. Men who have been raped should also seek medical attention. They are treated in much the same way as women who have been raped.

After a rape, the victim decides whether to consent to actions that will allow eventual prosecution. Advantages and disadvantages of proceeding with such actions should be explained. The victim should feel no pressure to consent, although consent is generally in the victim's best interest.

If the victim chooses to proceed, doctors are required by law to notify the police and to examine the victim. The examination can provide evidence for prosecution of the rapist. The best evidence is obtained when the rape victim goes to the hospital as soon as possible, without showering or washing, without brushing the teeth, without clipping nails, without changing clothes, and, if possible, without even urinating. The medical record resulting from this examination is sometimes used as evidence in court proceedings. However, the medical record cannot be released unless the victim gives consent in writing or a subpoena is issued. The record may also help the victim recall details of the rape if the victim's testimony is required later.

Immediately after a rape, the victim may be hesitant or afraid of undergoing a physical examination. Before the examination, victims are asked whether they prefer a male or a female doctor. If a male doctor examines a woman, a female nurse or volunteer is present to help allay any anxiety the woman may be feeling. Privacy and quiet are provided whenever possible.

Before beginning the examination, the doctor explains what will be done during the examination and asks the victim for permission to proceed. The victim should feel free to ask any questions about the examination and its purpose.

The doctor usually asks the victim to describe the events to help guide the examination and treatment. However, talking about the rape is often frightening and distressing. The victim may request to give a complete description later, after immediate needs have been met. The victim may first need to be treated for injuries and to have some time for calming down.

When the victim is able, the doctor asks the victim questions about the rape such as the following:

  • Which body parts were involved (vagina, mouth, and/or rectum)?

  • Did ejaculation (discharge of semen) occur?

  • Was a condom used?

  • Did the perpetrator threaten, use a weapon, or behave violently?

  • What did the perpetrator look like?

To help determine the likelihood of pregnancy, the doctor asks the woman when her last menstrual period was and whether she uses a contraceptive. To help interpret the analysis of any sperm samples, the doctor asks if the victim recently had sex before the rape and, if so, when.

The doctor notes physical injuries, such as cuts and scrapes, and may examine the genitals and anus for injuries. Photographs of injuries are taken. Because some injuries such as bruises become apparent later, a second set of photographs may be taken later.

Testing and evidence collection

A swab is used to take samples of semen and other body fluids for evidence. Other samples, such as samples of the perpetrator’s hair, blood, or skin (sometimes found under the victim's nails), are collected. Sometimes DNA testing of the samples is done to identify the perpetrator. Some of the victim’s clothing may be kept for evidence.

If the victim consents, blood tests are done to check for infections, including HIV infection. If the initial test results for gonorrhea, chlamydial infection, syphilis, and hepatitis are negative, the victim is tested again at 6 weeks. If results for syphilis and hepatitis are still negative, tests are repeated at 6 months. Blood tests for HIV infection may be repeated after 90 and 180 days. In women, a Papanicalaou (Pap) test is done to check for human papillomavirus (HPV) infection after 6 weeks.

Usually, a pregnancy test to measure the level of human chorionic gonadotropin in the urine is done during the initial examination of women who have been raped to detect any preexisting pregnancy. If the results are negative, the test is repeated within 2 weeks to check for pregnancy that may have resulted from the rape.

Treatment

  • Treatment of any physical injuries

  • Drugs and sometimes vaccines to prevent infections, including HIV infection

  • Emergency contraception if the woman wants it

  • Psychologic support or intervention

After the examination, the victim is offered facilities to wash, change clothing, use mouthwash, and urinate and defecate if needed.

Any physical injuries are treated. Tears in the genitals or anus may need to be surgically repaired.

Preventing infections

For preventing sexually transmitted diseases, the victim is given antibiotics. For example, all of the following may be given when the victim is first evaluated:

Victims who have not been vaccinated against hepatitis B are given the vaccine, followed by two more doses, one 1 month and one 6 months after the first dose.

If test results for HIV are positive, the victim probably had HIV infection before the rape because HIV infection acquired through sexual intercourse typically cannot be detected until 9 days to 6 months later. If test results for HIV are positive, treatment for HIV is started immediately.

If test results for HIV are negative, the HIV test is repeated several times over the next several months.

Drugs to prevent HIV infection may be offered to the victim. On average, the chance of developing HIV infection after rape from an unknown assailant is low—only about 0.2%. Risk may be higher if any of the following occurred:

  • Anal penetration

  • Bleeding (from the assailant or victim)

  • Male-male rape

  • Rape by several assailants (as may happen to men in prison)

  • Rape that occurs in areas where HIV infection is unusually common

Treatment to prevent HIV infection is most effective if started within 4 hours after penetration and should not be given if more than 72 hours have passed since penetration.

Preventing pregnancy

If the woman is not already pregnant, emergency contraception is provided if the woman wants it. Usually, it consists of a high dose of an oral contraceptive given immediately, then repeated 12 hours later. This treatment is 99% effective if given within 72 hours of the rape.

Inserting an intrauterine device (IUD) within 10 days of the rape is even more effective.

If pregnancy results from the rape, women may consider abortion.

Providing psychologic support

Doctors explain the psychologic reactions that commonly occur after the rape (such as excessive anxiety or fear or guilt) to the victim. This information can help victims accept and deal with their reactions.

As soon as feasible, a person trained in rape crisis intervention meets with the victim. Victims are referred to a rape crisis team if one is located in the area. This team can provide helpful medical, psychologic, and legal support. For victims, talking about the rape and their feelings about it can help them recover.

If victims continue to have symptoms after the rape, they may be referred to a psychologist, social worker, or psychiatrist.

Family members and friends may have some of the same feelings as the victim: anxiety, anger, or guilt. They may irrationally blame the victim. Thus, in addition to their own feelings, rape victims may have to handle negative, sometimes judgmental or derisive reactions of family members and friends, as well as those of officials. These reactions can interfere with recovery. Family members or close friends may benefit from meeting with a member of the rape crisis team or sexual assault evaluation unit to discuss their feelings and how they can help the victim. Usually, listening supportively to the victim and not expressing strong feelings about the rape are most helpful. Blaming or criticizing the victim may interfere with recovery.

A support network of health care practitioners, friends, and family members can be very helpful to the victim.

More Information

Drugs Mentioned In This Article

Generic Name Select Brand Names
FLAGYL
ZITHROMAX
PERIOSTAT, VIBRAMYCIN
ROCEPHIN
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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