Sexual assault accounts for 5 percent of all violent crimes reported in the 1995 U.S. Uniform Crimes Report. An estimated one in five women will be raped during their lifetimes.1 Prevalence studies suggest that at least 20 percent of all adult women and 12 percent of adolescent women have experienced some form of sexual abuse or assault during their lifetimes.2 Most rape victims feel there is a stigma attached to being a victim of sexual assault. As a result, sexual assault is the most underreported violent crime. Authorities believe that as few as one in three cases are reported; 3 some estimates are as low as 10 percent.4 The vast majority of information and statistics relate to female rape victims. Only recently has male sexual assault been recognized and reported. The estimated incidence is 2 to 4 percent of reported rapes.56
Many misconceptions are perpetuated about sexual assault. The most common is the assumption that rape is motivated by sexual desire. Rape is a violent crime, motivated by the need for power and control or by anger.5 Recent literature detailing the injuries sustained by rape victims supports rape as a violent crime. Tintinalli and Hoelzer's study of 372 rape victims reported that facial or extremity injuries were most common, and gynecologic injuries accounted for only 7 percent of all injuries.7 Genital injuries are not an inevitable consequence of rape, and lack of genital injuries does not imply consensual intercourse. Many victims are threatened with a weapon, the majority of victims suffer minor injuries, and only 1 to 2 percent require hospitalization.5
The physician's responsibility is to provide for the patient's physical and psychological well-being first; then, if the patient wishes to prosecute, to provide police with corroborative medical evidence. Victims should be encouraged to undergo an evidentiary examination; critical evidence may be lost if this exam is delayed. The victim may later choose not to proceed through the criminal justice system, as collection of forensic evidence does not commit her to seek prosecution.
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