Domestic and Sexual Violence __________________________________________________________________
SEXUAL VIOLENCE Although most cases of sexual violence are accompanied by physical force and/or active resistance, visible injuries are rare. Possible signs of sexual violence victimization include [15]: • Unwanted touching • Rape (i.e., actual or attempted unwanted vaginal, oral, or anal penetration by an object or body part) • Being forced or manipulated into doing unwanted, painful, or degrading acts during intercourse • Being taken advantage of while one is drunk or otherwise not likely to give consent • Being denied contraception or protection against sexually transmitted infections • Taking any kind of sexual pictures or film without consent • Being forced to perform sexual acts on film or in person for money • Threatening break up when sex is refused HEALTH EFFECTS AND IMPLICATIONS OF DOMESTIC VIOLENCE As is clear, victims of domestic violence experience a wide range of physical and psychological injuries. Typical injury patterns include contusions or minor lacerations to the head, face, neck, breast, or abdomen. These are often distinguishable from accidental injuries, which are more likely to involve the periphery of the body. In one hospital-based study, domestic violence victims were 13 times more likely to sustain injury to breast, chest, or abdomen than accident victims. Abuse victims are also more likely to have multiple injuries than accident victims. When this pattern of injuries is seen in a patient, particularly in combination with evidence of old injury, physi- cal abuse should be suspected [16]. As a result of prolonged stress, victims often manifest various psychosomatic symptoms that generally lack an organic basis. For example, they may complain of backaches, headaches/ migraines, and gastrointestinal problems. Often, they will complain of chronic pain, fatigue, restlessness, insomnia, or loss of appetite. Research indicates that women with a history of intimate partner violence are at greater risk of developing fibromyalgia and chronic fatigue syndrome [17]. Sleep distur- bances, including truncated sleep, nightmares, and restless sleep, are also common [18]. The likelihood of having some sort of stress-related sleep disturbance is 1.24 times greater for women affected by physical intimate partner violence and 3.44 times greater for victims of sexual abuse [18]. Great amounts of anxiety, guilt, and depression or dysphoria are also typical [16; 19]. In many women, this constellation of symptoms has been labeled “battered women’s syndrome.”
The long-term health implications should also be considered. In a study conducted by MORE magazine and the Verizon Foundation, 88% of women who have experienced sexual abuse and 81% of women who have experienced any form of domestic violence report having chronic health condi- tions (compared with 62% among women who experienced no domestic violence) [20]. In this study, the most common chronic health conditions among victims were low back pain (35%), headaches (32%), difficulty sleeping (30%), and depression/anxiety (30%). Victims of violence were also found to have increased incidences of diabetes, cervical pain, gastroesophageal reflux disease, irritable bowel syndrome, and post-traumatic stress disorder (PTSD). HEALTH EFFECTS AND IMPLICATIONS OF SEXUAL VIOLENCE Research indicates that victims of sexual violence experience a range of acute and long-term physical and psychological injuries as a result of the violence [21]. NON-GENITAL BODILY INJURY Non-genital bodily injury is seen in more than half of all rape victims presenting to emergency departments [22; 23]. In one study of 162 women examined between 2002 and 2006, signs of bodily injury were found in 61% of patients, with genital injury present in 39% [24]. Most common were bruises (56%) and abrasions (41%), followed by lacerations, penetrating injury, and bites. Evidence of injury was higher in the 137 cases examined within 72 hours of assault (66% vs. 33%) and in cases in which the assaults occurred outdoors (79% vs. 52%). On examination, one should inspect carefully for evidence of blunt traumatic injury to the head, neck, arms, legs, and torso, looking for signs of penetrating injury, lacerations, and bite marks. Bruising may be evident on the neck (attempted strangulation), hands, arms, breasts, or thighs. Signs of bodily injury are more prevalent in women younger than 30 years of age. Other factors showing a strong positive association with bodily injury include alcohol consumption, history of prior assault, and assault by strangers [22]. GENITAL INJURY Signs of genital traumatic injury are not always found after sex- ual assault, and in such cases should not be taken as evidence that sexual assault did not occur [24]. When routine inspec- tion is combined with additional examination techniques, such as colposcopy and toluidine blue staining, the rate for identifying genital injury approaches 70% [25]. A 2021 study compared 834 women, half of whom reported nonconsensual intercourse. External genital tears were found more often in the nonconsensual group [26]. Similarly, anal penetration and tears were also more common in the nonconsensual intercourse group. As such, these may be indicators of lack of consent.
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MDCT2026
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