_________________________________________________________________ Domestic and Sexual Violence
LONG-TERM PHYSICAL AND EMOTIONAL IMPACT OF SEXUAL ASSAULT
Chronic Somatic Disorders
Psychosocial Disorders
Pelvic pain, dyspareunia Functional gastrointestinal disorder Fibromyalgia Multisystem physical complaints Headaches Abdominal pains Source: [29; 30; 31; 33; 34; 35; 36]
Anxiety, depression, phobias Post-traumatic stress disorder
Sexual dysfunction Sleep disturbance Anorexia Work absenteeism
Table 2
The common types and location of genital injuries, and thus the areas to be examined most closely, are: • Bruises and abrasions to the labia, fossa navicularis, or perianal area • Ecchymoses, tears, or lacerations of the hymen • Abrasions and/or tears of the posterior fourchette • Tears/lacerations in the perianal area LONG-TERM PSYCHOSOCIAL IMPACT The impact of sexual assault leads to immediate and long-term physical and mental health consequences. In addition to the potential risk for acquiring a sexually transmitted disease (STD), approximately 1% to 5% of rape victims become pregnant [27]. The National Violence Against Women Survey (NVAWS) found that 33% of women and 24% of men received counseling from a mental health professional as a direct result of their last assault; 28% and 10%, respectively, lost time from work [28]. Survivors of sexual assault are also at increased risk for re-victimization and experience higher rates of depression, post-traumatic stress disorder, substance abuse, and suicide. In the aftermath of sexual assault, a variety of chronic somatic, cognitive, and emotional sequelae have been observed in sexual assault victims ( Table 2 ). The individual’s response and subsequent ability to cope with the trauma of the assault are influenced by a number of related factors. These include the nature and severity of the assault itself, age of the victim, relationship between the victim and assailant, prior history of abuse, and the person’s own ambient life stress and coping mechanisms. For some, the impact of a sexual assault experi- ence is severe and long-lasting, often resulting in difficulty with interpersonal relationships and tasks of daily living, sexual dysfunction, loss of work time, and increased utilization of healthcare resources [29; 30; 31]. The victim’s age and develop- mental stage can also affect help-seeking. Adolescents tend to delay seeking formal help more often than adult victims [32]. This delay could exacerbate both physical and psychosocial consequences.
A meta-analysis of clinical studies published between 1980 and 2002 revealed a significant association between prior sexual assault and the lifetime diagnosis of fibromyalgia, chronic pelvic pain, and functional gastrointestinal disorders [33]. In a cross-sectional, randomly selected study of 219 women fol- lowed in a Veterans Administration (VA) primary care clinic, a history of prior sexual assault was found to be associated with a significant increase in somatization scores, multisystem physical complaints, anxiety, work absenteeism, and health care utilization [34]. Among another cohort of women receiving VA medical and mental health care, the prevalence of post- traumatic stress disorder was found to be seven to nine times higher in women who had experienced a prior sexual assault, compared with those having no assault history [35]. It is also vital to remember that some victims have experienced cumulative sexual violence over the course of their lifetime. This often results in continued fear and anxiety and chronic stress, which is associated with an increased risk for chronic health conditions (e.g., hypertension, disordered sleeping, chronic pain, asthma) [36]. To summarize, the priorities of acute care counseling are to provide emotional support, assure a plan for patient safety, and assess coping skills and strength of support system post- discharge. When possible, arrangements should be made for ongoing counseling through sexual assault crisis programs. In anticipation of the long-term adverse effects of sexual assault, arrangements should be made for primary care follow-up and patients and families should be offered information and access to mental health services. SEXUALLY TRANSMITTED INFECTION The infections commonly reported in women after sexual assault are Chlamydia , gonorrhea, trichomoniasis, bacterial vagi- nitis, and pelvic inflammatory disease (PID) [37]. The possible exposure to hepatitis B virus and human immunodeficiency virus (HIV) is also an important consideration. In general, the risk of infection is relatively low; published estimates are 3% to 16% for chlamydia, 7% for trichomoniasis, and 11% for PID [38]. The risk, however, does vary directly with the degree of genital trauma, associated bleeding (sustained by the
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MDCT2026
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