Rape and Sexual Assault
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Rape and Sexual Assault
The various definitions of rape range from the broad (coercing a person to engage in any sexual act) to the specific (forcing a woman to submit to sexual intercourse). The United States Code includes the crime of rape under the more comprehensive term "sexual abuse." Two types of sexual assault are defined in the code: sexual abuse and aggravated sexual abuse. Sexual abuse includes acts in which an individual is forced to engage in sexual activity by use of threats or other fear tactics, or instances in which an individual is physically unable to decline. Aggravated sexual abuse occurs when an individual is forced to submit to sexual acts by use of physical force; threats of death, injury, or kidnapping; or substances that render that individual unconscious or impaired.
Many misconceptions exist about rape and sexual assault. It is often assumed that rape victims are all women who have been attacked by a total stranger and forced into having sexual intercourse. In reality, sexual assault can take many forms—it may be violent or nonviolent; the victim may be male or female, child or adult; the offender may be a stranger, relative, friend, authority figure, or spouse.
The number of sexual assaults reported depends on how those abuses are defined. The United States Code uses two terms to distinguish between different sexual activities:
- Sexual act: contact between 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) of the genitals of an individual under the age of 16.
- Sexual contact: intentional touching of the genitals, breasts, buttocks, anus, inner thigh, or groin with no sexual penetration.
According to the Federal Bureau of Investigation's Uniform Crime Reports, there were 95,136 forcible rapes reported to United States law enforcement agencies in 2002. Sixty-five out of every 100,000 women were reported to be victims of rape that year, up 4.7% from 2001 but down 3.9% from 1998. The actual number of rapes and sexual assaults, however, is in reality much larger; estimates of unreported rape range between 2 and 10 times the number reported to law enforcement. The National Violence Against Women Survey, jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the National Institute of Justice (NIJ) and conducted in the mid-1900s, found that one in six women (18%) and one in 33 men (3%) has experienced an attempted or completed rape. The survey estimated that approximately 17,722,672 women and 2,782,440 men in the United States have been raped or have had rape attempted as a child or adult, and that 302,091 women and 92,748 men were raped in the 12 months prior to the study.
There are numerous reasons why the majority of sexual assaults are never reported. Often the victim fears retaliation from the offender. He or she may be afraid of family, friends, the community, or the media learning 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.
THE VICTIMS. 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. Twelve to 18 year olds represented the largest group of victims at 33%; 20% were between the ages of six and 11; children less than five years old and adults between 18 and 24 years of age each constituted 14% of victims; 12% were between the ages of 25 and 34; and 7% were over the age of 34. Persons over the age of 54 represented 1% of all victims. One out of every seven victims surveyed in the study were under the age of six.
- Gender: Females were more than six times more likely to be a victim of sexual assault then males; more than 86% 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.
- Weapons: A personal weapon (hands, feet, or fists) was used in 77% of cases. No weapon was noted in 14% of assaults; other weapons (knifes, clubs, etc.) were used in 6% of cases. Firearms were involved in only 2% of assaults.
THE OFFENDERS. Similar statistics were gathered by the NCJJ regarding the perpetrators of rape and sexual assault. These characteristics included:
- Age: Over 23% of offenders were under the age of 18; juveniles were more likely to be perpetrators of forcible sodomy and fondling. The remaining 77% of offenders were adults and were responsible for 67% of juvenile victims. For younger juvenile victims (under the age of 12), juvenile offenders were responsible for approximately 40% 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% for victims aged six through 12, 3% for victims aged 12 through 17, and 1% for adult victims.
- Relationship with offender: Approximately 59% 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% of adult victims and 7% of juveniles.
- Past offenses: In 19% of juvenile cases, the victim was not the only individual to be assaulted by the offender, compared to only 4% of adult cases.
Victims of sexual assault may sustain a range of injuries; male victims are more likely than females to suffer severe physical trauma. The National Women's Study, funded by the National Institute of Drug Abuse, found that more than 70% of rape victims report no physical injuries as a result of their assault; only 4% sustain serious injuries that require hospitalization. At least 49% of victims, however, state that they feared severe injuries or death during their assault. Fatalities occur in approximately 0.1% of rape cases.
Sexually transmitted diseases (STDs) are a source of concern for many victims of sexual assault. The most commonly transmitted diseases are gonorrhea (caused by Neisseria gonorrhoeae), chlamydia (caused by Chlamydia trachomatis), trichomoniasis) (caused by Trichomonas vaginalis), and genital warts (caused by human papillomavirus). Syphilis (caused by Treponema pallidum) and human immunodeficiency virus (HIV) are also noted among some sexual assault victims. The transmission rate of STDs is estimated to be between 3.6% and 30% of rapes.
According to the National Women's Study, approximately 5% of adult female rape victims become pregnant as a result of their assault, leading to 32,100 pregnancies a year among women 18 years of age or older. Approximately 50% of pregnant rape victims had an abortion, 6% put the child up for adoption, and 33% kept the child (the remaining pregnancies resulted in miscarriage).
MENTAL HEALTH PROBLEMS. Also known as rape trauma syndrome, post-traumatic stress disorder (PTSD) is a mental health disorder that describes a range of symptoms often experienced by someone who has undergone a severely traumatic event. Approximately 31% of rape victims develop PTSD as a result of their assault; victims are more than six times more likely to develop PTSD than women who have not been victimized.
The symptoms of PTSD include:
- recurrent memories or flashbacks of the incident
- mood swings
- difficulty concentrating
- panic attacks
- emotional numbness
Persons who have been sexually assaulted have also been noted to have increased risk for developing other mental health problems. Over those who have not been victimized, rape victims are:
- three times more likely to have a major depressive episode
- four times more likely to have contemplated suicide
- thirteen times more likely to develop alcohol dependency problems
- twenty-six times more likely to develop drug abuse problems
Once a victim of 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 of sexual assault 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 or professional 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 United States hospitals and clinics to collect and document evidence, evaluate and treat for STDs and pregnancy, and refer victims to follow-up medical care and counseling. 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 includes:
- 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
- assessment 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
- collection of bloody, torn, or stained clothing
- taking samples for blood typing and DNA screening
While the concern of sexual assault victims of contracting an STD is often high, the actual risk of transmission is relatively low; the CDC estimates that the risk of contracting gonorrhea from an offender is between 6% and 12%, chlamydia between 4% and 17%, syphilis between 0.5% and 3%, and HIV less than 1%. Nonetheless, post-exposure prophylaxis (preventative treatment) against certain STDs is often provided for the victim. Treatment with zidovudine, for example, is recommended for individuals who are at a high risk of exposure to HIV. The CDC recommends the following prophylactic regimen be provided for victims of sexual assaults in which vaginal, oral, or anal penetration took place:
- a single dose of ceftriaxone, an antibiotic effective against Neisseria gonorrhoeae
- a single dose of metronidazole, an antibiotic effective against Trichomonas vaginalis
- a single dose of azithromycin or doxycycline, antibiotics effective against Chlamydia trachomatis
- inoculation with the post-exposure hepatitis B vaccine
In some instances, cultures may be taken during the medical examination and at time points 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.
Female victims at risk for becoming pregnant after an assault should be counseled on the availability of emergency contraception. According to the Food and Drug Administration (FDA), emergency contraception is not effective if there is no 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. It is therefore not a form of abortion.
A number of options are available for women if they choose to use emergency contraceptives to prevent pregnancy following a sexual assault. The Yupze regimen uses two oral contraceptive pills that contain both of the hormones estrogen and progestin. The risk of pregnancy is reduced by 75% after use of the Yupze regimen, reducing the average number of pregnancies after unprotected sex from eight in 100 to two in 100. Progestin-only oral contraceptives are also available and reduce the risk of pregnancy by 89% to 95%.
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