Rape and sexual assault

Notes

## Basic introduction

  • Rape is an assault of a person, involving sexual intercourse (i.e. penetration of the vagina, anus or mouth by a penis) without their consent.
  • In Kenya, rape is defined as “carnal knowledge of a woman without her consent or by use of force, duress or pretense”
  • Also in Kenya, the following groups of people are not legally deemed to be able to give sexual consent: girls below 18 years old, a mentally retarded woman and psychiatric cases.

## Statistics

  • Most victims of rape are women and most perpetrators male
  • It is claimed that an estimated 500,000 rapes are committed annually in South Africa.
  • 5% of male-on-female rapes result in pregnancy.
  • In Kenya, about 60% of sexual assault cases that are reported from the healthcare facilities involve children.
  • Transmission of HIV after one exposure (as it may be the case of a perpetrator who is HIV positive) to penetrative anal sex is about 0.5-3.2% and about 0.05 - 0.15% for after one exposure to penetrative vaginal intercourse.

## Effects of rape on the victims

  • Acquiring STDs, including HIV/AIDS
  • Chronic pain
  • Depression
  • Gynecological disorders
  • Increased risk of suicide
  • Infertility
  • Miscarriage
  • Mortality from injuries
  • Pelvic inflammatory disease
  • Pregnancy complications
  • Psychosomatic disorders
  • Reproductive disorders
  • Sexual disorders
  • Sexual dysfunction
  • Unsafe abortion
  • Unwanted pregnancy

## A rape kit (Sexual Assault Kit or Vitullo kit) that is used to collect forensic specimens consists of the following:

  • Instructions
  • Bags and sheets for evidence collection
  • Blood collection devices
  • Clear glass slides
  • Comb used to collect hair and fiber from the victim’s body (for DNA testing)
  • Nail pick for scraping debris from beneath the nails (for DNA testing)
  • Self-sealing envelopes for preserving the victim’s clothes, head hair, pubic hair, and blood samples
  • Sterile sample containers
  • Sterile urine collection containers
  • Swabs for collecting fluids from the lips, cheeks, thighs, vagina, anus, and buttocks (sperm microscopy will be done)
  • White sheets to catch physical evidence stripped from the body
  • Documentation forms
  • Labels
Symptoms
  • Sometimes there is no injury
  • Notable injuries
Diagnosis
  • Clinical review
  • Swabbing the vagina, urethra, throat, and rectum for microscopy and culture
  • Swabbing the vagina and cervix for sperm microscopy
  • Scraping of finger nails and combing /clipping of pubic hair to collect samples for DNA analysis to assist in identification of the assailant
  • X-rays, CT or MRI scans may be required.
  • NB: Genital injuries to children may be from an on-going or past cases of sexual abuse, so look out for scarring as one sign of the sexual abuse.
  • Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis
  • Blood sample for testing for syphilis and HIV (the tests are repeated after 3 months)
  • Urine for pregnancy test (the baseline test is done and the test is repeated after 4 months)
Differential
  • Not applicable
Prevention
  • Preventive measures requires a multidisciplinary approach involving individuals, communities, national, and international efforts
Management
  • Start by treatment of life-threatening emergencies.
  • Discourage the victim from bathing or showering to preserve the evidence.
  • Get informed consent to proceed with examination and treatment
  • Forensic examination then follows together with collection of evidence (including samples) that can be used to identify and prosecute the perpetrator
  • A social support staff is then made available to provide psychological care. A long-term psychiatric care may be required.
  • Victims with abrasions are immunized for tetanus (more so if 5 years have elapsed since their last immunization)
  • Offer emergency contraceptives to all women victims.
  • Initiate prophylactic treatment for:

_Vaginitis, gonorrhea, trichomoniasis and chlamydia

_HIV PEP regime (see the details under “HIV” in this publication)

­_Immunization against hepatitis B virus (can be considered)

  • If the assailant is apprehended collect the necessary specimen such as hair, blood etc.
  • The rape victims need to be followed for some few months
  • Constructive surgery may be required
  • Tranquilizers such as diazepam may be required.
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