Rape

Introduction

Rape is performance of the act of sexual intercourse by force, duress, intimidation or without legal consent (as with a minor).
It is a growing social disorder afflicting the poor and rich, alike, with devastating and longstanding emotional consequences for the afflicted, family and society at large.
It is an enormous societal problem that appears to be poorly recognized and grossly under reported.
An average of one in five adult women may have experienced sexual assault during her lifetime.
Adult women are much more likely to be raped by a spouse, ex-spouse, or acquaintance than by a stranger.
The girl-child is much more likely to be raped by her close male associates (non-strangers), not excluding her father, uncle, brother, cousin, neighbour, school teacher, family driver, security personnel, and even faith based instructor
Mental illness, alcohol and drug abuse appear to be predisposing factors; neglect and inattentiveness to the needs of the girl-child also contribute

Clinical features

  • Indirect presentation
  • Vague symptoms

Physical features:

  • Perineal pain
  • Bleeding per vaginam
  • Bruised face/body
  • Arthritis
  • Disordered gait

Psychological symptoms/disorders

  • Sadness
  • Depression
  • Refusal to respond to simple questions
  • Avoidance of eye contact
  • School/work absenteeism

Differential diagnoses

  • Vaginitis
  • Threatened abortion
  • Domestic violence
  • Alcoholism
  • Drug abuse
  • Depression

Investigations

Early

  • Vaginal/perineal swab for microscopy, culture and sensitivity
  • Semen: DNA analysis

Late

  • Urinalysis; urine microscopy, culture and sensitivity
  • Pregnancy test (blood)
  • HIV screening

Treatment objectives

  • Evaluate safety of the patient.
  • Assess and treat physical injuries
  • Provide emotional support
  • Assess and deal with the risk of sexually transmitted infections and pregnancy

It is important to document clinical findings

Non-drug measures

  • Reassure patient
  • Provide information about legal services

Drug treatment

  • Treat physical injury (as appropriate)
  • Treat STIs, UTI (as appropriate)
  • Treat HIV infection (if detected); Post exposure prophylaxis if clinical situation so requires
  • Manage pregnancy (as appropriate). If seen within 120 hours, give emergency contraceptives (e.g. prostinor2) to prevent unwanted pregnancy.
  • Rape is an indication for safe termination of pregnancy in some countries.
  • Treat depression (if present)

Prevention

  • Promote Basic Education for all
  • Reduce adult illiteracy
  • Promote family/community moral values
  • Promote Basic Health Education
  • Promote safe shelter and neighbourhoods
  • Legislate for new laws to deter potential rapists and protect females
  • Enforce existing laws on rape
  • Promote socio-economic well-being for all