Needs special expertise, and more of it

Rape is common but under-reported, with an estimated lifetime risk of up to one in four for women.1 Definitions vary between countries; in England and Wales the term refers to non-consensual vaginal or anal penetration by a penis, of a woman or a man. Serious sequelae include psychological problems, infection, and unwanted pregnancy. People who have been raped may present, immediately or later, to general practitioners or other clinicians, not all of whom may be familiar with such situations. Here we outline the care of people who present after sexual assault; we use the relatively neutral term clients, as suggested elsewhere.2

Optimal management depends on the client's wishes and needs, time since assault, and whether involvement of the police is requested. Meticulous medical notes are essential even if involvement of the police is declined initially, as reports may be required later for legal processes or compensation. Immediate considerations include safety, management of injuries, forensic examination, and emergency contraception. In situations of domestic violence or perpetrator's physical proximity a …