Clinical Review

Rape and sexual assault

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39211.403970.BE (Published 31 May 2007) Cite this as: BMJ 2007;334:1154
  1. Jan Welch, clinical director1,
  2. Fiona Mason, consultant forensic psychiatrist2
  1. 1Haven Camberwell, King's College Hospital, London SE5 9RS
  2. 2St Andrew's Healthcare, Northampton
  1. Correspondence to: J Welch jan.welch@kingsch.nhs.uk

    Sexual violence is a global problem. The lifetime risk of attempted or completed rape is up to 20% for women, but men and children are also often sexually violated.1 Sequelae include unwanted pregnancies; sexually transmitted infections, including HIV; depression; and post-traumatic stress disorder. Most of the literature on rape and sexual assault is retrospective, but we aim to provide an evidence based review of their management.

    Summary points

    • Rape and sexual assault are common, particularly among young women although men and children may also be assaulted

    • Perpetrators are usually known to those they assault

    • People who have been sexually assaulted often seek medical help but may not disclose the assault

    • Management includes treatment of injuries; emergency contraception; prevention of infections, including HIV; and psychosocial support

    • Although many people experience psychological symptoms after rape, most recover

    • A minority of people after assault have significant and disabling persistent symptoms that require specialist intervention and active treatment

    • Collection of evidence may be crucial in identifying and prosecuting perpetrators

    • Optimal acute management is the provision of all necessary services in one place and in a sensitive, safe, and forensically secure environment

    Sources and selection criteria

    We searched Medline using the term “sexual assault”. We also took account of the Cochrane review of interventions for emergency contraception and for trauma related symptoms and the prevention of post-traumatic stress disorder. Guidance from the National Institute for Health and Clinical Excellence and national and World Health Organization guidelines were also considered. We searched our personal archives of references and consulted experts.

    Who is sexually assaulted?

    Anyone can be sexually assaulted but some people are especially vulnerable, such as adolescents and young women, people with disabilities, poor and homeless people, sex workers, and those living in institutions or areas of conflict.1 Consumption of alcohol is commonly linked with sexual assault,2 although covert administration of drugs …

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