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According to Australian statistics, since the age of 15 years, 1 in 5 women and 1 in 20 men have been sexually assaulted and/or threatened.4 Sexual assault is defined broadly as any unwanted sexual contact that occurs without a person’s consent and which makes the victim feel uncomfortable, frightened or threatened. The behaviour can include any activity from sexual harassment through to life-threatening rape.
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The majority of perpetrators of sexual assault are known to their victims and a high proportion of perpetrators are current or ex-partners. For this reason, it is important to assess whether the patient is safe to return to their accommodation. Stranger assaults only make up approximately 15% of sexual assault cases.11
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Survivors of sexual assault should be allowed to accept or decline various assessment or treatment options offered by the practitioner. Many victims do not report sexual assault to police because of fear, humiliation or shame.
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Medical practitioners dealing with alleged sexual assault should familiarise themselves with the laws applicable in their state/territory. Self-care for clinicians is also of particular importance when dealing with this distressing problem.
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Disclosure of sexual assault
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Offer and provide privacy, safety and emotional support. Take the time to explain confidentiality and its limits, so that the patient is aware that the assault will not be discussed with the police or their family without their consent. Believe them, listen to them and be non-judgmental.
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Five important things to say:
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I am sorry this happened to you.
This is a crime—it was not your fault.
It’s good that you have talked to me about this.
I will do what I can to help you.
You are safe now (if applicable).
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Most jurisdictions require that the first person who hears an allegation of sexual assault must give evidence if the complaint comes to trial, so document the exact words used.
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If the patient presents following recent sexual assault, the following information will help guide management:12,13
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time and place of assault
brief description of the assault (i.e. what went where)
condom use
details of the assailant
preceding drug or alcohol use
violence used and any injuries
current contraception
risk assessment for patient and any children
accommodation issues
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When patients disclose sexual assault that took place in the past, it is not necessary or advisable to ask all the details about what happened at the first disclosure. The patient may not be ready to tell you details and doing so may easily take them back to their trauma, leading them to decompensate. Let the patient know that you are ready to listen to more details if or when they are comfortable telling you.14
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A patient may disclose sexual assault immediately or years after the event. Management depends on when the assault occurred.
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Recent sexual assault3
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Management options include:
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forensic examination by a specialist sexual assault service, preferably within 72 hours of the assault—this is still advised if the patient is undecided about reporting the assault
assessment and treatment of physical injuries
emergency contraception if indicated
testing for pregnancy or STIs according to need
urine or blood drug testing if suspected drugassisted sexual assault, i.e. when the patient has no memory of events and time or other suspicious circumstances—seek specialist advice
address safety and supports at home—alternative accommodation may be required
follow-up—patients may need to return for follow-up at 2 weeks and 3 months following STI checks
sexual assault counselling and support groups
ongoing support and monitoring of symptoms of trauma
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STI testing and prophylaxis
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take swabs and/or first-pass urine for testing gonococcus and chlamydia (PCR)
take blood for HIV, syphilis and hepatitis B
collect swabs from the oropharynx or rectum if indicated
give STI prophylaxis (see TABLE 118.2)—depends on type of assault and assailant; azithromycin for chlamydia prophylaxis is the most commonly used
at 2 weeks test for chlamydia, gonorrhoea and trichomonas (depending on risk)
at 6 and 12 weeks, test for HIV, hepatitis B and syphilis
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The long-term physical and psychological consequences of sexual abuse are many, often somatic or psychological, and can have devastating consequences for the victim. Disclosure to a trusted health professional may be the first step in the healing process. A sensitive response to disclosure can be critical in this process. Offer referral to an experienced therapist or sexual assault specialist counselling service, with access to up-to-date knowledge about relevant reporting and legal processes.14