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This is a description of the process used by the Sexual Assault Nurse Clinician (SANC) in Emergency Departments in Minneapolis, Minnesota, after the rape victim's injuries have been treated. The task of the SANC is to evaluate the care of injuries, collect and protect the chain of evidence, and handle other special concerns of the patient such as risk of pregnancy, sexually transmitted diseases, and crisis intervention. The victim is re-examined for injuries and questioned about the degree of force used. The SANC nurse only needs a brief summary of the assault, since the police obtained the detailed sequence of events. Evidence is collected in 3 categories: documentation of the use of force (photos); identification of the assailant (swabs of sperm, blood, hair); and proof that sexual contact occurred (motile sperm, acid phosphatase). The chain of evidence is a rigid protocol involving signed routing sheets and constant visualization of the evidence when it is not under locks. After the SANC nurse evaluates the patient's risk of pregnancy, she is counseled about postcoital contraceptive treatment and back-up termination. The victim is given the option of taking STD treatment, but is not routinely cultured or treated because of changing legal status of such practices. Most women choose immediate treatment because they feel contaminated and do not want another pelvic exam. If the victim comes for treatment after 36 hours, she is only given treatment of her injuries and referral for testing and counseling. In 417 rape cases in Minneapolis in 1990, 193 assailants were processed by the country attorney, 14 went to trail, and 6 of these were found guilty. Even though a small proportion of the evidence collected is ever used in court, it is important, as is the total care given the victim by the SANC nurse.
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PMID:The sexual assault examination: overview and lessons learned in one program. 160 9

A retrospective study was carried out of all women attending a Department of Genitourinary Medicine over a 3-year period. Note was taken of referring source, presenting symptoms, infection detected at STD screening and follow-up attendance. Comparison was also made between the number of women referred by the police surgeon and the number who actually attended. We observed an overall incidence of STD of 35% and noted that many infections had a similar prevalence to that of our normal clinic population over the same time period. Only 13% of the women referred by the police attended although after the initial visit attendance was similar regardless of referral source. A number of asymptomatic women were noted to have infection with Neisseria gonorrhoeae and Chlamydia trachomatis. Although, the risk of significant STD following sexual assault is low greater efforts should be made to encourage women to attend for screening whether or not they are symptomatic.
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PMID:Rape and sexually transmitted diseases: patterns of referral and incidence in a department of genitourinary medicine. 174 70

This article is a revision of a 1983 position paper of the Society for Adolescent Medicine with inclusion of the newest medical advances in research on adolescent sexuality; i.e., contraceptive compliance, promotion of behavior change, relationships of ethnicity and pregnancy, and male reproductive health. The issues for the 1990's will be sexually transmitted diseases' morbidity and mortality. Topics identified are sexual activity and adolescent pregnancy, care of the pregnant teen, sexually transmitted diseases, HIV infection, the male adolescent, sexual abuse in adolescents, gay and lesbian youth, interventions, reproductive health care of adolescents with disabilities and chronic illnesses, and training of primary care physicians. The HIV/AIDS epidemic has focused attention on the reproductive behavior of males. Sexual activity varies by racial/ethnic group. Interventions to delay sexual initiation needs to be examined, although condom use has increased among 17-19 year olds from 21% to 58% in metropolitan areas. However condom use is lowest among the group of men at highest risk of STDs: those who had ever used drugs, those who had ever had sex with a prostitute, and those that had 5 or more partners/year. Male beliefs about contraception have been infrequently examined. There are misconceptions about heterosexual transmission of HIV. Better screening is needed for STD detection. Fathers are more involved in prenatal care and postnatal intervention programs. 7% of children have been subjected to nonvoluntary sexual intercourse between the ages of 18-21. ; i.e., 12.7% of white women, 9% of black women, 1.9% of white males, and 6.1% of black males. Risk factors for white women were living apart form parents at 16 years, poverty, physical and emotional limitations, parental alcohol and smoking and drug use. Sexual assault was associated with hitchhiking and alcohol and drug use in 1 study cited. Physicians need to be sensitive to this issue and probe for information. The sexual needs of those unsure of orientation or who a re homosexual or lesbian are gradually becoming recognized. Among 12th graders. 1% of males and 1% of females viewed themselves as mostly or completely homosexual or lesbian, and 10% were unsure. Psychological and medical problems are encountered. Interventions needed are reproductive and STd information, multiple approaches in a variety of settings, adolescent clinics, and outreach.
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PMID:Society for Adolescent Medicine Position Paper on Reproductive Health Care for Adolescents. 183 15

Epidemiological data in 13 cases of sexual assault on men who attended a sexual assault referral centre are presented. All the assailants were male. The sexual orientation of the victims was predominantly heterosexual (7 of 13), 3 considered themselves to be homosexual and 3 were confused about their sexual orientation. The average age at the time of assault was 21.6 years. The most common form of assault was anal intercourse which occurred in 8 cases, followed by forced oral penetration which occurred in 6 cases. The proportion of known:unknown assailants (8:5) shows similar characteristics to those seen in female rape, use of weapons and multiple assailants were more common in assault on men. Seven men (54%) developed psychological problems following assault, and this was their main reason for presentation to the centre.
Int J STD AIDS
PMID:Sexual assault on men. 191 57

The records of 28 male victims of sexual assault were analysed retrospectively. The mean age at time of assault was 21.7 years and the mean number of assailants was 2.8. Sixteen victims (57%) reported skin or mucosal damage and 25 (89%) sustained penetrative anal intercourse. The threat of transmission of HIV was used by the assailant in 16 cases and sexually transmitted diseases, presumed consequent upon the attack, were found in 5 (18%). These observations suggest that male victims of sexual assault may be at particular risk of sexually transmitted infections, including HIV, and that efforts should be made to encourage them to come forward for help.
Int J STD AIDS
PMID:Adult male victims of sexual assault: an underdiagnosed condition. 203 59

One-hundred-and-fifty male patients who attended the department of genitourinary medicine (GUM) completed a questionnaire which enquired into a past history of sexual assault and asked certain details about the assault and various sequelae of such an experience. Twenty-one men gave a history of sexual assault, 11 of whom had been abused before the age of 16, 7 afterwards and 3 in both age groups. Victims of such an assault were more likely to be homosexual or bisexual than heterosexual. The substantial majority i.e. 104 (81%) of the 129 patients who had not been assaulted in the past had been brought up by both natural parents. However, of the 21 males who reported a history of previous sexual abuse only 11 (52%) had been raised by both natural parents alone and 9 of the remaining 10 who divulged such information had been brought up in other circumstances. The association between not being raised entirely by both natural parents and a history of previous sexual assault was significant (P < 0.01). Overall, physical contact of a sexual nature was the most commonly reported type of abuse, followed by anal and then by oral penetration. All of the perpetrators of assault were male except in one instance. Only 3 cases of assault were reported to the police or other agencies. Those who had been abused as minors were more likely to acknowledge subsequent psychological difficulties and to have obtained professional counselling. This problem is a significant one which goes largely undetected in GUM departments and elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)
Int J STD AIDS
PMID:Prior sexual assault reported by male attenders at a department of genitourinary medicine. 777 38

Multiple obstacles can hinder the medical evaluation of suspected child sexual abuse in pediatric primary care. The need for diagnostic accuracy is high. Knowledge of sexual abuse risk factors, an understanding of the victimization process, and awareness of the varied clinical presentations of sexual abuse can be of assistance. Open-ended questioning of the suspected victim is the most critical component of the evaluation. Skillful medical interviewing requires time, training, patience, and practice. Pediatricians lacking any of these four requirements should defer interviewing in sexual abuse cases to other professionals. Abnormal physical findings from sexual abuse are uncommon. Colposcopy has assisted pediatricians greatly in reaching consensus regarding diagnostic physical findings. Cases of acute sexual assault require familiarity with the forensic rape examination, STD screening and prophylaxis, and pregnancy prevention. Victimization from sexual abuse continues long after the abusive acts end, often requiring long-term therapeutic intervention. An emerging standard of care for medical evaluations of suspected child sexual abuse recognizes the requirement for patience and compassion while retaining objectivity. The pediatrician's primary concern must be for the child's physical and emotional well-being.
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PMID:Child sexual abuse. 871 Jul 23

One hundred and fifty women who attended the routine genitourinary medicine (GUM) clinic at the Leicester Royal Infirmary (LRI) between August 1993 and February 1994 completed a questionnaire enquiring into a past history of sexual assault. Of these, 52 (34.7%) confirmed that they had been assaulted previously, 18 below the age of 16, 22 after this age and 12 in both age groups. Non penetrative abuse was most common in those violated as minors and vaginal penetration in women assaulted over the age of 16. The strongest demographic indicator for sexual abuse among this study group was that of a current divorced/separated marital status. Assailants of minors were most likely to be someone known to the family whereas male intimates accounted for a third of assaults on older women. Sexual dysfunction was acknowledged by approximately half of those previously assaulted as a sequelae of abuse. It is important that GUM physicians remain alert for sequelae of sexual abuse and offer services appropriate to the victim's needs.
Int J STD AIDS
PMID:The prevalence of previous sexual assault among routine female attenders at a department of genitourinary medicine. 911 63

Experiments were performed to evaluate the efficiency of PCR-STR (Short Tandem Repeats) and PCR-sequence polymorphisms for the identification of stained pap smears and postcoital slides stained with cytological and forensic techniques. HLA-DQA1, PolyMarker, Amelogenin, HUMTH01, HUMVWFA31, HUMF13B, and HUMFES/FPS were determined. With the exception of the forensic Baecchi stain, all the PCR-systems gave consistent results in comparison with the reference blood from the donors. Cytological stained smears can be important evidence for identification in sexual assault cases and in missing person cases.
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PMID:PCR-based forensic testing of DNA from stained cytological smears. 914 41

Our objective was to determine the prevalence of sexual dysfunction among new heterosexual attendees at a central London genitourinary medicine (GUM) clinic. We carried out a cross-sectional study in which patients completed a self-administered questionnaire-the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and participated in a brief interview during which additional information was sought regarding the patient's sexual history. An overall transformed score of >5 on the GRISS was defined as indicative of overall sexual dysfunction and a score of >5 on any of the subscales as indicative of a specific sexual dysfunction. Twenty-five (24%) men and 10 (9%) women had a GRISS score in keeping with overall sexual dysfunction, the prevalence being significantly lower in women (P=0.01, chi2=6.56, 1df). Sixty-three men (59%) and 63 (60%) women produced scores indicative of significant abnormality on at least one subscale, including, in men: erectile dysfunction 20 (19%), premature ejaculation 23 (22%), and in women: vaginismus 26 (25%) and anorgasmia 23 (22%). Neither an abnormal overall or subscale score on the GRISS was associated with a current STD on KC60 diagnosis or a history of sexual assault for either men or women. There is a substantial prevalence of sexual dysfunction in new heterosexual attendees at our clinic, the service implications of which need to be addressed.
Int J STD AIDS 1997 May
PMID:Prevalence of sexual dysfunction in heterosexual patients attending a central London genitourinary medicine clinic. 917 51


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