Rationale:

• Most sexual assault patients do not report the assault, although they may seek medical treatment for related complaints such as rectal or genital pain, treatment of STDs, or postcoital contraception.
• Patients who have been given “date rape drugs” (i.e., sedatives such as flunitrazepam and γ hydroxy butyrate [GHB]) may report a history of loss of consciousness or being unable to account for a certain time interval and possibly waking up without clothes on or with clothes misapplied.
• A past history of sexual assault has been associated with an increase in number and intensity of health complaints and a decrease in many measures of mental health status.
• Many patients who suffer from intimate partner violence also experience sexual assault by the same partner, usually multiple times, with subsequent increase in the prevalence of depression and poor health outcomes.
• Most patients do not object to questioning by physicians about previous sexual assault.

Evidence:

• Cross-sectional telephone survey data from 3006 participants in the National Women's Study found that only one in four adult female sexual assault patients received medical care after the crime (6).
• A convenience sample survey of 89 women found that sexual assault victims displayed more health complaints and more frequently reported these complaints to health professionals than subjects who lacked a sexual assault history (7).
• A cross-sectional telephone survey of community women reported that those who experienced prior sexual assault and abuse were 10-fold more likely to report pelvic pain than those who lacked such a history (8).
• A cross-sectional Scandinavian study of 3539 gynecological clinic patients, chronic pelvic pain, psychosomatic symptoms, self-estimated poor health, and increased health care utilization were more prevalent in those who suffered a prior sexual assault (9).
• A two- to five-fold increase in levels of pelvic examination pain and distress was associated with prior sexual violence in a cross-sectional study of 67 female veterans (10).
• Experiencing forced sex as an adult was associated with an almost four-fold increase in the prevalence of somatic symptoms in a Norwegian cross-sectional population-based survey of 2730 women aged 18 to 40 (11).
• In an emergency department's verbal survey of 360 female patients, women who reported assault by a partner were significantly less likely to report the sexual abuse to police or seek medical care (12).
• In a random sample of 2876 participants in a large northwestern U.S. HMO, women who suffered sexual violence by an intimate partner are three times as likely to suffer from depression, with a strikingly high prevalence (39%) of depression (13).
• One review of the topic suggests that women who have experienced unusual lapses of consciousness may have been intentionally drugged and sexually assaulted and that practitioners need to be aware of these phenomena (14).
• A study of 148 intimate partner violence victims seeking protective orders found that 68% of them had experienced sexual assault by that partner, with 79% of those experiencing repeated sexual assault (15).
• One small, randomized, controlled trial of 66 female sexual assault patients showed efficacy of active psychoeducation and skills training in preventing subsequent sexual revictimization (16).
• Most (approximately 80%) of 1207 female patients over age 15 years responding to a convenience sample self-administered survey in 13 general practices in Hackney, East London, did not object to questioning by physicians about previous sexual assault (17).

Comments:

• None.