Medical brain notes 42

  SEXUAL ASSAULT Sexual assault is defined legally as involving any genital, oral, or anal penetration by a part of the accused’s body or by an object, using force or without consent.  Criminal sexual assault, orrape, often is further characterized to include acquaintance rape, date rape, “statutory rape,” child sexual abuse, and in-cest. These terms generally relate to the age of the victim and her relationship to the abuser.   Each year, some 365,000 women in the United States experience sexual assault, rape, or attempted rape. An es-timated 1 in 6 women have experienced sexual assault in their lifetimes. However, most do not file a complaint or report and, thus, its true prevalence is unknown. In the years between 1992 and 2000, 63% percent of completed rapes, 65% of attempted rapes, and 74% of completed and attempted sexual assaults against females were not re-ported to the police. Because of the complex problems caused by sexual assault, treatment is best managed by ...

  CHILD SEXUAL ASSAULT   Ninety percent (90%) of child victimization is by par-ents, family members, or family friends;  “stranger rape”   is relatively uncommon in children. It is extremely impor-tant to know who the perpetrator is and how the child sus-tained the injury, so that the child can be removed from an unsafe environment. Box 48.2 shows behavioral and physical signs and symptoms commonly associated with child sexual abuse.     Assessment/Examination   Because the assessment of a child for sexual abuse involves specific skills and has the potential for legal challenge, the  individual who undertakes this evaluation should have sig-nificant experience in this area.   This assessment usually is done by pediatricians and is beyond the skills of most general gynecologists. Awareness of and sensitivity to the issues, special needs, and circumstances of the child are important for obstetrician–gynecologists who are consulted to treat an i...

  DOMESTIC VIOLENCE   Domestic violence is reported by over 25% of women at some time during their lives and is a significant source of illness and injury to women.   Definition   Domestic violence  refers to violence perpetrated withinthe context of family or intimate relationships. Family members include parents, siblings, and other blood rela-tives, as well as legal relatives such as stepparents, in-laws, and guardians. Violence that occurs between current or for-mer partners is referred to as  intimate-partner violence  and includes male abuse by female partners and violence be-tween partners in lesbian, gay, bisexual, and transgendered relationships.   Domestic violence may involve one or more of three pre-sentations.  Physical abuse such as hitting, slapping, kick-ing, and choking, is the most obvious presentation. It is suspected with evidence of trauma, especially to the head and neck or trunk associated with a history of violence, or...