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Introduction to genital tract trauma and rape

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Sexual violence is a worldwide problem. The World Health Organization state (2002) the lifetime risk of sexual violence is up to 20% for women. The UK have quoted figures of 10% for women and 3% for men.

While most cases of sexual assault are not reported, there has been a doubling in reported sexual offences towards women in the last 15 years from 30,000 in 1995 to 60,000 in 2005, dropping back to 50,000 in 2009. A trebling has occurred since 1985. Over the same time conviction rates have fallen from 33% in 1978 to approximately 6% in 2006. This partly reflects poor facilities for responding to complaints, a shortage of experienced examiners and poor collection of forensic evidence.

Many acute cases present to Health Services, in particular A&E Departments, and apart from a small though increasing number of locations served by a Sexual Assault Reference Centre (SARC), there is all too often a lack of cooperative working within local services, lack of equipment and a lack of formal medical follow-up arrangements. So it is therefore important to know the policies and arrangements within your own area. All casualty departments should have a policy for the management of rapes, though this is not always read by the Casualty Officer’s faced with a case in the middle of the night.

While resuscitation and immediate clinical management is the prime concern of the gynaecologist, failure to collect adequate forensic specimens may deprive the patient of closure of the episode as a result of an unsuccessful prosecution of the perpetrator.

Sexual assault is a highly emotive subject. Forensically it is often possible to demonstrate that intercourse has taken place but more difficult to demonstrate if consent was validly given. This is not an area for the gynaecologist though they must get consent before performing an examination. It also has to be remembered that not all accusations of rape are true.

Learning objectives

When you have completed this tutorial you will:

  • have a working knowledge of the law relating to sexual offences and the current size of the problem
  • understand appropriate management when someone reports that they have suffered a sexual assault, i.e. the role of the doctor
  • know the principles of forensic examination
  • describe injury types using appropriate forensic terminology
  • have knowledge of the long-term health consequences arising from sexual assault
  • know how to write a statement

Last updated: 17/06/10 (tutorial reviewed and updated by Mr John Eddy)

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