A typical Rape is an expression of aggression, anger or thirst for power. In the rape of females occurs in about 50% of cases not genital and genital lesions.
Although there are different forensic and medical definitions of rape is usually defined as oral, anal or vaginal penetration, which takes place under threats or violence on a person against her will. If the victim is not majority, in this kind of penetration, whether wanted or unwanted, spoken in the United States of Statutory rape (statutory rape). A sexual assault is a rape or any other associated with coercion sexual contact; this includes the seduction of a child by means of affection or bribes; it also includes touching, kissing or presentation of the genitals. Rape and sexual assault, including sexual assault on children, are common; it is estimated that the prevalence of both in the course of life between 2 and 30%, tend to be but at about 15-20% by weight. However, the actual prevalence may be higher because rape and sexual assault are often not displayed. A typical Rape is an expression of aggression, anger or thirst for power. In the rape of females occurs in about 50% of cases not genital and genital lesions. Women are often victims of rape and sexual assault than men. Men are often raped by other men, often this happens in prison. Raping men are at higher risk of injury than women and show the assault on rare; often multiple assailants are involved. Symptoms and signs A rape can cause the following symptoms: injury outside the genital injuries genital Mental symptoms Sexually transmitted diseases (STD, such as hepatitis, syphilis, gonorrhea, chlamydia, trichomoniasis, HIV infection [rare].) Pregnancy (rare) Although the physical injuries are usually relatively low, lacerations of the upper vagina can be severe. Other injuries may result from strokes, pressure, stab or gunshot wounds. The mental symptoms are of rape in the foreground. In the short term experience, most rape victims anxiety, nightmares, sleep disturbances, anger, embarrassment and / or shame. Immediately after an attack, the behavior of the persons concerned may comprise the entire spectrum of volubility, tension, weeping and trembling to shock and disbelief, accompanied by indifference, apparent calm and smile. Seldom the postures latter reflects a lack of concern; rather, they are an expression of avoidance response, from physical exhaustion or coping strategies that require control of emotions. Alternatively, the anger is often left out of hospital employees. After a sexual assault to friends, family members and officials often express judgmental, mockingly or otherwise negative. Such reactions may hinder recovery. Most sufferers recover in the course of time; However, v can. a. occur in women than long-term impact of rape post-traumatic stress disorder (post traumatic stress disorder, PTSD posttraumatic stress disorder (PTSD)). PTSD is an anxiety disorder, symptoms of which reliving (z. B. flashbacks, intrusive, disturbing thoughts or images), avoidance reactions (eg. As compared to situations, thoughts and feelings associated with the trauma) and hyperexcitability (z. B. . sleeping, irritability, poor concentration) belong. The symptoms last for> 1 month to affect the social and professional life significantly. Clarification objectives of investigation of rape are medical evaluation and treatment of injuries and assessment, treatment, and prevention of sexually transmitted diseases and pregnancy collection of forensic evidence Psychological evaluation Psychological Support If patient (inn) en seek advice before the medical examination, they will be informed about it that they do not dispose of their clothes or change, they do not wash or shower still make vaginal douches, are allowed to use mouthwash not brush your teeth yet, as this could destroy evidence. If possible, all rape victims are (often in hospital emergency rooms) referred to a rape center on site. Such centers have specially trained staff (in the US, for. Example, the so-called. “Sexual assault nurse examiners” [SANE]). The advantages of an investigation by rape are explained, but it is up to the victims to agree to the examination or reject it. If the patient (inn) s consent, the police will be informed. Most patients (inn) s are highly traumatized, and dealing with them requires tact, empathy and compassion. A female victim will possibly feel at a doctor feel better than with a doctor; any doctor who examines a female victim, must be accompanied by a staff member. Whenever possible, the patient (inn) en a private, peaceful environment should be allocated. To capture forensic evidence and medical reports, a form will (sometimes called a “rape kit” included.) Used (typical components of such a form, see Table: Typical single examination for suspected rape), which should be adapted to the local requirements. Since the medical report u. U. is used in court, the results must be legible and set out in for jurors possibly intelligible language. Typical single examination for suspected rape Category Specific Details General Information Particulars of the victim Minors name, address and telephone number of the parent or guardian name of the police officer, badge number and station name date, time and place of the inspection history (circumstances of the assault, incl. Date, time, place known to the victim?) information about / the attackers (number, name [if known], description) use of threats, fixations or weapon (N type of sexual contact vaginal, oral, rectal; Condom use?) Type of extra-genital lesions Whether bleeding occurred (the victim or attacker) Whether and where there has been an ejaculation of the attacker actions of the victim after the rape such. B. vaginal douching or bathing use a tampon or sanitary napkin urinating or defecating changing clothes eating or drinking application of toothpaste, mouthwash or drugs or drug last menstrual period date of the last voluntary sexual intercourse when Kontrazeptionsanamnese (recently eg. As oral contraceptives, intrauterine device ) Physical examination General (extragenital) injuries to the injury to the perineum, hymen, vulva, vagina, cervix and anus foreign material (body-z. B. stains, hair, soil, branches) examination with Wood’s lamp or colposcopy, if any evidenceCondition of the clothing (eg. B., damaged stained, foreign matter adhering) Small samples of clothing including a small piece of the Immaculate, for the police or the laboratory asserviert hair samples, including loose hair clinging to the victim or the clothing..; spermaverkrustete pubic hair and pubic hair cut the victim – at least 10 (for comparison) head u.. Pubic hair semen samples from the cervix, vagina, rectum, mouth, thighs drawn blood sample of the victim Dried blood samples of the attacker, body and clothing of the victim taken urine sample saliva buccal swab Cut and scraped fingernail samples Other samples, depending on the medical history or physical examination findings laboratory tests acid phosphatase, for detection of sperm * native preparation from the vagina in NaCl solution (for the detection of motile sperm) sperm analysis on sperm morphology and A-, B- or H-blood group antigens Ausgangsserologie syphilis in Opfer§ initial tests for sexually transmitted diseases when Opfer§ blood group determinations. (using blood of the victim and the attacker dried blood samples) urine tests, including Dr ogen screening || and pregnancy tests Other tests, depending on the medical history or physical examination findings treatment, referrals, clinical comments of the physician specifying witness the investigation signature whereabouts of the evidence name of the individual who has brought the evidence or taken delivery date and time of delivery and receipt * this test is particularly useful if the attacker had a vasectomy, a oligospermia has o who used a condom, which may be absent sperm. If the test can not be performed immediately, a sample should be frozen. This test should be carried out by the examining physician, if the time is still early enough to detect motile sperm. In 80% of cases in the semen blood group antigens are found. § This test is not recommended by all experts as evidence of pre-existing sexually transmitted diseases could be used to discredit the victim in court. || recommend numerous experts, comments or tests mar. refrain alcohol or drug consumption, because evidence of intoxication can be used to discredit the victim in court. History and examination prior to examination must / give the patient (in) their consent. Because playing the events the victims often fear or embarrassment prepares, the examiner peace, compassion and nonjudgmental understanding readiness must radiate and must not urge to hurry. Discretion should be ensured. The examiner elicited specific details, u. a. Nature of the present injury (especially the mouth, breasts, vagina and rectum) bleeding or abrasions on the victim or patient (estimated to reduce the risk of infection with HIV or hepatitis to help) Description of the attack (z. B. penetrated which orifices were whether ejaculation has occurred or a condom was used) aggression, threats, use of weapons and violence on the part of the attacker’s description of the attacker most or all of these questions are part of rape forms (s. Typical single examination for suspected rape). Of / patient / in should be informed why such questions are asked (eg help that information on the use of contraceptive measures, to assess the risk of pregnancy after rape;. Information about previous coitus help to determine the predictive value of sperm tests) , The conduct of the investigation should be explained step by step and the results with the / of those affected are discussed. If possible, you should take pictures of the injuries. The mouth, the breasts, genitals and rectum are carefully examined. Frequently injured sites are the labia minora and the rear vagina. Illumination with a Wood’s lamp has traces of sperm or foreign material on the skin. Colposcopy is a particularly sensitive method to detect subtle injuries to the genitals. Some colposcopios have a slip-camera that allows the detection and taking pictures of injuries in one operation. Whether the use of toluidine blue to mark injured areas is accepted as a method of detection depends on the jurisdiction ab.Tests and collecting evidence Routinely, a pregnancy test and serological tests for syphilis, hepatitis B and HIV are made. carried out within a few hours after a rape, these tests provide information about pregnancy or infections that were present before the rape, but not those that develop after the rape. Vaginal discharge is examined for trichomoniasis vaginitis and bacterial vaginosis; to test for gonorrhea and chlamydia samples from each penetrated body opening (vagina, mouth, rectum) are taken. If the / the patient / in terms of events has memory lapses during the period of rape, a drug screening for flunitrazepam (so-called. Date-rape drug or knockout drops) and gamma-hydroxybutyrate (GHB) should be considered. Tests for drugs and alcohol are controversial because evidence of intoxication can be used to discredit the victim in court. The following follow-up examinations are performed: After 6 weeks: gonorrhea, chlamydia, HPV infection (initially using a cervical smear from a Pap test), syphilis and hepatitis after 90 days: HIV infection after 6 months: syphilis, hepatitis and HIV However, infection tests controversial for sexually transmitted diseases, as evidence of pre-existing sexually transmitted diseases could be used to discredit the victim in court. If the vagina is penetrated and the pregnancy test in the first test was negative, the test is repeated within the next 2 weeks. In patients with lacerations of the upper vagina, v. a. in children, a laparoscopy may be necessary to recognize the extent of the injury. Evidence that could document the offense of rape is collected. Usually these include clothing, smears from the mucous membranes of the cheek, the vagina and rectum, hair samples that are combed out of the head and pubic hair, along with control samples (from the victim plucked), (cut and scraped) fingernail samples, blood and saliva samples and, when available, seed samples (s. Typical single examination for suspected rape). Numerous detection kits are commercially available, with some states recommend special kits. Often the evidence or missing is after showering, changing clothes or activities that relate to the point of penetration such. As vaginal douches, no longer meaningful. Over time (.. V a for> 36 hours) is reduced or disappears the significance of the evidence; depending on the competent jurisdiction evidence may be taken up to 7 days after a rape. To asservation the evidence a chain of measures must be observed, the evidence must be kept for a person to legitimate all the time. The samples are individually packaged, labeled, dated, sealed and stored until they are delivered against a receipt to a third party (usually police or laboratory personnel). In order to identify the attacker in some jurisdictions, samples for DNA analysis taken (including Germany). Psychological treatment assistance or intervention prophylaxis against sexually transmitted diseases and may possibly against hepatitis B or HIV infection emergency contraception After examining the victim gets an opportunity to wash and move to rinse the mouth and possibly go to the toilet. As part of the local crisis management rape crisis referrals to medical and psychological services can be issued and lawyers are taught. Most injuries are minor and can be treated conservatively. In lacerations vaginal surgical repair may be required. Psychological support is sometimes possible to the investigator, strong guilt or anxiety by “common sense” (z. B. reassurance, understanding, value judgment-free behavior) break down. Possible psychological and social effects are explained, and the victim is presented to a trained in rape crisis management specialists. Because the full extent of the psychological effects are not always on the first test can find further consultations are provided at two-week intervals. Serious psychological effects (eg. As recurrent flashbacks significant sleep disorders, anxiety with significant avoidance behavior), or those who are up to the subsequent examination dates have subsided, represent an indication for referral to a psychiatrist or psychologist. Family members and friends can provide important support offer, but they sometimes need help from professionals in the rape crisis management to cope with their own negative reactions. PTSD can be effectively treated (posttraumatic stress disorder (PTSD): Therapies) with psychosocial and pharmacological measures .Prävention infections Routine empirical prophylaxis against sexually transmitted diseases is the administration of ceftriaxone (125 mg in a single dose) (against gonorrhea, metronidazole 2 g po as a single dose) against trichomoniasis and bacterial vaginosis and either doxycycline (100 mg po 2 times / day for 7 days), or azithromycin (1 g po unique) against chlamydial infection. Alternatively, one can give azithromycin (2 g p.o.) covering both gonorrhea and chlamydia infection plus metronidazole (2 g p.o.), both as a single dose. The empirical prophylactic treatment of hepatitis B and HIV after rape is controversial. Regarding hepatitis B recommend the Centers for Disease Control (CDC) an appropriate vaccination if the victim does not already vaccinated and his immunity is documented. Vaccination is repeated after 1 and 6 months. Hepatitis B immunoglobulin (HBIG) is not administered. Regarding HIV most experts recommend to offer a prophylaxis; However, those affected should be informed that their risk of being raped by an unknown attacker is increased by only about 0.2%. The risk may be higher under the following conditions: Anal Penetration bleeding (the attacker or victim) rape of a man by a man rape by multiple attackers (. Eg male victims in prisons) rape in areas with a high prevalence of HIV infection the treatment is best