Medical Complications of RAPE

Acquaintance rape refers to those sexual assaults committed by someone known to the victim (a date, teacher or family member).

Incest refers to sexual intercourse among family members, including step-relatives and parental figures living in the home.

Date rape is a subset of acquaintance rape and refers to forced or unwanted sexual activity that occurs within a dating relationship.

Statutory rape refers to sexual intercourse with a female under a specified age. In the Philippines, this age is under 18 since they have not reached the legal age of consent.

Child sexual abuse is contact or interaction between a child and an adult when the child is being used for the sexual stimulation of that adult or another person.

The legal aspect of rape is best left to a lawyer for discussion. This article will deal with medical complications of rape. Rape is a violent crime. As such, many of its medical sequelae result from the degree of violence. The following are just some of the common conditions. I have grouped them into physical and emotional complications.

PHYSICAL COMPLICATIONS:

A. LACERATIONS

This is also called gashes, tears or cuts. This occurs when the force or trauma causes a break or cut in the skin surface. If the full thickness of the skin is broken, there will be excessive bleeding. In this case, suturing or the application stitches is necessary to control the bleeding, prevent infection from affecting the wound and to make the resulting scar better looking. As a first aid, clean the area well with soap and water, elevate the affected area if this is possible, or apply pressure to minimize bleeding. Go to the nearest medical facility to get the proper care and management.

Lacerations can occur in all parts of the body. However, since rape involves the sexual organs, there is special emphasis in this area. Lacerations in the female external sexual organ (vagina) will bleed profusely since that area is well-supplied by blood vessels. Lacerations can be external or internal. External lacerations are easier to diagnose and manage since they can be seen from the outside. In cases of internal lacerations, it may be necessary to use instruments such as a vaginal speculum so that the doctor can peer inside the vaginal vault to see where the bleeding is coming from.

If the laceration is shallow or does not involve the full thickness, you do not need to have suturing of that wound. This type will have minimal bleeding, minimal pain and no numbness or tingling at the site. However, it is important to clean the wound well with soap and water. You may or may not apply sterile gauze or medicated plaster strips.

B. BRUISES

A bruise develops when a blow leads to breakage of small blood vessels near the surface of the skin leading to blood clotting under the skin surface. Since there is very minimal tear or even no open wound for the blood to flow out of your skin, a blood clot is formed and is visible as a black and blue mark or tiny red dots. To minimize the extent of the bleeding and alleviate pain, an ice pack is applied for a few minutes several times in 1 to 2 days. After this, a warm compress is placed over the mark to enhance the absorption of the blood by the surrounding tissues. A bruise can be also called a hematoma. When it forms around the eye, it is popularly called a „black eye‰.

C. INFECTIONS

Infection can occur from the wounds inflicted on the victim. This is suspected when there is swelling, redness, warmth and pain in the affected area. Urinary tract infection or UTI is common among sexually active females so it is not a far fetched idea that the victim may develop this after the incident. Antibiotics will control the infection but it is important for you to seek medical opinion first so the correct antibiotic can be given.

Of special interest is sexually-transmitted disease or infection (STD or STI). Many sexual offenders are repeat offenders and as such, there is s high probability that this person has STD. This is suspected if the victim develops foul-smelling vaginal discharge, lower abdominal or vaginal pain, burning sensation and/or fever. Diagnosis is done by physical examination of the character of the discharge and either a gram-stain or culture of this. The antibiotic to be given depends on the type of infectious organism.

HIV infection or AIDS is a possibility so the victim must be screened for this also. Since this disease does not present early symptoms, repeated HIV tests should be done for a period of time, until the doctor is satisfied with the results. A (+) test will require immediate treatment.

D. PREGNANCY

A most unwanted sequelae of rape is pregnancy. It is bad enough that the woman suffered a heinous crime but worse is that she bears the product of this sexual act. Philippine law does not allow abortion or termination of pregnancy even if the pregnancy is unwanted and is a result of rape. The moral and legal issues regarding this need a lengthy discussion and are not within the scope of this article. Be that as it may, the woman will be treated by an obstetrician as she would any other pregnant woman but co-management with a psychiatrist is encouraged.

EMOTIONAL COMPLICATIONS:

This is a more difficult complication to treat. There is a wide range of emotions that a victim undergoes. Many times, there will be denial to hide the shame a victim feels by being violated. At times, even the family members would themselves hide the incident and encourage the victim to do the same. In this case, the victim is left alone to deal with the emotional trauma. At this time, emotional support and understanding is very important. A psychiatrist will be the best doctor to treat the patient. Psychotherapy may be all that is needed but in cases when there is severe depression, suicidal tendencies or other acts where the victim can be a danger to herself or society, it may be necessary to put her under medication.

Many victims of childhood sexual molestation may never be known until such time when they get a nervous breakdown in adulthood. Children who are victims of sexual molestation may be too afraid to talk since majority of the offenders are people they know or who exert authority over them. When a child suddenly withdraws from playmates and other people, have nightmares or crying spells, suffer bad grades and generally change their behavior, it may be necessary to bring her to a child psychiatrist to investigate the possibility of sexual molestation.

THE ROLE OF A DOCTOR

Oftentimes, a doctor is only consulted for the victim to have a medico-legal report. In the Philippines, the best places to go for this are the Medico-legal Department of the National Bureau of Investigation along Taft Avenue in Manila and the Philippine National Police at Camp Crame in Quezon City. You can also go to government hospitals. Private hospitals will usually not accept medico-legal cases but they will surely treat any medical emergency if necessary. A doctor then is not only a person who does the medical report but is the one who will treat the injury a rape victim has, within the scope of his/her specialty. But the first step is in the hands of the victim herself or those people around her, whether family, friends or relatives.