Sexual assault is any type of sexual activity or contact that a person does not consent to. Sexual assault, including rape, may cause physical injury or illness or psychological trauma. Survivors should be evaluated for injury, sexually transmitted infections, pregnancy, and acute or posttraumatic stress disorders; they are asked to give permission for an examination to collect evidence. Treatment includes infection prophylaxis and mental health care.
Sexual assault victims may have tears in their genitals or anus, cuts and bruises, upsetting emotions, and difficulty sleeping.
Sexually transmitted infections, infection with the HIV (human immunodeficiency virus), and pregnancy are risks.
People who are raped should be thoroughly evaluated in a center staffed by specially trained people (rape center).
Treatment of physical injuries, vaccinations and antibiotics to prevent or treat infections, emergency contraception, and counseling or psychotherapy are often needed.
If possible, family members and close friends should meet with a member of the rape crisis team to discuss how to support the rape victim.
Rape is typically considered to be any penetration of the vagina or anus with any body part or object or penetration of the mouth with another person's sex organ when the person does not or cannot consent to it (called nonconsensual sexual contact). Consent cannot be given by a person who is incapacitated (because they are intoxicated or have mental or physical limitations). In people younger than the age of consent, penetration of the vagina, anus, or mouth—whether wanted or not—is considered rape (statutory rape).
Typically, rape is an expression of aggression, anger, or the need for power and control rather than being sexually motivated. Many people who are raped are also physically beaten and/or injured.
Sexual assault is a broader term. It is defined as any type of sexual activity or contact that a person does not consent to. Sexual assault may include the use of force and threats to coerce any sexual contact. The victim is a person who does not consent or who cannot consent because they are incapacitated.
Victims of rape and sexual assault include people of all genders. However, women and girls have the highest rates of being raped and sexually assaulted. In the United States, the estimated lifetime incidence for rape is 19.3% of women and 1.7% of men. Reported percentages are probably lower than the actual percentages.
Symptoms and Effects of Rape and Sexual Assault
Symptoms and complications of rape and sexual assault can include
Physical injuries
Psychological trauma
Pregnancy
Physical injuries resulting from a rape may include injuries of the anus or genitals (such as tears in the upper part of the vagina), and injuries to other parts of the body (such as bruises, black eyes, cuts, and scratches). Rape can also have long-term effects on physical health.
The psychological effects of a sexual assault or rape are often more devastating than the physical.
Immediate effects
Immediately after a sexual assault, the victim's behavior can range from talkativeness, tenseness, crying, and trembling to shock and disbelief to lack of emotion and stillness. Lack of emotion rarely indicates lack of concern. Rather it is probably a way to avoid thinking about what has happened or to keep emotions under control. Or the victim may show little or no emotion because of physical exhaustion or emotional numbness.
Sexual assault victims typically also feel fearful, anxious, and irritable. They may feel angry, depressed, embarrassed, ashamed, or guilty (wondering whether they may have done something to provoke the rape or could have done something to avoid it). Their anger may be directed at themselves or misdirected at hospital staff or family members.
Difficulty sleeping and nightmares are common.
Victims may develop symptoms of stress (called acute stress disorder). Acute stress disorder may be diagnosed when symptoms are present for 3 days to 1 month after the rape. Victims may be unable to remember important parts of the event. This type of memory loss (called dissociative amnesia) is a symptom of acute stress disorder or posttraumatic stress disorder.
Posttraumatic stress disorder
For most victims, symptoms lessen substantially over a period of months.
Some victims develop posttraumatic stress disorder (PTSD). It is diagnosed when symptoms of PTSD do the following:
Continue for more than a month
Significantly interfere with a victim's social activities and work
Are not caused by another medical problem or substance use
Symptoms of PTSD include
Re-experiencing the trauma (for example, as flashbacks or intrusive and upsetting thoughts or images)
Avoiding situations, thoughts, and feelings related to the trauma
Having problems with thinking and mood (such as feeling responsible for the assault or not being able to have any positive feelings)
Being unable to remember significant parts of the event
Being excessively alert for signs of danger and being easily startled
Feeling extremely tense, agitated, or irritable and unable to relax
Having problems concentrating and sleeping
Many victims who develop PTSD also develop depression and/or other mental health disorders, such as a substance use disorder.
Risk of infection or pregnancy
After a rape, there is a risk of infections, such as sexually transmitted infections (such as gonorrhea, trichomoniasis, chlamydia, human papillomavirus infection, and syphilis), hepatitis B, hepatitis C, and bacterial vaginosis. Infection with the human immunodeficiency virus (HIV) is a particular concern, but the chances of acquiring it in a single encounter are low.
A woman may also become pregnant after being raped.
Evaluation of Rape and Sexual Assault
A physical examination, including a pelvic examination
If the victim consents, tests to collect evidence and check for sexually transmitted infections
A pregnancy test
If people have been a victim of rape, having a thorough medical evaluation is important. Whenever possible, people who have been raped or sexually assaulted are taken to a sexual assault center that is staffed by trained, concerned support personnel, such as sexual assault nurse examiners (SANE). The center may be a hospital emergency department or a separate facility. Some areas have a sexual assault response team (SART), which includes people who work in health care, forensics, the local rape crisis center, law enforcement, and the prosecutor's office.
The sexual assault care team explains the procedures (physical examination and other tests) for collecting evidence that could allow eventual prosecution, and the victim decides whether to consent. Advantages and disadvantages of proceeding with such actions are explained. The victim should feel no pressure to consent.
If the victim chooses to proceed, health care professionals are required by law to notify the police and to examine the victim. The examination can provide evidence for prosecution of the rapist. The best evidence is obtained when the rape victim goes to the hospital as soon as possible, without showering or washing, without brushing the teeth, without clipping nails, without changing clothes, and, if possible, without even urinating. The medical record resulting from this examination is sometimes used as evidence in court proceedings. However, the medical record cannot be released unless the victim gives consent in writing or a subpoena is issued. The record may also help the victim recall details of the rape if the victim's testimony is required later.
Immediately after a rape, the victim may be hesitant or afraid of undergoing a physical examination. The medical team does everything possible to make the person feel comfortable and safe.
Before each step of the examination, the health care professional explains what will be done and asks the victim for permission to proceed. The victim should feel free to ask any questions about the examination and its purpose. The victim should also feel free to refuse any part of the examination.
The health care professional usually asks the victim to describe the events to help guide the examination and treatment. However, talking about the rape is often frightening and distressing. The victim may request to give a complete description later, after immediate needs have been met. The victim may first need to be treated for injuries and to have some time for calming down.
When the victim is able, the doctor asks the victim questions about the rape such as the following:
Which body parts were involved (vagina, mouth, and/or rectum)?
Did ejaculation (discharge of semen) occur?
Was a condom used?
Did the perpetrator threaten, use a weapon, or behave violently?
What did the perpetrator look like?
To help determine the likelihood of pregnancy, the doctor asks the woman when her last menstrual period was and whether she uses a contraceptive. To help interpret the analysis of any sperm samples, the doctor asks if the victim recently had sex before the rape and, if so, when.
The doctor notes physical injuries, such as cuts and scrapes, and may examine the genitals and anus for injuries. Photographs of injuries are taken. Because some injuries such as bruises become apparent later, a second set of photographs may be taken later. Colposcopy may be done to check for subtle genital injuries. For colposcopy, the vagina and cervix and/or anus are examined using a magnifying instrument.
Testing and evidence collection
A swab is used to take samples of semen and other body fluids for evidence. Other samples, such as samples of the perpetrator’s hair, blood, or skin (sometimes found under the victim's nails), are collected. Sometimes DNA testing of the samples is done to identify the perpetrator. Some of the victim’s clothing may be kept for evidence.
If the victim consents, blood and urine tests are done to check for infections, including HIV infection.
If the initial test results for pregnancy and sexually transmitted infections are negative or if the victim refused treatment for sexually transmitted infections, the victim is tested again:
At 1 week: Gonorrhea, chlamydia, and trichomoniasis
At 2 weeks: Pregnancy
At 4 to 6 weeks: Syphilis and HIV infection
At 3 months: Syphilis, hepatitis, and HIV infection
In women, a Papanicalaou (Pap) test is done to check for human papillomavirus (HPV) infection after 6 weeks.
Usually, a pregnancy test to measure the level of human chorionic gonadotropin in the urine is done during the initial examination of women who have been raped to detect any preexisting pregnancy. If the results are negative, the test is repeated within 2 weeks to check for pregnancy that may have resulted from the rape.
If the victim cannot remember events around the time of rape, doctors may check for evidence that a date rape drug such as flunitrazepam, which is a benzodiazepine, or gamma hydroxybutyrate,, an illicit recreational drug, was used by the rapist. Testing for illicit drugs and alcohol is controversial because evidence of intoxication may be used to discredit the victim.
If tears in the vagina are severe, especially in children, laparoscopy may be done. For laparoscopy, a flexible viewing tube is inserted into the vagina or other organs so that they can be directly examined.
Treatment of Rape and Sexual Assault
Treatment of any physical injuries
Medications and sometimes vaccines to prevent infections, including HIV infection
Emergency contraception if the woman wants it
Psychological support or intervention
After the examination, the victim is offered facilities to wash, change clothing, use mouthwash, and urinate and defecate if needed.
Any physical injuries are treated. Tears in the genitals or anus may need to be surgically repaired.
Posttraumatic stress disorder can be effectively treated with psychotherapy and medication.
Providing psychological support
Health care professionals explain the psychological reactions that commonly occur after a sexual assault (such as excessive anxiety or fear or guilt) to the victim. This information can help victims accept and deal with their reactions. Clinicians also reassure the victims that the assault was not their fault and provide general support.
As soon as feasible, a person trained in rape crisis intervention meets with the victim. Victims are referred to a rape crisis team if one is located in the area. This team can provide helpful medical, psychological, and legal support. For victims, talking about the rape and their feelings about it can help them recover.
If victims continue to have symptoms after the rape, they may be referred to a psychologist, social worker, or psychiatrist.
Family members and friends may have some of the same feelings as the victim: anxiety, anger, or guilt. They may irrationally blame the victim. Thus, in addition to their own feelings, rape victims may have to handle negative, sometimes judgmental or other negative reactions of family members and friends, as well as those of officials. These reactions can interfere with recovery. Family members or close friends may benefit from meeting with a member of the rape crisis team or sexual assault evaluation unit to discuss their feelings and how they can help the victim. Usually, listening supportively to the victim and not expressing strong feelings about the assault are most helpful. Blaming or criticizing the victim may interfere with recovery.
A support network of health care professionals, friends, and family members can be very helpful to the victim.
Preventing or treating infections
Sexually transmitted infections are treated with antibiotics.
Victims who have not been vaccinated against hepatitis B are given the hepatitis B vaccine, followed by two more doses, at 1 month and 6 months after the first dose.
The HPV vaccine is given after a rape to people aged 9 to 26 years if they are unvaccinated or incompletely vaccinated.
If test results for HIV are positive, the victim probably had HIV infection before the rape because HIV infection acquired through sexual intercourse typically cannot be detected until 9 days to 6 months later. If test results for HIV are positive, treatment for HIV is started immediately.
If test results for HIV are negative, the HIV test is repeated several times over the next several months.
Medications to prevent HIV infection may be offered to the victim. On average, the chance of developing HIV infection after rape from an unknown assailant is low. Risk may be higher if any of the following occurred:
Anal penetration
Bleeding (from the assailant or victim)
Male-male rape
Rape by several assailants (as may happen to men in prison)
Rape that occurs in areas where HIV infection is unusually common
Treatment to prevent HIV infection is most effective if started within 4 hours after penetration and should not be given if more than 72 hours have passed since penetration.
Preventing pregnancy
Emergency contraception is provided if the woman wants it and has a negative pregnancy test. Usually, it consists of a high dose of a hormonal medication given immediately by mouth, then repeated 12 hours later.
Inserting an intrauterine device (IUD) within 5 days of the rape is also effective at preventing pregnancy.
If pregnancy results from the rape, doctors counsel women about their options, including continuing the pregnancy or terminating the pregnancy.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
U.S. Department of Veteran Affairs: National Center for posttraumatic stress disorder (PTSD): This web site provides links to general information about PTSD, types of trauma, and problems that can result from PTSD, such as chronic pain, depression, and difficulty sleeping.
RAINN (Rape, Abuse & Incest National Network): RAINN provides resources and crisis support services through their website and the National Sexual Assault Telephone Hotline at (800) 656-HOPE (4673)
National Sexual Violence Resource Center (NSVRC): NSVRC provides research and tools to advocates working to end sexual harassment, assault, and abuse.
