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As the rape rate increases, hospitals increasingly are being called upon to treat rape victims/Proper evidence collection and sympathetic care can help law enforcement officials as well as victims.
Rape is a rapidly spreading form of violence. The physician must examine and treat the victim and establish an adequate record for legal purposes. Treatment of the victim includes follow-up for late-emerging ego disruption and is greatly aided by employing the assistance of organized agencies such as a hospital-based Social Service or a Rape Crisis Center. It is also important that the victim receive adequate protection against venereal disease and pregnancy.
If a rape crisis center and specialized personnel are not available, the family physician can adequately examine and treat the rape victim as well as collect and properly handle all the required medical evidence. The detailed history has several facets. Laboratory confirmation can be obtained for prior consensual intercourse, sodomy and other special aspects. Treatment is indicated for the prevention of venereal disease and pregnancy. Psychologic support is essential. The physician's examination and testimony can play an important legal role.
The case records of 117 women examined at University Hospital for the complaint of alleged rape have been reviewed. The usual victim was white, single, under the age of 25 years, and attacked by a single assailant. Fifteen patients sustained serious physical injury, and 60 received minor injuries. Six children required hospitalization for reparative surgery. One patient required hospitalization for 9 days secondary to severe emotional stress. The number of attacks was lowest in the daytime and highest from midnight to 6:00 AM. Cultures from the endocervix were positive for gonorrhea in 12% of rape victims. Unfortunately, it would appear from public records that there is little hope of the attackers being convicted.
Acanthocephalan males have cement glands associated with the vas deferens, secretions from which seal the female vagina with a cap after copulation and so prevent subsequent insemination. Homosexual rape results in the male victim having the genital region sealed off with cement and effectively removed from the reproductive population. Sperm and cement are transferred to females during copulation, but apparently only cement is transferred to males during homosexual rape. Acanthocephalans conform to a parental investment model, and we interpret the evolution of the cement gland and sexual behavior as the result of sexual selection.
In a 4X3 design (religious orientation vs. marital status of victim), 167 Ss were given a case account of a rape. Intrinsically religious Ss devalued the victim less than did Ss who were extrinsically oriented, indiscriminately proreligious and indiscriminately nonreligious. No significant effect was noted for the marital status of the victim, nor was there a significant interaction between these two variables.
Generally acid phosphatase (ACP) assay is used for testing cases of alleged rape. Comparison of three different chemical methods for Acid Phosphatase (Andersch's method with p-nitrophenyl-phosphate substrate and tartrate inhibitor (A-Tart), Roy's method with thymolphthalein phosphate substrate (R-TMP), and Babson's method with alphanaphthyl phosphate substrate) indicated that Roy's method (R-TMP) should be the preferred one. This method had both acceptable sensitivity and confirmed specificity. Our data confirmed that the vaginal wash of normal healthy women has a very low level of ACP activity. Because of inconclusive data in the literature regarding this ACP level, a normal and equivocal range of ACP was suggested until more is known about causes and interferences. Possible sources of normal ACP activity in the wash fluids were also indicated.
The crime of rape requires medical evaluation and therapy concomitant with the collection of legal evidence for potential prosecution. A practical, inexpensive evidence kit has been disigned that meets the needs of the local health department, police department, hospital emergency centers, and district attorney personnel. Costs of assembly and specimen analysis are assumed by the police department. Chain of custody is assured through tamper-proof bags, appropriate reporting forms and police involvement in specimen pick-up. Victims participate in chain of custody by sharing in collection and authorization. The requirement for physician appearance in court is thus lessened. Standardization of examination and reporting prompts all community hospitals to share in examinations, preventing over loading of a single, busy facility. Six months' experience had borne out the anticipated simplification of collection, standardization of reporting, and reduction of physician involvement in legal procedures.
Of 500 patients seen because of rape, semen was identified in vaginal secretions by the identification of spermatozoa in 61%, by an acid phosphatase value of 50 units or more in 40%, and by the identification of a foreign blood group substance or a high titer of own blood group substance in 16%. The addition of the determination of the acid phosphatase to the search for spermatozoa identified semen in only 1.4% more patients, or a total of 62.4%. Identification and titers of blood group substance were confirmatory only, but further characterized the source of the semen in 25% of those patients with spermatozoa. Spermatozoa were identified for as long as 48 hours, and elevated acid phosphatase was not found after 18 hours. Acid phosphatase was elevated in only 62% of patients with spermatozoa.
All physicians should know the basics of care for the alleged rape victim. In a systematized approach, the procedure is presented for treating the patient and for collecting testimonial evidence in the event the assailant is apprehended and the crime becomes a legal case.
As the crisis of women who have been raped is more frequently brought to the attention of mental health workers, male counselors are increasingly being confronted with responsibility for aiding female victims. This paper considers the difficulties inherent in men fulfilling this therapeutic task, and discusses male misconceptions and responses that may undermine the efforts of well-meaning counselors.
The involvement of mates and family members in counseling interventions designed to help victims of rape in their post-traumatic reconstitutive efforts is critical. Suggestions are offered for assisting those close to the woman in their attempts to explore and articulate feelings and concerns about the crisis.
Problems of measurement of the incidence of rape are considered, and empirical findings are summarized regarding prevalence, demographic and psychiatric characteristics of offenders, spatial and temporal distribution of offenses, victim-offender relationships, and evidence about recidivism and progression of crimes. Findings are discussed in the framework of blame models and their implications for treatment and prevention.
Quantitative and interview data on rape victims' self-evaluation and attributions of personal responsibility were studied to explore the relevance of theories of "defensive attribution" and maintenance of belief in a "just world." Clinical implications of the findings for adjustment of victims, counseling, victim compensation, and the legal system are discussed.
Either victim or rapist or both were drinking prior to 72% of the rapes occurring in Winnipeg from 1966 through 1975, and the presence of alcohol increased the likelihood that the victim would be injured prior to sexual intercourse.
Forcible rape is a violent crime, as are all cases of sexual assault. In more than one-third of the cases, the victims are children, and a significant number of victims are elderly women. Although few of these victims have serious physical injuries, they all suffer psychological trauma that will affect their lives and the lives of those around them. All of these victims need medical care and psychologic counseling if they are to adjust and reenter society without difficulty.
A prospective series of 110 alleged rape victims from July through November 1974 at Denver General Hospital is presented. The victims and assailants are characterized. The laboratory established proof of recent coitus in 68%. Four-fifths of the victims presented within 12 hours of the alleged incident. The analysis of ABO vaginal antigens appears to be promising for assailant identification. Follow-up by appointment in this group was successful in only 5%. Only a minority of cases led to arrest and criminal proceedings. Suggestions are made for alternative approaches to victims based on new developments in forensic laboratory procedures.
A woman's response to rape can be divided into three phases: an acute reaction, an intermediate stage and a period of resolution. Proper management of the physical and emotional problems of each phase, ideally by the woman's family doctor or gynecologist, may prevent future problems. Treatment during the first phase includes responding to the emotional needs of the patient as well as doing a pelvic and general physical examination to detect any injuries; information for possible legal procedures may be obtained quickly and efficiently. Follow-up particularly psychological, is important in the second and third phases.