Rape is defined as sexual intercourse forced on a person without his or her permission.

According to most estimates, 80-90% of rapes are not reported to authorities. Current trends project that 1 in 3 American women will be sexually assaulted at some point during her life.

The typical rape victim is a 16-24 year-old woman. Anyone, however -- man or woman, adult or child -- can be the victim of rape. Most commonly, the assailant is a 25-44 year-old man who plans his attack. He usually chooses a woman of the same race. Nearly half the time, the victim knows the rapist at least casually, by working or living near him. Alcohol is involved in more than 1 out of 3 rapes.

Over 50% of rapes occur in the victim's home. The rapist breaks into the victim's home or gains access under false pretenses, such as asking to use the phone or posing as a repairman or salesman.

Rape is a violent act, and most commonly committed by a male upon a female. However, some cases of rape have been reported in which a woman has raped a man. Rape also may occur between members of the same sex. This is more prevalent in situations where access to the opposite sex is restricted (such as prisons, military settings, and single-sex schools).

Rape is an act of violence expressed through sex, but is not primarily about sex.

Those who face some form of discrimination are believed to be at higher risk of sexual assault. This increased vulnerability can assume various forms. For example, those with disabilities or limited language skills have a decreased ability to call for help; prostitutes or convicted prisoners have decreased credibility.

PREVENTION

The most useful prevention tool currently available is to make women more aware of the reality of rape. Law enforcement agencies strongly advocate prevention as the best form of protection. The following safety tips may help minimize the chance of being raped:

• Keep doors/windows secured with locks.
• If walking or jogging, stay out of secluded or isolated areas and arrange to do the activity with at least one other friend, rather than alone. It is best to engage in activities during daylight hours.
• Try to appear strong, confident, aware, and secure in your surroundings.
• Keep car doors locked while driving, check back of car for intruders prior to getting in, and park in open, well-lit areas.
• On public transportation, sit near the driver or up front if possible; avoid sitting near groups of young men obviously associated with one another.
• Consider taking a self-defense class, which can promote self-confidence and provide useful skills and strategies for different situations.
• Carry items that can call attention to you if needed (whistles, personal alarms, etc.)
• If an assault attempt is initiated, scream loudly and/or blow a whistle.
• Do not hitchhike. If your vehicle breaks down and someone offers to give you a ride, ask the person to call for help while you stay locked in your vehicle.

It is better to respond quickly and actively to an attack, according to numerous studies. People, especially women, who resist the attacker this way are more likely to avoid being raped, compared with those who exhibit either passive behavior or no resistance.

SYMPTOMS

Rape is a very traumatic event. The person who was raped may or may not be able to say that she was actually raped, or she may seek medical attention for a different complaint. Emotional reactions differ greatly and may include: confusion, social withdrawal, tearfulness, nervousness or seemingly inappropriate laughter, numbness, hostility, and fear.

A person who was raped may have a variety of other physical concerns needing to be addressed. Physical abuse is often present as well. Emergency room staff are specially trained to deal with all of these situations.

SIGNS AND TESTS

A history will be obtained in a supportive and non-judgmental way. This will include the details of the attack: the date and time of the rape, where it occurred, and what the attacked person has done since the attack (for example, showered and changed clothes or came directly to the hospital).

If possible, this interview should be done with both medical and investigating police present, to eliminate the need for the person to repeatedly recall the incident.

Additional medical history that should be obtained includes: any possibility of pregnancy prior to the attack; the date of the last menstrual period; a pertinent gynecological history, including any prior sexual abuse or assault; and the presence of chronic illness or recent illness or injury, as well as current medications.

A complete physical examination should be done to document any objective signs of trauma. Pictures may be taken to note bruises, scrapes, or cuts. X-rays will be taken if fractures are suspected.

Numerous samples and specimens may be collected for evidence including clothing, pubic hair samples (particularly if foreign materials are seen within it), fingernail scrapings, and vaginal samples to examine for evidence of sperm and test for sexually transmitted diseases (mouth or anal samples may also be required).

TREATMENT

In many cities, rape cases are referred to specific emergency rooms. This allows for more specialized care for the unique needs of the person who was raped, and assures proper procedures are followed to maintain the "chain of evidence" necessary for a case that may go to trial.

Such sexual assault treatment centers may also employ, or have available on-call, a team that is specialized in assessing and dealing with the emotional, physical, and legal issues a person who was raped faces. Most state laws require that the person be evaluated in the emergency room prior to the rape being officially reported.

It is recommended that a person go to the hospital immediately after the rape occurs, without changing clothes, showering, douching, or urinating. Such activities may alter or destroy evidence helpful in identifying and prosecuting the rapist.

Treatment focuses on providing enough emotional support while attempting to collect enough objective evidence to verify the person's complaint of rape. If the person who was raped has a support person she wants present, the treatment team should try to make that possible; otherwise someone (such as a nurse) should be "assigned" to stay with the person throughout the interviews and examination.

Someone who was attacked should not be left alone unless she wishes to be. She should be offered the choice of being interviewed in street clothes rather than in a patient gown.

The examination and collection of specimens should be fully explained beforehand, and whenever possible, the person should be given choices in an attempt to give her back a sense of control. Maintaining a supportive environment, free from any judgmental statements, may encourage a person who has been attacked to express whatever feelings arise.

Treatment includes addressing any potential for pregnancy or sexually transmitted diseases, offering information relevant to those possibilities, and providing care for the immediate physical and emotional trauma incurred, as well as planning follow-up care.

If there is a chance that the rapist is HIV-infected, post-exposure prophylaxis (PEP, a way to reduce the odds of infection by immediate use of antiretroviral medications) should be explained and offered. Referral to a local rape crisis center may be helpful. These centers offer peer support, and advice necessary for adequate healing from the trauma.

OUTLOOK

Recovery from a rape typically includes the acute phase (immediate period of physical pain and wound healing, emotional reactions and coping mechanisms put into action), and the reorganization phase (occurring about one week after the rape and lasting months to years, as the person attempts to "get on with life").

Group psychotherapy with other rape survivors as been show to be the most effective treatment.

COMPLICATIONS

Some women are never fully able to recover emotionally from a rape. Posttraumatic stress disorder (PTSD) is a common complication. Symptoms include recurrent nightmares, intrusive memories (flashbacks) of the event, social withdrawal, depression, anxiety, and numbing of emotions. Cognitive psychotherapy and antidepressant medications have been shown to be effective treatments for PTSD.

More than 50% of rape victims have some difficulty in re-establishing relationships with spouses or partners or, if unattached, in re-entering the "dating scene."

Any pre-existing psychiatric disorders may be worsened. Suicidal behaviors, depression, and substance abuse may develop or become more prominent.

CALL YOUR HEALTH CARE PROVIDER IF

• You have been raped: go to the nearest emergency room right away. Do not shower or change your clothes.
• You were sexually assaulted in the past but never sought or received adequate care.
• You have been raped (recently or in the past) and are experiencing personal or relationship problems.