Sexual assault—Intervention in primary care

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Amy, a 27-year-old woman, visits the clinic for a routine refill of her sertraline. She has been taking it for three years, with good control of her anxiety and depression. On this visit, as in prior visits, you ask about precipitating factors for her initial symptoms, as well as screen for domestic violence and sexual assault. She answers that she was raped right after high school while traveling abroad and again in college in a fraternity basement. She has not discussed either of these incidences with anyone except her current boyfriend, stating, “Since it happened twice, it must be my fault. I read that if it happens more than once, it’s the woman’s fault.”

Sexual assault prevalence

Unfortunately, Amy’s experiences and response are not unusual. According to findings from the National Intimate Partner and Sexual Violence Survey, approximately 19.3%, or more than 23 million women in the United States, have experienced rape during their lifetimes, and 27.3%, or nearly one in four women, have experienced unwanted sexual contact during their lifetime.¹ Among women, 78.7% were younger than 25 years of age when the rape occurred, and 40.4% were younger than 18 years of age when the rape occurred.¹ In addition, an estimated 1.7 %, or almost 2 million men, have been raped during their lifetimes.¹

Victims of sexual assault on college campuses are especially vulnerable, as they are often socially isolated, away from home, and without their usual safety net of trusted friends. In addition, they may be scared of the social repercussions that may result from reporting an assault by a well-known or respected campus figure. These considerations may compound the physical and emotional trauma of being assaulted. Due to common societal misconceptions, many survivors are unsure whether their experiences were indeed assault. They may feel guilty, especially if they had been under the influence of a substance or perceive that the attack was their fault. In addition, they are often unaware of, or are intimidated by, the available resources.

Which of the following statements do you most agree with regarding sexual assault:

Partially due to the prevalence in this age group, President Barack Obama and Vice President Joe Biden established a White House Task Force to Protect Students From Sexual Assault in January 2014.² In May 2014, this task force reported that nearly 20% of female college students have been assaulted, but only up to 12% have reported the assaults.³ Furthermore, statistics gathered from campus records may not be comprehensive, as off-campus assaults are often not included.⁴ Studies of unreported rape, mainly taken from college samples, indicate that between 6% and 14.9% of men report committing acts that meet legal definitions for rape or attempted rape, and that only a small minority of reported cases ever result in successful prosecution.⁵ In addition, CDC estimates that 43.9% of women and 23.4% of men experience forms of sexual violence other than rape during their lifetimes, such as “being made to penetrate, sexual coercion, unwanted sexual contact, and noncontact sexual experience.”¹

Definitions

Sexual assault includes a variety of types of unwanted sexual touching or penetration without consent. One type of sexual assault is rape, defined by the Bureau of Justice Statistics (2009) as “forced sexual intercourse including both psychological coercion as well as physical force. Forced sexual intercourse means vaginal, anal or oral penetration by the offender(s). This category also includes incidents where the penetration is from a foreign object. Rape is an act of violence expressed sexually.”⁶ The definition of rape by the Federal Bureau of Investigation (FBI) also includes vulnerable victims: those who are intoxicated or otherwise mentally or physically incapable of demonstrating a lack of consent.⁷ Between 45% and 77% of women who are rape victims have not recognized their experience as rape.⁶

Sexual assault other than rape includes unwanted kissing or fondling, and noncontact sexual experiences, such as being flashed or forced to view sexually explicit media.