Recognition, symptoms, and medical and mental health consequences
As in Amy’s case, many survivors of sexual assault do not report the incident for days, weeks, years, or even decades. Long-term physical and psychological consequences can include post-traumatic stress disorder (PTSD), chronic pain, gastrointestinal disorders, headaches, depression, anxiety, eating disorders, and/or unhealthy behaviors such as smoking, risky sexual behavior, and alcohol or drug use.6 Sexual assault victims who develop PTSD are 13 times more likely to have alcohol-related problems and 26 times more likely to have two or more serious drug abuse problems than nonsexual assault victims.6 In one study, women who had experienced rape were 3.1 times more likely to have fibromyalgia syndrome than those without a history of rape.10
Survivors of sexual assault tend to access health care services more often and have more medical complaints than those who have not been assaulted.6 Two-thirds of women who sustained injuries during a sexual assault do not seek treatment for the injuries initially, though they do have an increased number of physician and emergency room visits for up to three years after the assault.11 There is also an association between a history of sexual violence and increased pregnancy-related physical symptoms.12
Health care professionals need to be aware of changes in behaviors, increasing numbers of visits, and certain subjective as well as objective signs that sexual assault may have occurred. Many survivors may not see the correlation between the history of rape and their current symptoms and issues. Screening with every visit can help open dialogue and gives the survivor the opportunity to address the issue at any time, even if it has occurred in the distant past. It is never too late to address the issue and to help a survivor with the healing process.
Prevention and education
Historically, the onus for prevention and education has been aimed toward women alone, and in some cases, the survivor has been blamed for the assault occurring. A recent shift has focused on education, prevention, recognition, and intervention for the entire community, particularly aimed at college campuses (because the majority of rapes occur before age 25) and includes men as well as women.
In September 2014, the President and Vice President launched a public awareness campaign called It’s On Us in partnership with nearly 200 colleges and universities, collegiate sports organizations, and other organizations and companies. The campaign’s goal is to make the whole community responsible for prevention through recognition, discouraging and/or intervening to stop sexual assault before it occurs, and creating an environment in which sexual assault is unacceptable and survivors are supported.13
The White House Task Force to Protect Students from Sexual Assault is also working to identify how prevention can be implemented at the kindergarten through 12th grade level, recognizing that prevention needs to be done earlier than college age, because 40.4% of victims of rape are younger than age 18 years.
The University of Kentucky and the Kentucky Association of Sexual Assault Programs conducted a prevention and intervention study in 26 high schools in Kentucky during a five-year period. The study was based on more than 80,000 anonymous student surveys, included about 5,000 students, and was funded with a $2 million grant from the CDC.14,15 The study, started in 2009, was done to test the effectiveness of a sexual violence prevention program that teaches students about the 3 Ds: distract, direct, and delegate.14 The program is called the Green Dot Program and was implemented in 13 of the 26 Kentucky high schools in the study.14,15 The study concluded that in the 13 schools with the educational program, the rate of violence, harassment, stalking, and dating violence was reduced by at least half.14,15 In the 13 schools without the program, the rate of violence actually increased.15 This shows how early intervention can indeed make significant improvements with the safety of our students, as well as help toward the long-term goal of reducing the overall rate of sexual assault.
Many colleges are now implementing programs to help toward these goals as well. One example is the Sexual Assault Peer Advocate (SAPA) program at Dartmouth College in New Hampshire that is staffed by students who have taken a 32-hour training course. These students are available 24 hours a day to assist students who have undergone sexual assault or intimate partner violence. They work with survivors, friends, family, and partners and help educate the college community.8