INDEX

    Sexual Assault – Treatment

    Obstetrics and Gynecology, Special Populations, Trauma

    Last Updated Jul 23, 2020
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    Context

    • Sexual assault (SA) is a crime of power and control.
    • 1/3 women and 1/6 men will experience a sexual assault in their lifetime.
    • 96% of perpetrators are male.
    • An approach to sexual assault applies principles of trauma-informed care: safety, trustworthiness, choice, collaboration, empowerment.
    • How the patient is treated at the outset (i.e. with compassion, validation and giving them their choice in their care journey) will guide their subsequent course in how they handle the trauma of their assault.
    • Medical treatment is different and separate from forensics. Patients should be able to get decent medical care at any ER/UCC/FD office in BC.
    • Forensics are nice if we can have it, and only if the patient wants. Forensic care is mostly only offered at specialized sites within each Health Authority.  We generally have a bit of time to get forensics, but ideally sooner the better, especially if looking for toxicology.

    Context

    Emotional and psychosocial care:

    • Acknowledge difficulty and courage in seeking care.
    • Respond with empathy, belief, and without judgment.“What happened is not your fault.”
    • Offer to have support person to accompany patient, if available (patient friend, family, and/or through community organization (see Patient Community Resources section below).
    • Identify existing sources of support and coping strategies.
    • Consider offering referrals to:
      • Mental health services for post-assault counselling.
      • Social work.

    STI prophylaxis and treatment:

    Emergency contraception: 

    Other:

    • Consider Tetanus booster if > 10 years since last booster, Tetanus Immune globulin if not previously immunized.

    Criteria For Safe Discharge Home

    • Safety plan in place.
    • Options for post-assault counselling and social support offered.
      • See “Patient Community Resources” section below.
      • Social Work.
      • Mental Health Services.
    • Follow up:
      • With family physician (if they have one).
      • Lab testing:
        • Pregnancy test in 1 month.
        • HIV and syphilis in 1 and 3 months.
      • Prescriptions for STI prophylaxis if started in ED.
        • For ex. HIV PEP for 28 days.
      • Completion of Hepatitis B vaccination (if first dose provided during visit).

    Criteria for Consult

    • Requiring psychiatric stabilization.
    • Currently Pregnant and/or at risk of miscarrying.
    • Immunocompromised.
    • Requires a Copper IUD insertion.
    • severe trauma including genital or ABD trauma (eg. Perforated viscus), or strangulation with airway concerns or Loss of consciousness.

    Criteria For Transfer To Another Facility

    Quality Of Evidence?

    Justification

    Summarized from regional protocols. May vary regionally within the province.

    Moderate

    Other Resources

    Patient Community Resources

    Recommended Courses

    Related Information

    Reference List

    Relevant Resources

    RELEVANT CLINICAL RESOURCES

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