rape [L, rapere, to seize] , a sexual assault, homosexual or heterosexual, the legal definitions for which vary from state to state. Rape is a crime of violence or one committed under the threat of violence, and its victims are treated for medical and psychological trauma. Kinds include statutory rape. See also sexual assault. ▪ OBSERVATIONS: Characteristically the victim is frightened and feels vulnerable, humiliated, and personally violated. General physical examination may reveal cuts, bruises, and other injuries. Pelvic or genital examination may show traumatic injury to the internal or external genitalia or anus. ▪ INTERVENTIONS: Careful physical examination should be conducted by specially trained health care personnel, and a detailed history obtained. Evidence and medical specimens are collected as indicated. Ideally counseling is available and offered immediately to all victims of rape. In the case of a woman who has been raped by a man, a pregnancy test may be performed to document current pregnancy status. Prophylaxis against conception may be administered. Medications may be given to prevent the development of sexually transmitted disease. Arrangements for ongoing emotional support are made. ▪ PATIENT CARE CONSIDERATIONS: A trained empathetic caregiver of the same gender is assigned to stay with the victim. Privacy for the history, examination, and police interview is ensured. The victim may or may not choose to report the incident to the police. The victim must sign a special form to allow specimens to be released to a law enforcement agency. In general, it is the role of the caregiver and other specially trained medical workers to examine, treat, and collect specimens as necessary but not to decide that rape has occurred. Before discharge it should be ascertained that someone can be with the victim, since depression, anger, guilt, and fear may occur after rape.
