Sexual Assault

Hospitals may have medicolegal sexual assault clinics, staffed by police officers, nurses, &/or doctors. Where there is no such clinic or if the clinic is closed, hospital clinicians will need to attend to the legal as well as clinical matters.

Patients presenting to gynaecology with a complaint of sexual assault

• Patients who have not already attended a sexual assault clinic should be encouraged to do so first, if available. Full examination, treatment, follow-up, & legal requirements will be dealt with by that clinic. If a patient declines to go, attend to the clinical needs, then offer telephone numbers and encourage the patient to call for counselling & advice. The suggestion of police involvement is mandatory but may not be accepted
• If there is no sexual assault clinic, take a relevant history, examine the patient carefully, & make clear notes. Use the ‘rape kit’ – provided by the police - to complete a full medicolegal examination. Some instructions are provided with the kit. Complete the J88 assault form. A police officer should assist with submission of the ‘rape kit’.
• Handle all patients with extreme care. Patients frequently remember the events in hospitals/clinics with bitterness and a feeling of being let down by those who are expected to care.
• The patient may wish to be examined by a female doctor, & this should be arranged if possible.
• Children with vaginal bleeding must undergo an examination under anaesthetic to determine the extent of injury & complications. Discuss first with a consultant. Consent from a parent/guardian is required. Call a consultant or paediatric surgeon if there is anything more than superficial damage to the vagina, vulva or perineum. Beware – absence of the hymen is NOT necessarily an indication of penetration. Take specimens for the ‘Rape kit’
• EUA, suturing may also be required for a teenager/adult. Take specimens for the ‘Rape kit’
• Prophylactic antibiotics should be prescribed. For adults, use azithromycin 1G or ceftriaxone 250mg im as a single dose, doxycycline 100 mg orally twice daily & metronidazole 400 mg orally twice daily for 10 days.
• Regarding post-exposure antiretroviral prophylaxis, Nthabiseng Clinic at CH Baragwanath, for example, can assist rape survivors who are HIV negative. If the HIV result is unknown, do a rapid test for HIV & give ARVs to those who are negative, or positives not on ARVs
• Emergency contraception must be provided to women at risk of pregnancy. Give Ovral two tablets orally for 2 doses 12 hours apart with metoclopramide 10mg orally three times daily, with follow-up to exclude pregnancy or levonorgestrel. See the chapter on contraception for alternatives
• Counselling is available from social workers & must be offered/organized