Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments

Objective

To describe medical services provided to sexual assault patients in US emergency departments and to identify the percentage of hospitals always providing the 10 elements of comprehensive medical care management (CMCM).

Methods

A cross-sectional study was conducted in a national sample of US hospitals. A 26-item telephone survey assessed provision of services to sexual assault survivors in accordance with CMCM. Management included acute medical care comprising history and physical examination; acute and long-term rape crisis counseling; STI testing and prophylaxis; emergency contraception counseling and provision; and HIV testing and prophylaxis. The primary outcome was extent of provision of these elements.

Results

Overall, 582 emergency departments responded to the survey. The following components of CMCM were provided: acute medical care (582 [100.0%]); rape crisis counseling (234 [40.2%]); STI management (448 [77.0%]); emergency contraception (351 [60.3%]); and HIV management (380 [65.3%]). Only 101 (17.4%) hospitals provided all 10 elements of CMCM.

Conclusion

Less than one-fifth of US hospitals provide comprehensive services to sexual assault patients. A national program incorporating clinical guidelines, checklists, and funding for sexual assault forensic/nurse examiner programs could improve the standard of care provided in emergency departments—the primary point of contact for acute care of sexual assault survivors.     

Audit on the management of complainants of sexual assault at an emergency department

Objective

Proper medical management should be offered to rape complainants, including systematic investigation for sexual transmitted diseases, prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow up. We conducted an audit on the medical management of complainants of sexual assault in a public university hospital with a high referral of rape complainants.

Study design

Retrospective study of rape complainants, based on medical records (n = 356) including women admitted at the emergency department between January 1, 2002 and December 31, 2007.

Results

Most complainants were Caucasian (median age: 25 years, range: 15-79 years). About 82% of the assaults were committed by one assailant only, and almost two-thirds of the rapes were characterized by vaginal penetration. In 8% of the patients, no blood sample to screen for sexually transmitted disease had been taken and in 38% of the patients, no cervical smear for C. trachomatis had been done. Prophylactic antibiotics were provided to 40% of the patients. Eighty percent of the complainants who were not using contraception received an emergency contraceptive treatment. Respectively, 10%, 16% and 11% of the complainants were seen at a gynecological, infectious diseases or psychological support follow-up visit.

Conclusion

Only about 20% of the complainants received optimal care. Different steps were taken to improve the medical management, including a specific computerized checklist and involvement of a social nurse for the follow up. These steps aim at reducing psycho-affective and medical morbidity of rape complainants.     

Providing quality care to the sexual assault survivor: education and training for medical professionals

One in every six women in the United States will be the victim of an attempted or completed rape over the course of their lifetime.³ Health care providers trained in sexual assault examination procedures are not available in all clinical settings. CNMs/CMs have most of the requisite training to provide this service, and they are ideally poised to help women who report sexual abuse. We can assist persons who have been sexually assaulted by becoming educated in sexual assault care, attending specialty training as sexual assault examiners, joining SARTs, and serving as sexual assault response coordinators in our communities. Education about sexual assault care in midwifery programs can facilitate the ability of CNMs/CMs to provide physical assessments and forensic examinations to sexual assault victims.Once training has been obtained, it is essential to stay current about topics such as emergency contraception, STI treatments, and new methods of forensic evidence collection. Sexual assault examiners must have a knowledge of available referral sources and local resources where the person reporting these crimes may receive assistance as needed. Providing medical and forensic care for women who are victims of sexual violence should be considered a core practice within the midwifery scope of practice. CNMs/CMs need to be well prepared to care for sexual assault patients by receiving proper education and training. Specific instruction concerning care for victims of sexual and domestic violence, along with an introduction to serving as an expert witness, should be an integrated into midwifery education programs as part of the core curriculum.     

The short-term outcome of laser in the management of female pelvic floor disorders: Focus on stress urine incontinence and sexual dysfunction

Objective

Female pelvic floor disorders, including female stress urinary incontinence (SUI) or sexual dysfunction are notorious for affecting the quality of women's life. It is reported that laser therapy might result in collagen remodeling and improvement in tissue firmness. The study was conducted to evaluate the short-term outcome of female pelvic floor disorders treated by laser therapy.