Emergency contraception for sexual assault victims in North Carolina emergency departments

INTRODUCTION: One in 5 women is a victim of sexual assault. This study examines the administration of emergency contraception to victims of sexual assault in North Carolina hospital emergency departments. METHODS: One hundred seventeen surveys were mailed to hospital emergency departments across the state to determine their emergency contraception practices for victims ofsexual assault. The survey contained 11 questions about emergency contraception practices for victims. RESULTS: Of the 117 surveys, 103 were returned revealing that just over 50% of the hospitals in North Carolina treated victims with emergency contraception without exception. Both dispensing emergency contraception and providing information about emergency contraception were significantly associated with having a sexual assault nurse examiner program. CONCLUSION: Results from this study demonstrate inconsistent provision of emergency contraception to victims of sexual assault; however, there is greater consistency of emergency contraception use by emergency departments using sexual assault nurse examiners.     

51例性侵害案件中受害人性防卫能力鉴定分析

目的:探讨精神障碍患者受性侵害的特征及性防卫能力在司法鉴定中的评定。方法:采用自制调查表对51例女性受性侵害案司法鉴定资料进行统计分析。结果:鉴定诊断以精神发育迟滞为主,对性防卫能力丧失、性防卫能力削弱及性防卫能力存在三组中受害人案发后是否主动报案、是否获利、赔偿态度及平时的社会适应能力状况进行比较,存在显著差异(P<0.05)。结论:年轻的女性精神发育迟滞患者更容易被性侵害,在进行性自我防卫能力评定时应掌握客观证据,从犯罪嫌疑人的犯罪特征、受害人的社会适应情况及对性行为的性质、后果的理解能力等多方面综合考察评定。     

Sexual assault and its medical, medicolegal, and social aspects--a retrospective study

A retrospective study of medical, medicolegal and social aspects was conducted in collaboration with the department of forensic medicine and toxicology during a period 2004-2009 among 42 victims of sexual assault who were admitted in the department of gynaecology and obstetrics of RG Kar Medical College, Kolkata. Majority (71%) of the victims were girls between age group 6-15 years. Sixty per cent of the victims were from poor family, 43% were illiterate and 72% had vaginal tear which required surgical management.     

Fundamental issues in forensic semen detection

Sperm detection can be an important factor in confirming sexual assault in cases of rape. A large number of cases received in a forensic laboratory involve sexual offenses, making it necessary to examine exhibits for the presence of seminal stains. The objective of this paper is to provide an overview of the most important methods and tests used in the identification of spermatozoa or constituents of seminal fluid during the investigation of alleged sexual assault cases in forensic medical practice. Furthermore, this paper focusses on the basic knowledge that is necessary to the graduate students who wish to specialize in forensic sciences.     

Postcoital contraception: How effective and what fetal risk,if ineffective??

Various postcoital contraceptive regimens are described. An antiemetic can be given to minimize the nausea and vomiting which are side effects of high-dosage estrogen. If pregnancy occurs despite treatment, the possible risk to the fetus is unknown. This method of contraception is only for emergency use. Regular contraception should be employed if sexual exposure is to be continuing.     

Offering HIV prophylaxis to people who have been sexually assaulted: 16 months'' experience in a sexual assault service

The sexual assault service, operated by the Children's & Women's Health Centre of British Columbia in partnership with the Vancouver General Hospital Emergency Department, started offering HIV prophylaxis in November 1996 to patients presenting to the emergency department after a sexual assault. In the first 16 months of the program a total of 258 people were seen by the service, of whom 71 accepted the offer of HIV prophylaxis. Only 29 continued with the drug treatment after receiving the initial 5-day starter pack, and only 8 completed the full 4-week treatment regmen and returned for their final follow-up visit. Patients at highest risk for HIV infection (those who had penetration by an assailant known to be HIV positive or at high risk for HIV infection [men who have sex with men, injection drug users]) were more likely to accept prophylaxis and more likely to complete the treatment than those at lower risk. Compliance and follow-up were the main problems with implementing this service. Service providers found it difficult to give the information about HIV prophylaxis to traumatized patients. After this program evaluation, the service changed its policy to offer HIV prophylaxis only to people at high risk of HIV infection. This targeting of services is expected to make the service providers' jobs easier and to make the program more cost-effective while still protecting sexual assault victims against HIV infection.     

Sexual assault tracking study: who gets lost to follow-up?

OBJECTIVES: To determine whether loss to follow-up can be predicted in patients who present to an emergency sexual assault assessment service and to generate hypotheses regarding the prediction of loss to follow-up on the basis of patient characteristics, assault characteristics and the services provided. DESIGN: Prospective, exploratory study. SETTING: Emergency department functioning as a regional sexual assault centre in a tertiary care hospital. PATIENTS: All 294 women over the age of 16 years who presented to the emergency department with a complaint of sexual assault and consented to be followed up. INTERVENTIONS: Telephone interviews at 24 to 48 hours and 1 month after presentation; face-to-face interviews after 1 week, 3 months and 6 months. MAIN OUTCOME MEASURES: Follow-up status (tracked versus lost to follow-up), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Scale (Beck) and Rape Trauma Symptom Rating Scale (RTSRS). RESULTS: At 24 to 48 hours 136 (46%) of the patients could not be reached. Only 61 (21%) were still tracked at 6 months. Loss to follow-up at 1 month accurately predicted loss to follow-up at 6 months in 209 (98%) of 214 patients. For tracked patients the STAI-Y and Beck scores improved over 6 months. These scores at 1 week did not predict follow-up status at 6 months, but the numbers were small. Subjects with a higher RTSRS score at 24 to 48 hours were most likely to remain tracked throughout the 6 months. CONCLUSIONS: Decisions regarding how vigorously to track patients with a complaint of sexual assault can tentatively be based on the characteristics of the victim and of the assault. We hypothesize that the characteristics predicting loss to follow-up include denial and avoidance behaviour, lack of a telephone number or forwarding address, history of a psychiatric condition, a disability (e.g., deafness), characterization as a "street person," a high degree of violence or injury in the assault, and threat by the assailant. Although a predictive model requires further data, crisis intervention services in an emergency department are essential, given the large number of patients lost to follow-up.     

性自我防卫能力评定量表在女性精神障碍的应用研究

目的探讨性自我防卫能力评定量表在广州地区女性精神障碍者被性侵害案鉴定中的应用情况，检验其与专家鉴定是否具有一致性。方法运用CSSAS对91例女性精神障碍者进行评定，将评定情况与专家鉴定意见相比较。结果（1）性自我防卫能力量表评定结果显示，非MR及轻度MR组中分别有45．4％、25．8％被鉴定者的性自我防卫能力存在，中、重度MR组均未见有量表评定性自我防卫能力存在者，中度MR组有26．7％性自我防卫能力削弱。（2）专家鉴定结果显示，非MR组及轻度MR组中分别有12．5％、6.5％有性自我防卫能力，中、重度MR组中全部为无性自我防卫能力。（3）专家鉴定结论与量表评定结果之间存在一些差异，专家鉴定为无性自我防卫能力的较多。结论CSSAS在广州地区使用的信效度较好，具有拓展使用价值。     

Male victims of sexual assault.

OBJECTIVE--To compare the demographics, physical findings, and assault characteristics of incarcerated, sexually assaulted men with those of nonincarcerated, sexually assaulted men. DESIGN--Case series of 99 adult male victims of sexual assault evaluated over a 3-year period. SETTING--Memphis Sexual Assault Resource Center, a nonhospital-based clinic that serves as the primary resource for sexually assaulted victims in the Memphis and Shelby County, Tennessee, area. PARTICIPANTS--All adult male victims of sexual assault evaluated at the Memphis Sexual Assault Resource Center during the study period were included in the study. Ninety-nine victims were studied, including 80 incarcerated men and 19 men from the community. RESULTS--The victims of sexual assault in the community group were older than the victims in the incarcerated group. Apart from the age difference and weapon use, there were no statistically significant differences between the incarcerated and nonincarcerated victims. CONCLUSIONS--The similarities between the two groups suggest that sexual assault of men may not be unique to prisons, and all men are potential victims. Further studies are required to better understand these crimes and to develop education and prevention programs.     

Emergency physicians and sexual involvement with patients: an Ontario survey

OBJECTIVE: To describe Ontario emergency physicians' knowledge of colleagues' sexual involvement with patients and former patients, their own personal experience of such involvement, and their attitudes toward postvisit relationships. DESIGN: Mailed survey. SETTING: Ontario. PARTICIPANTS: Emergency physicians practising in Ontario. RESULTS: Of 974 eligible mailed surveys, 599 (61.5%) were returned. Of these respondents, 52 (8.7%) reported being aware of a colleague in emergency practice who had been sexually involved with a patient or former patient. When describing their own behaviour, 37 respondents (6.2%) reported sexual involvement with a former patient. However, of this group, only 9 (25.0%) had met the patient in an emergency department. Thus, of the total number of respondents, only 1.5% (9/599) reported sexual involvement arising out of an emergency department visit. Most respondents (82.4%) agreed that it is inappropriate behaviour to ask a patient for a date after an emergency assessment and before the patient's departure, and 66.4% felt that it is inappropriate to contact the patient after discharge. However, only 10.6% believed it to be unacceptable to request a social meeting after encountering a patient previously cared for in the emergency department in a nonprofessional setting. Most respondents (96.5%) did not believe that sexual involvement could ever be therapeutic for the patient. However, only 66% felt that it was always an abuse of power and 62.4% supported zero tolerance of all sexual involvement between physicians and patients. CONCLUSIONS: Vague regulatory guidelines currently in place have failed to dispel confusion regarding what is acceptable social behaviour for physicians providing emergency care. Our results support the need for clarification, and suggest a basis for guidelines that would be acceptable to the emergency medical community: that an emergency visit should not form the basis for the initiation of personal or sexual relationships, yet neither should it preclude their development in nonmedical settings.     

Parivar Seva's experience with emergency contraceptive pills

Parivar Seva, an NGO working in the area of reproductive health carried out an operation research project as a feasibility study on emergency contraception recently. The study was conducted among 1120 clients coming after unprotected sexual intercourse or improper use of any contraceptive method by using emergency contraception pills coming within 3 days and IUCD coming between 3 and 5 days of unprotected sexual intercourse. It was found that failure of emergency contraception was as low as 0.6%. The success rate in term of preventing pregnancy was 99.4% both with combined oral contraception pills and laevonorgesterol. There lies the scope for introducing emergency contraception in India wide and it can occupy a unique position in a range of contraceptive choices currently available to Indian women, as it can prevent unwanted pregnancies. A coalition of 30 like minded organisations including the Parivar Seva had formed a subcommittee on emergency contraception to evolve strategies to address promotion of emergency contraception.     

Emergency department post-coital contraception in Northern Ireland

Background The granting of a licence to Levonelle as an emergency hormonal contraceptive in the Republic of Ireland may require accident and emergency (A&E) departments to formally provide such a service. This article outlines the experiences of a Northern Ireland A&E unit. Aims To examine the pattern of attendance of patients requesting emergency contraception at an A&E department and to assess if adequate standards of care are achieved. Method Retrospective case note review of 100 patients attending the A&E department requesting emergency contraception. Results Sixty-one per cent of requests for emergency contraception were outside normal pharmacy opening hours. Seventy-seven per cent of these patients were less than 26 years old. Most (63%) attended within 24 hours of unprotected sexual intercourse. Forty-three per cent of the patients studied had used no contraception prior to this request. Recording of menstrual details and sexual behaviour as part of the consultation was variable. Conclusions A&E departments receive requests for emergency hormonal contraception particularly from younger women (<25 years). A&E staff must have appropriate training and support to manage these consultations effectively.     

Virginity examinations in Turkey: role of forensic physicians in controlling female sexuality.

CONTEXT: Although the Turkish Medical Association has deemed "virginity examinations" a form of gender-based violence, women in Turkey are often subjected to such examinations by forensic physicians for both legal and social reasons. Little is known about these physicians' role and attitudes in this practice. OBJECTIVES: To assess forensic physicians' experiences and attitudes regarding virginity examinations in Turkey and suggest potential solutions to the problems identified. DESIGN: Cross-sectional self-administered survey. SETTING: Surveys were completed during the Forensic Science Congress held in Kusadasi in April 1998 as well as in urban academic and medical practice settings between April and October 1998. PARTICIPANTS: Of 158 physicians who practice, are formally trained in, or are in training for forensic medicine, 118 completed the survey (response rate, 74.7%). MAIN OUTCOME MEASURES: Frequency and circumstances of conducting virginity examinations, opinions regarding beneficial and adverse consequences of these examinations, and recommendations for changing the practice, as measured by a 100-item questionnaire. RESULTS: Overall, survey respondents reported conducting 5901 examinations in the previous 12 months; 4045 were conducted because of alleged sexual assault and 1856 for social reasons. Although 68% of forensic physicians indicated that they believed virginity examinations are inappropriate in the absence of an allegation of sexual assault, 45% had conducted examinations for social reasons. The majority of the respondents (93%) agreed that the examinations are psychologically traumatic for the patient. In addition, more than half (58%) reported that at least 50% of patients undergo examinations against their will. CONCLUSIONS: Nearly half of forensic physicians in Turkey conduct virginity examinations for social reasons despite beliefs that such examinations are inappropriate, traumatic to the patient, and often performed against the patient's will. Physicians' participation in such practices is inconsistent with principles of bioethics and international human rights.     

The profile of women who seek emergency contraception from the family planning service

OBJECTIVES. To review the profile of emergency contraceptive users, their reasons for using emergency contraception, and whether they use it correctly. DESIGN. Retrospective analysis of medical records. SETTING. Six Birth Control Clinics and three Youth Health Care Centres of the Family Planning Association of Hong Kong. PARTICIPANTS. Women requesting emergency contraception between 2006 and 2008. MAIN OUTCOME MEASURES. Demographics of emergency contraception users, reasons for requesting emergency contraception, number of times the subject had unprotected intercourse before emergency contraception use, type of emergency contraception provided, coitus-treatment intervals, and outcomes. RESULTS. A total of 11 014 courses of emergency contraception were provided, which included 10 845 courses of levonorgestrel-only pills, 168 intrauterine contraceptive devices, and one course of pills plus an intrauterine contraceptive device. The mean age of the users was 30 years. Two thirds (65.6%) were nulliparous and 64.9% had not had a previous abortion. Their major reasons for requesting emergency contraception were: omission of contraceptive at the index intercourse (38.9%), condom accidents (38.0%), and non-use of any regular contraceptives (20.6%). Non-users of contraceptives were more likely to have had a previous abortion. In all, 97.9% of women took emergency contraception within 72 hours of their unprotected intercourse; 98% had had a single act of unprotected intercourse. None of the intrauterine contraceptive device users became pregnant. The failure rate for emergency contraceptive pills was 1.8%. CONCLUSIONS. Women requested emergency contraception because contraceptives were omitted or condom accidents. Health care providers should focus on motivating women with a history of abortion to use contraceptives, and ensure that condom users know how to use them correctly. Most women followed instructions on the use for emergency contraception and their outcomes were satisfactory.     

136例女性性被害司法精神医学鉴定

目的：主要探讨司法鉴定中女性性被害司法精神医学鉴定的特点。方法：本研究选择武汉市精神卫生中心司法鉴定科2007年1月1日～2012年1月1日按法定程序鉴定136例女性性被害司法鉴定案例资料,精神障碍的诊断符合《中国精神障碍分类与诊断标准》第3版（ CCMD-3）之标准。结果：所有的案例中以精神发育迟滞的诊断最为多见（61．76％）,其次为精神分裂症（20．59％）,和心境障碍（8．09％）;性防卫能力的影响因素很多,本文显示在文化程度（p＜0．05）,有无工作（p＜0．01）及婚姻状况（p＜0．05）3方面存在有差异;性侵实施者多熟悉受害者情况,大部分为受害者的熟人。结论：智力状况,社会功能缺陷,家庭支持程度均可影响到患者的性防卫能力,应针对性采取有效措施进行防范,同时建议尽早完善相关的法律法规,切实维护女性精神障碍患者的合法权益。     

广州地区女性精神障碍者被性侵害案鉴定特点分析

目的 探讨发生在广州地区女性精神障碍者被性侵害案的特点,为预防此类事件的发生及维护这类妇女群体的权利提供参数.方法 自制调查表对要求进行性自我防卫能力评定的91例女性精神障碍者相关因素进行分析. 结果 (1)在被性侵害的女性精神障碍者中以精神发育迟滞(73.7%)及精神分裂症(14.3%)的患者最多见;躁狂状态占5.5%;其他占6.5%.(2)性自卫能力丧失者(80.2%)明显多于性自卫能力削弱者(13.2%)及性自卫能力存在者(6.6%).(3)无性防卫能力者以中度精神发育迟滞最多(51.8%),其次是轻度精神发育迟滞(23.2%);中度、重度精神发育迟滞及伴有其他异常者全部为无性防卫能力(100.0%);轻度精神发育迟滞者中以无性防卫能力的比例最高(56.5%).(4)案发地点以受害人自家(24.2%)、犯罪嫌疑人家(34.1%)以及空地或偏僻处(28.6%)为多.受害者家住异地的占63.7%;案发地在乡村的70.3%.结论 女性精神障碍者被性侵害案例有其自身特点,应特别注意加强轻、中度精神发育迟滞及精神分裂症患者的监护.     

Use of Emergency Contraception could Halve Induced Abortion Rate in Shanghai, China

Objective To investigate and estimate the proportion of the induced abortion that could have been prevented by using emergency contraception in Shanghai.Method Structured interviews were conducted in 606 women (413 married and 193 unmarried) aged 18-49 years, who were attending three health care centers in Shanghai for termination of first trimester pregnancy.Results A total of 98.2% of the pregnancies were unwanted, and 63.7% of the women.recognized that they were at risk of pregnancy soon after the intercourse. It is estimated that 52.2% of the induced abortion could have been prevented if the women had used levonorgestrel-only emergency contrdcception. Only 28.5% of the respondents were aware of emergency contraception. The most important sources of information about emergency contraception identified by respondents were books/newspapers/periodicals (38.2%), and relatives/friends (30.6%). Family planning health education on emergency contraception was noted by 28.9% of married women but only by 5.8% of unmarried women. A portion of 85.5% of all respondents reported they would be willing to use emergency contraception when needed. Those more willing to use emergency contraception included younger, better educated, and unmarried women experiencing their first pregnancy. Women preferred drugstores (60.1%) than hospitals (30.29%)for obtaining emergency contraception.Conclusion Women‘s needs for emergency contraception were enormous. Promotion of emergency contraception by providing information and improving service could have a substantial impact on reducing the rate of induced abortion in Shanghai.     

56例性受害案司法精神医学鉴定分析

目的 探讨司法精神医学鉴定中性受害案的鉴定特点。方法 将56例女性精神病人性受害案司法鉴定的所有资料进行统计分析。结果 性受害人以青少年、低文化程度的农民居多。精神疾病诊断列前3位的是精神发育迟滞(71．4％)、精神分裂症(21．4％)和情感性精神障碍(5．4％)。56例中大部分(71．4％)评定为无性自卫能力，极少数(3．6％)评定为有性自卫能力。结论 应加强对女性精神病人的治疗与监护，并引起全社会的关注。     

Civilian cranial gunshot wounds: a Jamaican experience

Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. Ten patients had surgery, two of whom died. Six complications occurred: two patients each developed an infection, cerebrospinal fluid fistula or seizures. All patients were victims of an assault and all had intracranial penetration, the most common sites of which were facial and frontal. Median hospital stay was eleven days. The Glasgow Coma Score on admission was a good prognostic indicator. Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault.     

米非司酮合并氨甲蝶呤用于紧急避孕初步观察

目的 对小剂量米非司酮（２５ｍｇ）合并小剂量氨甲蝶呤（５ｍｇ）用于紧急避孕进行初步的临床观察。方法 １７名受试者在无防护性交或避孕失败后采用本方案紧急避孕。结果 无论是性交后７２ｈ之内还是性交后超过７２ｈ服药,无一例妊娠,且无明显副反应发生,使小剂量米非司酮紧急避孕的效果得到了提高并且拓宽了其使用时限。结论 该法有可能成为一种安全高效,不受性交时间、次数制约的新型紧急避孕方法。