1. SEXUAL ASSAULT and ABUSE
Presented by: Mrs. Mary Elizabeth Pacuska, M.S.N.

2. Definitions
Rape: “forced sexual intercourse (vaginal, anal, & oral), including both psychological coercion and physical force.”
Sexual Assault: “completed or attempted attacks involving unwanted sexual contact, includes such acts as grabbing, fondling or verbal threats.”

3. Long Term Consequences
Effects vary according to:
Age
Severity
Frequency
Relationship to Perpetrator
Number of Perpetrators

4. Child Sexual Abuse
Reported up to 80,000 times a year, but the number of unreported instances is far greater, because the children are afraid to tell anyone what has happened
Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger.
No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is "wrong," will develop problems resulting from the inability to cope with the over stimulation.

5. Long Term Symptoms of Sexual Abuse
inappropriate sexual knowledge
sexually aggressive behavior
sex play with other children
Depression,
anxiety
substance abuse dissociation
sexual dysfunction
revictimization
risk of HIV, STD

6. Intimacy/Sexuality Incident of abuse often first sexual experience
given confusing messages by perpetrator
confusing/conflicting emotions

7. Physiologic Effects of Sexual Abuse
Deregulation of stress system
increased cortisol
decreased testosterone
increased sexual behaviors
early onset of puberty
Physical consequences; injury, infection, STD

8. High Risk Behaviors less likely to use contraceptives pregnancy STD
prostitution
Substance use/abuse

9. Consensual Sex To regain: self-esteem, attention, power control
Unable to resist request

10. Family Background Dysfunctional/disrupted family
Multiple types of abuse; sexual, physical, psychological

11. Revictimization
History of childhood CSA - increases likelihood of adult abuse/assault
High risk behavior
Impaired social skills
Personality characteristics abuser looks for
Stronger reaction to adult abuse
trouble communicating with partners
emotional attachment
sexual problems (desire, arousal, orgasm)
anxiety and guilt about sex
Degree of dysfunction correlated with degree of abuse

12. Male Victims
Impact on sexuality: sexual acting out, sexual identity confusion, STDs, dangerous sexual behaviors - e.g., auto-erotic asphyxiation
sexual functioning: low libido, premature ejaculation, erectile failure, inability to ejaculate

13. Male Victims: Reporting Sexual Abuse
Men less likely than women, especially if abuse committed by a woman
Feelings of shame, helplessness, and emasculation
Fear of being labeled homosexual
Interpreting the event as favorable, harmless

14. Survivors as Perpetrators
All abusers have been abused, however not all abused become abusers

15. Rape Myths Real rapes are only committed by strangers.
Women who are raped were just asking for it.
Unless a weapon is used it isn't rape.
If he bought dinner she "owes" him sex.
If a woman doesn't fight against her attack it isn't really rape.
Husbands can't rape their wives. It's her duty.
Women cry rape because they had sex and changed their minds.
If it is really rape then the victim will report it immediately.
She really wanted to have sex so it was ok to get rough.
Rape only happens to women.
Rape only happens to women who are on the streets late at night.
I don't know anyone who's ever been raped.

16. Types of Rape Date rape & Acquaintance rape Stranger Rape Marital rape
Male rape

17. Types of Rapists
Anger Rapist
Power Rapist
Sadistic Rapist

18. Incidence and Prevalence
Every 2 minutes in US
1 out of 6 American women
9 out of 10 victims are women
44% under 18
Although 80% white, minorities more likely
Ages highest risk years
Average age of rapist is 31
In 1 out of 3, perpetrator intoxicated
98% of males who raped boys report that they are heterosexual

19. Statistics 62% of female rape victims knew their assailant
43% are raped by a friend or acquaintance, 34% by a stranger, 17% by an intimate, 2% by a relative

20. Rape: Long Term Consequences
physical injury
STDs
long-term psychological consequences
eating and sleep disorders
depression
problems establishing trust in relationships
Post traumatic stress disorder (PTSD)

21. PTSD Following exposure to an extreme trauma for one month or more:
persistent re-experiencing of trauma
persistent avoidance of stimuli associated with trauma or numbing persistent increased arousal

22. Date And Acquaintance Rape
Acquaintance rape: nonconsensual sex between two individuals who know one another
Date rape: nonconsensual sex occurs between two people who are in a romantic relationship

23. Date Rape Statistics
25% of college women victims of rape or attempted rape
85% of rapes on campuses are acquaintance/date rapes
73% do not recognize their experience as rape
Alcohol involved in 90% of campus rapes
70% college students admit to sexual activity as a result of being intoxicated
42% of college women raped do not tell
84% of college men who committed rape claimed definitely NOT rape

24. Safety Tips Know your own feelings about sex
Communicate your feelings and sexual intentions clearly
Do not allow yourself to be isolated
Protest LOUDLY!!
Be smart and aware of your surroundings
Drink responsibly
Have an alternative mode of transportation
Pay your own way

25. Date Rape Drugs Alcohol Rohypnol Gamma Hydroxybutyrate (GHB) Ketamine
Any drug that causes drowsiness

26. Symptoms of Date Rape Drugs
Begin in minutes
Abnormally sleepy, dizzy, confused, and intoxicated
Very drunk with very little alcohol
Loss of memory and judgment
Maximum effect in 1-2 hours
May last up to 24 hours
Memory gaps and blackouts
Wake up feeling violated
Waking in strange places
May notice bruises on their bodies

27. Dangers of Date Rape Drugs
Respiratory depression
Aspiration
Death

28. Protect Yourself from Date Rape Drugs
Do not let someone push drinks on you
Do not accept a drink from anyone you would not “put your life in their hands”
NEVER leave a drink unattended
If you feel sick or drunk go to someone you KNOW and TRUST
Never leave alone!!!
Call 911

29. Marital Rape
History - Rape: "sexual intercourse with a female not his wife without her consent" Sir Matthew Hale, Chief Justice in 17th century England "The husband cannot be guilty of a rape committed by himself upon his lawful wife, for by their mutual matrimonial consent and contract, the wife hath given herself in kind unto the husband which she cannot retract."
1970s: challenged by women’s rights movement July 5, marital rape a crime in all 50 states

30. Marital Rape Higher incidence for women: 7.7 % men Domestic violence
Risk factors: pregnancy, illness, attempting to leave partner, drug and alcohol abuse by perpetrator, previous experience of abuse

31. Marital Rape Effects: physical injury
STDs long-term psychological consequences disordered eating sleep problems depression problems establishing trust in relationships PTSD

32. Rape Trauma Syndrome Disorganization: Immediate impact
Emotional Reactions
Physical Reactions
Social Responses
Sexual Disturbances
Reorganization:
Psychological
Physical Problems
Social Responses
Sexual Relationships

33. Factors Influencing Recovery
Personality type
Support systems
Relationship with offender
Degree of violence
Type of sexual assault
Perception of the assault
Social/cultural influences
Previous experiences with stress
Success in coping with previous crisis
Immediate personal contacts after assault

34. Rape is about power, control and anger!!!!!
The truth is:
Rape is an act of violence
Rape can happen to anyone
Rapists can be anyone
Rapists commit rape again and again until caught

35. Protect Yourself Use your head
Be alert! Walk with confidence and purpose
Be aware of your surroundings
Don’t let alcohol or drugs cloud your judgment
Trust your instincts

36. When the unthinkable happens
Surviving is your goal!
Try to escape. Scream. Be rude. Make noise.
Talk, stall for time, assess your options
If weapon, do what ever it takes to survive

37. Surviving the rape
Find a safe environment... away from the attacker
Have a friend stay with you for moral support Keep the evidence of the attack... don't bathe, douche or brush your teeth
Write down details of the attacker and attack to recall at a later time for the police
Call a rape crisis center near you or HOPE
Get medical attention even if you have no physical injuries due to the risk of   STD's and  pregnancy and to preserve forensic evidence.
Report the rape to law enforcement
(Hospital must notify police, victim does not have to talk to them)
Remember it wasn't your fault!!!
Give yourself the time you need to heal... it may take a while

38. If someone you know is raped
Believe her or him
Don’t blame the victim!!!
Offer support, patience, and compassion

39. PHYSICAL EXAM and EVIDENCE GATHERING
SAFE/SANE: Sexual Assault Forensic Examiner/ Sexual Assault Nurse Examiner
SART: Sexual Assault Response Team

40. REGISTRATION Registration: Insurance Victims Compensation Program
$500/exam
$100 for medication

41. Medical Treatment for Minors
Emancipated: can give consent for medical treatment
or older
2. High school grad
3. married or been married
4. pregnant or has been pregnant
Any minor can give consent for treatment of STD’s

42. Physical Exam Possible injuries External genitalia
Internal examination
Anal orifice and mouth
Cultures of mouth, throat, cervix and rectum
Rape Kit : Chain of Evidence

43. Medical Issues
Trauma
Drug Induced Rapes
STD’s
Prganancy

44. Psychological and Emotional Support
VRC
Private Counseling