Integrated clinical service for sexual assault victims in a genitourinary setting

Abstract

Background: Reported sexual assault is increasing, and the diverse immediate and longer term needs of the victim are usually met by exposure to a number of healthcare professionals often in diVerent locations, involving delays and travel, increasing the trauma for the victim. Objectives: To set up a centre to address the immediate and longer term needs of the sexual assault victim and review issues arising during the development of the service. Methods: Description of setting up the service in the genitourinary medicine department of Kings College Hospital, south London, and the aspects of care oVered. Results: The number of victims referred by police increased from 15 in 1992 to 58 in 1996. In 1996, 55 female and three male victims were seen. 23 diVerent police stations brought victims for examination; mean age of the victim was 27 years (range 14-60), median time between assault and examination was 22 hours (range 3 hours-3 months); 23% had genital injuries, 59% had other physical injury, and 11% needed further hospital care. 71% accepted screening for sexually transmitted infection (STI), 21% had an STI diagnosed, 16% of the women required emergency contraception, 26% received prophylactic antibiotics, and 58% saw a health adviser. 70% had a follow up appointment arranged of which 50% attended. Conclusion:The high uptake of STI screening, emergency contraception, health adviser consultation, and follow up supports the concept of a comprehensive integrated system to meet the disparate needs of the victim while still obtaining the necessary forensic evidence. The wide catchment area of service users indicates gaps in services available for the assault victim. Earlier genitourinary involvement after sexual assault is becoming increasingly pertinent in relation to HIV prophylaxis. (Sex Transm Inf 1999;75:116-119)

Review of 212 individuals attending a city centre genitourinary medicine clinic following acute sexual assault

“…Because of concerns about higher rates of STI and high default rates, some centres offer prophylactic antibiotic treatment for chlamydia, gonorrhoea and trichomoniasis rather than re-swabbing after 14 days. 7,8 As the overall prevalence of STI was no greater than in the routine clinic population, this Edinburgh study does not justify the introduction of STI screening or routine prophylactic antibiotic therapy at the time of the forensic medical examination. However, prophylactic antibiotics will continue to be offered to the small number of individuals who feel unable to undergo any STI screening.…”

The Haven: a pilot referral centre in London for cases of serious sexual assault

“…Unfortunately, our understanding of the complications and our ability to reduce the occurrence of long term effects are limited by low rates of reporting and the lack of integrated care for those who do report their assault 3 . In 1999 we reported our experience of setting up a service to provide forensic examination, medical care and psychological support for victims of sexual assault within a genitourinary setting 4 . We provided this service on three days each week from 1992 to 1999, during which period problems with the availability within London of female forensically trained doctors at other times increased.…”

Medico legal procedures related to sexual assault: a 10-year retrospective experience of a Daphne protocol application

“…As defined by World Health Organization gender violence is 'the greatest public health issue and violation of human rights in the world; it is a violation of a person's physical and mental integrity (WHO 2014). SA is a traumatic life event in which the negative outcomes increase with increasing severity of abuse including physical maltreatment (McCauley et al 1997) such us lacerations, fractures, genital mutilation, sexually transmitted diseases (Lacey 1990), gynecologic disorders (Walling et al 1994;Golding et al 1998) unwanted or pathological pregnancies (Murphy et al 2001), depression (Wise et al 2001), eating disorders (Goodwin et al 2003), self-destructive behaviours (Alix et al 2017) genito-urinary and sexual disorders (Vella et al 2015), post-traumatic stress disorders (Kendler et al 2000;MacMillan et al 2001;Sprinter et al 2007;Jonas et al 2011;Gauthier-Duchesne et al 2017;Bottomley et al 1999). Internationally, different approaches are taken to the collection of forensic evidence and to the clinical and psychological assessment of alleged victims Berry et al 2014).…”