Defined succinctly by the New England Journal of Medicine, sexual assault is a broad term that can include rape, unwanted touching of genitalia, or even forced viewing of pornography or related materials.
Sexual assault is a complicated problem that can impact every victim differently. It can involve an intertwined trio of psychological, physical, and legal ramifications.
After a sexual assault occurs, a long list of follow-up steps can pop up for a victim. One of the first next steps to take should be to consult a healthcare professional as quickly as possible – this is crucial.
Time is of the essence of the treatment for physical consequences from sexual assaults. However, overall treatment post-sexual assault typically consists of both mental and physical components.
FAST FACT: to understand the true extent of the issue in the United States, there are a multitude of organizations that offer information about sexual assault-related statistics. Some examples of reputable organizations that offer insight into the prevalence of sexual assault are the Bureau of Justice Statistics (BJS), Centers for Disease Control and Prevention (CDC), and the Rape, Abuse & Incest National Network (RAINN). However, these statistical outlets also note that sexual assault cases are distinctly underreported.
It is not possible to cover all aspects of post-sexual assault courses of treatment in a single article, but this discussion breaks down certain thoughts about medications specifically for sexual assault victims. Although men can also be victims of sexual assault, this discussion primarily focuses on women.
Medication treatment post-sexual assault most commonly encompasses emergency contraception and STD prevention. Additional treatments can be given, but they are highly dependent on the situation and specific type of injuries obtained.
Psychological and behavioral therapies are also commonly administered, but those aren’t typically medicine-related as a first-choice option. CBT, counseling, or other types of similar interventions may be recommended by a behavioral health professional.
Emergency Contraception
After a sexual assault occurs, emergency contraception may be warranted. However, there are a few different options to consider.
A ParaGard IUD (copper IUD) is noted to be up to 99.9% effective, but it must be placed by a healthcare professional into the uterus. It must be placed within 5 days after the assault occurs.
Ella (ulipristal acetate) is an oral pill taken as a single dose. Ella works best if it is taken within 5 days after an assault occurs, but it may be less effective in patients weighing more than 195 pounds (88.5 kg). Ella requires a prescription from a prescriber.
Plan B One-Step (or generic) is another oral pill taken as a single dose. Plan B One-Step works best if it is taken within 3 days after an assault occurs, but it may be less effective in patients weighing more than 165 pounds (74.8 kg). A prescription is not needed for Plan B One-Step.
As a general concept, the sooner emergency contraception is started, the more effective it typically is.
Prevention of Sexually Transmitted Diseases (STDs)
Starting a preventative medicine for STDs does not occur for every sexual assault scenario. However, depending on the offender(s) and the situation, medicine may be prescribed to prevent an STD from developing. The list below is not an all-encompassing list of possible STDs.
Chlamydia preventative therapy has two primary first-choice options. One option would be to take azithromycin as a single oral dose or another would be to take doxycycline orally 2 times per day for 7 days.
Gonorrhea preventative therapy has a few first-choice options. Commonly, it can consist of either a singular ceftriaxone intramuscular injection, a singular oral dose of cefixime, or a singular dose of azithromycin.
Hepatitis B preventative therapy is typically covered through the Hepatitis B vaccination series. If not already immunized, a patient would receive a vaccination dose in the emergency room, followed by a second dose 1-2 months later, and a third dose 4-6 months after the first dose.
HIV preventative therapy varies, and it’s especially crucial to obtain a medical evaluation < 72 hours (3 days) after a sexual assault occurs. If the aggrevator is HIV positive, then time is especially of the essence.
HIV medications, regardless if in the preventative or in the treatment setting, are highly patient-specific. However, one common HIV preventative regimen for patients without contraindications is Truvada (tenofovir TDF/emtricitabine) or Descovy (tenofovir TAF/emtricitabine) taken orally once daily for 28 days.
Of note, the CDC does not have guidelines for HIV prevention in cases of sexual assault when the HIV status of the aggrevator is unknown. As a result of this lack of guidance, treatment initiation is up to the discretion of the healthcare professional.
Tetanus preventative therapy is typically covered through a tetanus booster as needed.
Trichomoniasis preventative therapy typically consists of a singular oral dose of metronidazole.
As a bonus, see the previous Pharmacist Consult article discussing Common First-Line STD Treatment Options. Although, keep in mind that prevention and treatment are two different methodologies.
Treatment of General & Genital Injuries
General body trauma and/or genital injuries are commonly reported by rape victims. Injuries as such should be treated by specialists in an emergency-care type setting. General injuries can consist of, for example, lacerations, blunt injuries, broken bones, etc.
For injuries of this type, the sooner that immediate medical attention can be accessed, the better.
A Sexual Assault Evidence Kit (SAEK), commonly known as a rape kit, is also an important thing to be aware of. If a victim were to call the National Sexual Assault Hotline at 800.656.HOPE (4673), the hotline operators can help direct the caller to a nearby treatment facility.
Getting a forensic evaluation (via a SAEK) is usually free, it increases the likelihood of offender prosecution, and it can help with a victim’s physical evaluation, diagnosis, and treatment.
Other Organizational Resources (Crisis Intervention and Emotional Support):
- National Sexual Assault Hotline (available 24/7): 1-800-656-4673
- For those that prefer a chat function, utilize this option.
- Administration for Children & Families within the US Department of Health & Human Services
- DrugAbuse.com (courtesy of the American Addiction Centers)
- HelpGuide.org
- National Sexual Violence Resource Center (NSVRC)
- RAINN
- Resources By State On Violence Against Women
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Sexual Assault – Victim Connect Resource Center
- College students: most university health departments offer more specific, local resources
References:
- Linden JA. Care of the Adult Patient after Sexual Assault. N Engl J Med 2011; 365:834-841. DOI: 10.1056/NEJMcp1102869
- Sexual Assault and Abuse and STDs. Centers for Disease Control and Prevention. Last updated 4 June 2015. Accessed 9 August 2020.
- Effects of Sexual Violence. RAINN. Accessed 10 August 2020.
- What is a Sexual Assault Physical Exam? RAINN. Accessed 10 August 2020.
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