Sexual assault

Overview
Sexual assault is defined as being forced to participate in a sexual activity against your will. The force may involve physical restraint or being overpowered; coercion through threats to your life or physical safety; or taking advantage of your incapacity if you have a mental illness or developmental disability, are intoxicated, or have taken or been given drugs.
Rape is a type of sexual assault involving either vaginal, oral or anal penetration without your consent. Although what constitutes rape is defined by law and state statutes, such activity is usually considered to be rape whether the person who has been assaulted is male or female and whether or not the victim and assailant are legally married. Such activity may also be considered rape if the person who has been assaulted is incapacitated (through intoxication or "date rape" drugs for example) or incapable of giving consent (mentally ill, developmentally disabled or an elderly person with dementia, for example).

Sexual assault is driven by aggression, not sexual desire. The gender of the person who has been assaulted is not necessarily an indicator of the assailant's sexual preference. Many assailants who have raped men report a sexual preference for women, having relationships with women as well as men, and having a female intimate partner.


Special populations
Men
Men who've been raped comprise 6 to 10 percent of those seeking help at sexual assault treatment centers. The number of male rape victims is considered highly underreported due to social stigma, however. Men often receive little social support after an assault.

When men are rectally raped, pressure on the prostate can produce erection and sometimes orgasm. Because of this, heterosexual men who've been raped often have concerns about their sexual orientation following such an assault. They may need to be reassured that these are physiological reactions and don't necessarily indicate a homosexual orientation.

Men who've been raped are often concerned about what might have motivated an assault from another man, such as appearing effeminate. These men may need reassurance that they didn't cause the assault -- rape is driven by aggression rather than sexual desire.

Post-traumatic symptoms common among men who've been raped are similar to those of women who've been raped, such as fear, depression, suicidal thoughts or behavior, anger, physical complaints, sexual dysfunction and impaired peer relationships.

Gay and lesbian men and women
Gay and lesbian men and women who've been sexually assaulted typically experience the same emotional reactions as heterosexual men and women in the same situation. They may feel more vulnerable and stigmatized, however. The degree to which they recover from the assault often depends on the degree of discrimination they face and the degree to which they receive support.

Same-gender assaults are often erroneously labeled as "homosexual assault," but most same-gender sexual assaults involve heterosexual men assaulting gay men as a means of humiliation or embarrassment. In some states, such assaults of gay men may be prosecuted as hate crimes. Some heterosexual men assault lesbian women in an effort to "reorient" them to heterosexuality. Woman-against-woman assaults are rare, but do occur. Women sexually assaulted by other women experience the same emotional reactions as those who've been assaulted by men, and may also question their sexual orientation.

Developmentally disabled individuals
An estimated 68 to 83 percent of people who are developmentally disabled will be sexually assaulted in their lifetime. This shocking statistic makes people who are developmentally disabled 50 percent more likely to experience sexual assault than the general population.

Nearly 100 percent of sexual assault cases involving a person who is physically disabled are perpetrated by someone the person knows. Thirty percent of cases involve a family member, 30 percent a friend and 27 percent a service provider. A person who is developmentally disabled may be reluctant to report sexual assault by a service provider because it may threaten his or her independence. For example, a person who accuses a staff member of a group home of sexual assault may be reinstitutionalized.

The ability of a person who is developmentally disabled to understand and process information may be limited, making him or her particularly vulnerable to assault. Simple language and concrete examples are needed to ensure proper communication.

People who are physically disabled experience the same emotional reactions as other people who have been sexually assaulted, but may also need to deal with how their disability may have made them vulnerable to assault. They may need to be reminded that able-bodied people are also sexually assaulted and that the assault is not only a function of their physical disability.

Elderly adults
Elderly adults may be more vulnerable to sexual assault than the general population because of decreased strength and agility, declining cognitive abilities and dependence on caregivers. Elderly women are at increased risk for vaginal tears and injury due to decreased lubrication, decreased elasticity of the vaginal walls, and atrophy and thinning of the vaginal tissues. An elderly person may be reluctant to report sexual assault, afraid that a report might compromise his or her independence.

Refugees
Of refugees those who leave their home country for political asylum who seek counseling, 80 percent of women and more than 50 percent of men report experiencing sexual torture or rape during conflict in their home country. Illegal immigrants (those who choose to leave their home country without legal permission) may be reluctant to report sexual assault to authorities for fear they may be deported. Refugees or immigrants may be unaware of their rights or not know how to access services to cope with sexual assault.


"Date rape" drugs
Rohypnol, gamma hydroxybutyrate (GHB) and ketamine have emerged in the last few years as popular "date rape" drugs. These drugs are odorless, colorless and tasteless, allowing them to be secretly added to a beverage and unknowingly ingested. These drugs incapacitate a person so that he or she cannot resist a sexual assault, and often cannot remember it later.
Rohypnol (flunitrazepam)
Street names include rophies, roofies, roach and rope. Although the drug's importation into the United States is banned, it's available in Mexico. A sedative or hypnotic effect begins 20 to 30 minutes after ingestion and lasts for six to eight hours. The person experiences lack of inhibition and anterograde amnesia, in which he or she cannot remember events experienced while under the influence of the drug. Rohypnol is potentially lethal when mixed with alcohol or other central nervous system depressants.

GHB
GHB is a central nervous system depressant that has been abused in the United States for euphoric, sedative and anabolic (body building) effects. The drug is difficult to distinguish from water. Street names include liquid ecstasy, soap, easy lay, Georgia home boy or great hormones at bedtime.

GHB was widely available over the counter at health food stores until 1992. It's currently available online and at many gyms, college campuses, raves, nightclubs and on the street.

Effects of GHB include sedation and seizures (especially when combined with methamphetamines). In some cases, GHB can cause a coma. When combined with alcohol, it can produce difficulty breathing and nausea.

GHB is highly addictive and withdrawal is intense, occurring within six to eight hours. Withdrawal effects include insomnia, anxiety, tremors and sweating.

Ketamine
Ketamine is an anesthetic approved in the United States for human and animal use, but it's mostly sold for veterinary use. Street names include special K and vitamin K. Effects of the drug include dream-like states and hallucinations, delirium, amnesia, impaired motor function, high blood pressure and depression. Potentially fatal respiratory problems can also occur.


Characteristics
Physically, a person who has been sexually assaulted may have vaginal or anal injuries, bruising, an unwanted pregnancy or sexually transmitted disease, or other injuries sustained during the sexual assault.
Psychologically, you may feel embarrassed, vulnerable, violated or paranoid. You may be angry at the attacker or yourself for having been na with no particular target. You may fear for your physical safety or a repeated assault. You may be concerned about friends' or loved ones' reactions to the incident. You may also have nightmares and experience again any prior sexual assaults or traumas. You may feel uncertain or deny that the experience was actually sexual assault.

Socially, you might avoid certain places or situations. You may have interpersonal difficulties or experience relationship problems with your partner. You may be reluctant to engage in healthy consensual sex. You may question your gender identity or sexual orientation. You may be hesitant to report the incident to authorities or talk about the incident. Social isolation or substance use can also occur.

Symptoms such as decreased energy, anxiety, depression, inability to concentrate and hopelessness may warrant further evaluation by a health care professional.

As with all physical symptoms, consult your medical doctor to rule out a medical condition. If these or any other symptoms cause you distress that doesn't seem to improve, seek additional help and support from a mental health care professional.


Coping strategies
Medical examination
A medical exam should be done as soon as possible after a sexual assault occurs. The person who has been assaulted should not shower or douche before this medical exam to avoid destroying valuable physical evidence of the sexual assault. In most states, postrape medical care is financially supported by the state or victims' advocacy groups when a police report has been filed.

People who have been sexually assaulted may be reluctant to undergo such an exam immediately after the assault due to shame, self-blame or fear of exposing themselves to further humiliation. However, a medical exam can ensure proper treatment for physical injuries sustained during the assault, screen for sexually transmitted diseases and unwanted pregnancy, and provide preventive birth control if necessary. Evidence gathered during the exam can establish that sexual activity occurred and the injuries sustained were inconsistent with consensual sex, as well as determine the identity of the alleged assailant through DNA samples.

Reporting the assault
People who have been sexually assaulted are often reluctant to report the assault to the authorities. In fact, only an estimated 14 to 32 percent of sexual assaults or rapes are ever reported to the police. There may be many reasons behind this reluctance to report sexual assaults. For example:

People who have been sexually assaulted often blame themselves for the assault and may fear being blamed by others for allowing the assault to happen.

People who have been sexually assaulted often fear their names will be made available to the media and the assault will be publicized.

People who have been sexually assaulted often fear unsympathetic responses from authorities.

More than 60 percent of men and women who have been sexually assaulted report being assaulted by a person they know, and 18 percent of women who have been sexually assaulted report being assaulted by people with whom they are intimate. They may fail to report the assault for fear of jeopardizing these relationships. People in dependent relationships with their assailant (such as a person who is elderly or disabled) may be particularly reluctant to report the abuse.

Women often fail to recognize cases of sexual assault. Only an estimated 11 to 27 percent of women who have experienced assaults meeting the legal definition of rape actually consider the assaults to be rape. Women who have been victimized repeatedly may become desensitized to the warning signs of pending sexual assault and fail to recognize dangerous situations.

Men are often reluctant to report sexual assault for fear of being perceived as homosexual or "less of a man" if they do so. Because many people believe the misconception that only women are victims of rape, many men who have been sexually assaulted may fail to consider their assaults rape.

Gay and lesbian men and women often fear unsympathetic or homophobic reactions from authorities if they report cases of sexual assault.
Establishing personal and public safety are compelling reasons to report a sexual assault. Because sexual assault perpetrators often continue their assaults, go on to victimize others, and do not stop their behavior or seek treatment until they're jailed or otherwise incarcerated, it is particularly important to report all cases of sexual assault.

If you've been sexually assaulted, crisis intervention counseling can help you work through the trauma and associated psychological issues. Legal assistance and victims' advocacy groups can provide other needed services. A support group for people who've been sexually assaulted can help you connect with others facing similar situations.