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Butler County Rape Crisis Program
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110 S. College Avenue, Oxford, OH 45056
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WHAT ARE THE EMERGENCY MEDICAL
CONCERNS I SHOULD BE AWARE OF?
·Sexual assault victims may be unaware of serious (even life-threatening)
injuries they sustained during the assault. For example, if the victim's head was banged against the floor or a wall, she may have sustained a serious "closed head" injury. If you have been sexually assaulted, seek out professional medical assistance as soon as possible. Don't rely on on-line information, the advice of friends, etc.- the bottom line is you need to get professional medical attention as soon as possible.
·Following a sexual assault, the victim's body preserves
evidence of the crime. Within an hour, this physical evidence begins to deteriorate. Within 72 hours, most physical evidence of the crime which was left on the victim's body is gone. In order to preserve evidence, recent rape victims should go directly to the hospital without changing clothes, bathing, showering, douching, eating, drinking, brushing teeth, changing tampons or pads, using the toilet, etc. If possible, they should bring a complete change of clothing with them, since shoes and clothing may be taken as evidence. BUT REMEMBER, even if the assault happened some time ago, many forms of important evidence may still exist (torn or stained clothing or sheets, hairs and fibers, bruises, bitemarks, witness statements, etc.). Police departments and/or hospital staff may be able to find evidence victims are unaware of (for example, even one hair root or a small amount of semen or saliva on the skin or clothing can be used in DNA testing). Even if the assailant used a condom, or if the victim has already showered, evidence may still be available. Only law enforcement and forensic professionals can determine whether or not there is enough evidence of the crime available to support prosecution.
·Remember, ONLY a hospital emergency department or designated SANE (Sexual Assault Nurse Examiner) organization can provide an evidence collection examination for the victim. This type of physical evidence is very powerful in criminal prosecutions. Victims do not have to go through the evidence collection exam, but if there is any chance at all that they may decide to press charges, they need to have the evidence collected ASAP. Having physical evidence collected DOES NOT obligate victims to press charges, but it does help to keep their options open.
·After physical evidence on the victim's body and clothing have been collected at the hospital, the police will be called to pick up the evidence, and they will need to speak with the victim briefly about the crime. The case will be assigned to a detective and an investigation of the crime will begin. It is important to realize that individual police departments vary in their willingness to allow victims to change their minds about pressing charges.
·Hospitals can also provide diagnosis and treatment of injuries,
sexually transmitted infections, and
pregnancy. Planned Parenthood or a family doctor would be the best referrals for help with these concerns if the victim does not want to go to a hospital. In order to get an appointment quickly, the victim may need to tell the receptionist at Planned Parenthood or her doctor that she has been assaulted.
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2. INFORMATION YOU SHOULD KNOW AS A SURVIVOR OF SEXUAL ASSAULT
(based upon a fact sheet given to sexually assaulted patients when they are examined in Ohio hospitals, developed by the Ohio Department of Health)
You have been violently assaulted. This assault was both physical and emotional. You are safe here. The people here with you are here to help. You will need to begin the recovery process by answering some questions about the assault. There will be questions that will be asked of you that we know will be difficult and sometimes painful. These questions may include:
-When was your last voluntary sexual contact?
-Do you know the person who raped or sexually assaulted you?
-Have you ever had voluntary sex with this person before?
-Had you been using drugs or alcohol?
-Are you currently using birth control?
None of the questions are intended to imply that you were at fault in your assault occurring. You are not to blame for this assault. The information and specimens being requested will enable us to get a complete medical history. The specimens will help document circumstances and events in regard to the assault. Doctors, nurses and other medical staff will ask some of these questions so that they can provide the best medical care to ensure your physical health.
The law enforcement officer will ask some of the same and additional or similar questions to better enable them to apprehend the assailant in the event you decide to press charges. Since the crime of rape/sexual assault is a felony offense, hospital personnel are required by law to report this assault to the law enforcement officer. You are encouraged to talk to law enforcement personnel so that they will have on record the fact that this crime has taken place. It is always your right to decide whether or not to talk with the law enforcement representative.
If you choose to work with law enforcement, a detective will develop the
evidence in the case through inspection of the crime scene, interviews with
witnesses, and submission of the physical evidence to a forensic evidence
laboratory. After the investigation has been completed, the detective
will turn all of this information over to the local Prosecuting Attorney, who decides whether or not
enough evidence is available to prosecute the case. It is your right to have someone of your choosing remain with you at all times during law enforcement questioning and during the medical exam.
If you choose to talk to a law enforcement officer, they will want to know the date and time of the assault and the location where the assault took place. You will want to obtain the names, badge numbers and telephone numbers of the officers who meet with you in the hospital. Having this information on hand will enable you to phone them if you remember additional information regarding the attack or wish to inquire about the status of your case.
After all the paperwork is completed, you will be asked to undress and your clothes will be retained as a part of evidence collection. If you did not bring additional clothing to wear home, you may either call a family member or friend and ask them to bring clothes to the hospital or inform hospital personnel of your need for clothing. Many hospitals maintain a supply of clothing for sexual assault survivors.
A doctor, emergency nurse or
Sexual Assault Nurse Examiner (forensic expert) will examine you for physical injury. Because much of the evidence of the assault could be on your body, it is important that specimens be taken from various areas of your body, including from your fingernails, samples of pubic hair, swabbing the inside of your mouth, vagina, and rectum. This is a routine part of the examination that occurs for every rape survivor. A blood sample may be drawn. Depending upon the kinds of injury, x-rays may be taken. You may want to discuss with the attending physician, nurse or social worker your concerns about pregnancy and sexually transmitted infections, including HIV/AIDS.
We recognize that you have been through a terrible experience. We are here to help. Information about other services that may assist you will be provided before you leave. YOU ARE A SURVIVOR.
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THE FOLLOWING INFORMATION SHOULD BE GIVEN TO THE SEXUAL ASSAULT SURVIVOR AFTER THE MEDICAL EXAM BUT PRIOR TO LEAVING THE EMERGENCY DEPARTMENT
I. Common Reactions
Rape or any form of sexual assault is one of the most painful and upsetting things that can happen to a person. After the assault, you may be frightened, angry, experience restlessness, and an inability to concentrate. You may experience disbelief or denial, depression, mistrust of people and a lack of confidence in yourself. Feeling guilty, embarrassed and ashamed are also common reactions. All of these reactions are normal, understandable reactions to being raped.
With time and understanding, these feelings and experiences will subside. Rape causes a great deal of disorganization in your life. Give yourself permission to take as long as you need to heal and recover. It often helps to talk with someone, particularly someone trained in rape issues, about the feelings you are experiencing.
II. What to expect from this point on
A. Follow-up law enforcement investigation
Whether or not your assailant is prosecuted, the law enforcement officer may be back in touch with you. You will probably have an interview with a detective trained in sexual assault investigation. The time and place of the interview will depend upon your physical and emotional circumstance, as well as the law enforcement's policy about follow-up interviews. You will have to talk about the assault again. Try to recall as much detail about the assault as possible. If at any time you feel uncomfortable as to why a certain question is being asked of you, you have the right to ask the police officer to explain the reason for the question. Remember, you have the right to have someone of your choosing with you during law enforcement interviews.
B. Follow-up medical treatment
Five to six weeks after your examination in the emergency room, you should be rechecked for sexually transmitted infections, including AIDS. This will involve a blood test and pelvic examination. You will then have more information available to you to enable you to make choices about your health and future.
While only about 1% of rape survivors become pregnant as a result of the attack, you may want to have a pregnancy test conducted at this same time.
You may make appointments for these tests with your personal doctor, free clinic, women's health center, neighborhood health clinic or hospital.
For information about free or low-cost AIDS testing you may call your local Planned Parenthood or
community health clinic. In Butler County, Ohio, you may telephone the Community Counseling & Crisis Center's 24-hour hotline (numbers listed at the bottom of this page) for referrals.
C. Support services
People who have been trained to work with survivors of rape are available to talk with you about your feelings. They can also help you with legal and medical questions. You don't have to go through this alone. Crisis counseling after an assault can make a difference. You are not going crazy and these feelings will not last forever.
Follow your inner feelings about the people you trust with your emotions and don't be afraid to question what they say and how they act towards you. Choose someone who will understand your experience and feelings and who will allow you to take as much time as you need for your recovery.
ADDITIONAL INFORMATION ON SEXUALLY TRANSMITTED INFECTIONS (STI's) AND PREGNANCY:
It is virtually impossible to tell immediately after a sexual assault if you have contracted any sexually transmitted diseases or have become pregnant. The tests you were given at the hospital were base line tests, which determined whether you had any infections or were pregnant at the time of the assault. The tests for sexually transmitted diseases need to be repeated so as to get reliable results.
A test for chlamydia can be repeated within 2 to 4 weeks after exposure. A pelvic examination will be required. If you notice any chronic itching or vaginal discharge, abdominal pain, bleeding between periods or heavier bleeding for prolonged periods, or fever, contact your doctor or gynecologist. Up to 80% of women have no symptoms of chlamydia in its early stages. In men, some of the symptoms include discharge from the penis, a burning or itching sensation during urination, that may appear during the morning but go away later in the day.
A test for gonorrhea can be repeated within 10 to 14 days following the assault. This will require a pelvic examination. The test for syphilis can be repeated with reliable results in 6 to 8 weeks.
A blood test is required and some clinics may also require a pelvic exam. Gonorrhea and syphilis should show up on these subsequent tests if they were contracted from the assault. It is important to keep in mind that in the early stages of gonorrhea and syphilis, there are no symptoms in women. Repeat tests are the only way to know if you have contracted an infection. Both diseases are fairly easy to cure with antibiotics, especially in the early stages.
Tests for herpes and genital warts must be performed when symptoms appear. The herpes virus may show some symptoms soon after the assault. Genital warts may take as long as 3 months to show up after the assault. If you notice any sores, blisters or pimples in your genital or anal regions, see your doctor or gynecologist.
Hepatitis B is a sexually transmitted virus that is not routinely tested for. It may take up to 6 months or longer before any symptoms appear. Symptoms may include nausea, weight loss, dark urine, feeling sick or run down, abdominal pain or cramping (without a menstrual period), and yellow eyes. There may not be any symptoms so you may want to check with your doctor.
AIDS is caused by a virus known as the human immunodeficiency virus (HIV). many victims of sexual assault are extremely fearful
that they may have been exposed to HIV during the assault. Remember that if
you press charges against your assailant, you have the right to request that
he be tested for HIV. For more information, see our
"Legal Information" page (or click on the
link called "Victims Rights in Ohio").
There are two options in HIV testing: anonymous or confidential. Testing done anonymously means that your name will not be taken. If the test is confidential, your name will be taken. This would mean that the test results become part of your permanent medical record and some insurance companies ask to review your records before insuring you or paying your medical claims. Some people feel that the very fact that you have had the test may cause an insurance company to be biased against you. This may be an important consideration to you if you do not want anyone to know that you took a HIV test. A test for HIV infection should be repeated twice, at 3 months and 6 months after the assault.
It can take up to 6 months for the antibodies associated with HIV to show up on the test. It is very important that you and your partner take protective measures such as wearing a condom until you are found to be HIV negative at the 6 month test. In addition, do not donate blood until that time.
At the hospital you were also given a base line pregnancy test to determine if you were pregnant at the time of the assault. If you were not provided with pregnancy prevention options, and miss a period after the rape, get a pregnancy test. Keep in mind that the pregnancy test kits sold in stores may not give an accurate result as those kits may have been in the store for a long time. A urine pregnancy test 3 weeks after your assault is recommended.
A follow-up medical evaluation 3 to 4 weeks after the assault is a good idea. This information is not intended to be a comprehensive list of the different kinds of follow-up medical care you may need. You should follow the instructions the emergency department doctor and nurse gave you; and if you have any questions, you may wish to call one of the following agencies for assistance:
-your local city or county health department
-a women's health center
-a neighborhood health clinic
-the hospital where you were examined and treated after the sexual assault
-a rape crisis center or victim/witness program
In an emergency,
please call 911
or go directly to your local hospital.
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