SEXUAL ASSAULT Sexual assault Rapestatutory rape Rape defined

SEXUAL ASSAULT

• Sexual assault = Rape/statutory rape • Rape defined as: the unlawful compelling of a person through physical force or duress to have sexual intercourse.

• Statutory rape = sexual intercourse with a girl/boy under the age of consent • Sexual assault = rape + other things like nonconsensual sexual touching, groping, kissing, child sexual abuse, sexual torture, attempted rape, sexual harassment

• Sexual harassment: intimidation & bullying of a sexual nature; unwelcome, inappropriate attention of a sexual nature; unwanted touching of a sexual nature; leering, catcalls, applying pressure to obtain sexual favors etc

• Elderly sexual assault: ovr 60 yo, usually unable to take care of themselves bcos of advanced age, illness, stroke, other disability, etc • Perpetrated usually by caretakers/caregivers

Premium times (Nov 9 th, 2015) – www. premiumtimesng. com “Only 18 rape convictions in Nigeria’s legal history – lawyer” Mr Evans Ufeli (human rights lawyer in practice for over 10 yrs)

“Prevalence & pattern of rape among girls and women attending Enugu State University Teaching Hospital, southeast Nigeria” (International Journal of Gynaecology and Obstetrics, 2015) (Ohayi et al)

Findings: q of 1374 gyn emergencies, 121 rapes (8. 8%) q Mean age: 13. 1± 8. 1 yrs q. By presentation, more than 72 hrs had passed for majority q. Perpetrators known to >80% of the young victims q. Four (3. 3%) became pregnant

“Reported sexual violence among women and children seen at the Gynecological emergency unit of a rural tertiary health facility, northwest Nigeria” Annals of Medicine & Health Science Research, 2015. (Ashimi, A, Amole, T & Ugwa, E)

Findings: v. Prospective study, 1/9/2011 to 31/8/2013 v. During the period, 973 consultations for gyn emergencies, out of which 24 cases were of sexual violence (3%) v 22/24 (97. 4%) were children < 16 yo, 11/24 had no formal education, 8/24 were hawkers v. Perpetrators were known in 20/24, of which 11 were neighbors, 7 were customers & 2 were family members

“Correlates of self-report of rape among male school adolescents in Ile-Ife, Nigeria” (Ogunfowokan et al, Journal of Interpersonal Violence, 2014) o 338 male adolescents, mean age 16 yo o 6% had raped an adolescent girl in the past o Of the rapists, 55% had raped their sexual partners & 55% had participated in gang rape in the past o Factors associated with rapes: smoking , Et. OH, & being a 1 st born son o For rape prevention programs, male adolescents are an important group to target.

Males can be victims too! Usually perpetrated by other males, especially in prisons. Sodomy – “anal intercourse” Females can be perpetrators too when the male is under the age of consent ie a juvenile (statutory rape) Adult men can be raped by adult women too. Tactics are different but if unwanted, the women are rapists. – unwanted kissing, groping & other sexual activities leading to forced attempted or completed sexual intercourse.

• Effects of sexual assault: 1. Physical trauma & consequences, STIs & consequences, unwanted & unplanned pregnancies 2. Psychological effects – anger, anxiety, feeling of guilt & self blame, depression, nightmares, subsequent sexual dysfunction, promiscuity, hating of sex, PTSD, addiction etc

Role in a case of rape: 1. Hx & PE (rape kit) – absence of sperm does not exclude that rape may have indeed taken place 2. Non-cellular semen markers(acid phosphatase, though also found in vaginal fluid in smaller quantity, (very high levels are found in seminal fluid{500 -1000 x > any other bodily fluid}), PSA (p 30) a glycoprotein derived from prostatic cells, whether or not man is vasectomized. Females never have p 30/PSA )

p 30/prostate specific antigen: P 30 is a semen-linked glycoprotein of prostatic origin. Semen contains high levels, in both normal & vasectomized men. Absent in women, therefore highly likely a male-specific antigen. Detectable in vaginal fluid for up to 27 hrs post coitus; c/w acid phosphatase which is detectable for only approx 14 hrs post coitus.

Acid Phosphatase Acid phosphatase is a lysosomal enzyme that is present in bone, skin, kidney, liver, intestine , blood cells and prostate. The prostate contains very high levels.

Blood group typing ABO(H) antigens occur on red blood cells They are soluble and can be secreted into bodily fluids such as semen or vaginal fluid 80% of people are “secretors” If to be used in sexual assault case, blood group of victim and suspect must be checked out

DNA Even in the absence of ejaculation, it could be possible to collect male DNA from a sexual assault victim that could be linked to the suspect from the shedding of penile skin cells. Female DNA belonging to the victim could be obtained from the penis or a different male DNA belonging to the victim could be obtained from the penis of a suspect(in homosexual rapes)

3. Treat injuries promptly 4. Provide psychological support & counselling

5. Legal evidence (very important in some parts of the world. Very doubtful that it is useful in Nigeria) 6. Prevention of STIs, (Neisseria gonorrhea & Chlamydia trachomatis) HIV & pregnancy (must intervene before 72 hrs)

• Pregnancies resulting from rape worldwide ranges from 5 -18% in different studies • Children of rape face a lifetime of difficult relationships with their mothers & other family members

• Some studies suggest that conception rates from rapes are higher for biological reasons (release of hormones that lead to reflex ovulation)(Jochle, Wolfgang, Gottschall, Jonathan, Gottschall, Tiffani). Myth & misinformation in the dark ages stated that for a woman to conceive, she has to “enjoy” sex & since rape is forced sexual intercourse, it can never lead to pregnancy.

Current scientific consensus is that pregnancy is not any more or less likely to result from rape, considering all conditions being equal, that promote pregnancy (the act of intercourse, ovulation, normal sperm count, normal uterine lining etc).

SUMMARY 1. Sexual assault is a violation, a terrible crime! 2. It can occur to both sexes, adults & children 3. It has both physical and long-standing psychological consequences 4. It is a taboo subject, many ( maybe most) go unreported

5. As physicians, we must treat reported rapes professionally, have sympathy for victims & treat them tenderly, protecting their privacy & doing all we can to seek justice for them in the law courts 6. Must remember to prevent STIs, pregnancies & HIV, when possible.

7. When a woman is pregnant as a consequence of rape, whether or not to keep the pregnancy & child is a decision faced by her & the family. Often a very difficult decision for religious and conservative people.

8. Remember (even if you don’t remember any of this lecture) that rape is NEVER the fault of the victim!! Always try to educate those who blame rape victims, especially if they are respected members of the community such as pastors & others who are ignorant even though they should know better.