Rape

Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without that person’s consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person who is incapable of giving valid consent, such as one who is unconscious, incapacitated, has an intellectual disability or is below the legal age of consent.[1][2][3] The term rape is sometimes used interchangeably with the term sexual assault

People who have been raped can be traumatized and develop posttraumatic stress disorder.[10] Serious injuries can result along with the risk of pregnancy and sexually transmitted infections. A person may face violence or threats from the rapist, and, in some cultures, from the victim’s family and relatives.

Rape is defined in most jurisdictions as sexual intercourse, or other forms of sexual penetration, committed by a perpetrator against a victim without their consent.[17] The definition of rape is inconsistent between governmental health organizations, law enforcement, health providers, and legal professions. It has varied historically and culturally. Originally, rape had no sexual connotation and is still used in other contexts in English. In Roman law, it or raptus was classified as a form of crimen vis, “crime of assault”. Raptus described the abduction of a woman against the will of the man under whose authority she lived, and sexual intercourse was not a necessary element. Other definitions of rape have changed over time.

Until 2012, the Federal Bureau of Investigation (FBI) considered rape a crime solely committed by men against women. In 2012, they changed their definition from “The carnal knowledge of a female forcibly and against her will” to “The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” The previous definition, which had remained unchanged since 1927, was considered outdated and narrow. The updated definition includes recognizing any gender of victim and perpetrator and that rape with an object can be as traumatic as penile/vaginal rape. The bureau further describes instances when the victim is unable to give consent because of mental or physical incapacity. It recognizes that a victim can be incapacitated by drugs and alcohol and unable to give valid consent. The definition does not change federal or state criminal codes or impact charging and prosecution on the federal, state or local level; it rather means that rape will be more accurately reported nationwide.[21][22]

Health organizations and agencies have also expanded rape beyond traditional definitions. The World Health Organization (WHO) defines rape as a form of sexual assaultwhile the Centers for Disease Control and Prevention (CDC) includes rape in their definition of sexual assault; they term rape a form of sexual violence. The CDC lists other acts of coercive, non-consensual sexual activity that may or may not include rape, including drug-facilitated sexual assault, acts in which a victim is made to penetrate a perpetrator or someone else, intoxication where the victim is unable to consent (due to incapacitation or being unconscious), non-physically forced penetration which occurs after a person is pressured verbally (by intimidation or misuse of authority to force to consent), or completed or attempted forced penetration of a victim via unwanted physical force (including using a weapon or threatening to use a weapon) Some countries or jurisdictions differentiate between rape and sexual assault by defining rape as involving penile penetration of the vagina, or solely penetration involving the penis, while other types of non-consensual sexual activity are called sexual assaultScotland, for example, emphasizes penile penetration, requiring that the sexual assault must have been committed by use of a penis to qualify as rapeThe 1998 International Criminal Tribunal for Rwanda defines rape as “a physical invasion of a sexual nature committed on a person under circumstances which are coercive” In other cases, the term rape has been phased out of legal use in favor of terms such as sexual assault or criminal sexual conduct.

Scope

Victims of rape or sexual assault come from a wide range of genders, ages, sexual orientations, ethnicitities, geographical locations, cultures and degrees of impairment or disability. Incidences of rape are classified into a number of categories, and they may describe the relationship of the perpetrator to the victim and the context of the sexual assault. These include date rape, gang rape, marital rape, incestual rape, child sexual abuse, prison rape, acquaintance rape, war rape and statutory rape. Forced sexual activity can be committed over a long period of time with little to no physical injury

Most rape is committed by someone the victim knows. By contrast, rape committed by strangers is relatively uncommon. Statistics reported by the Rape, Abuse & Incest National Network (RAINN) indicate that 7 out of 10 cases of sexual assault involved a perpetrator known to the victim.

The WHO report describes the consequences of sexual abuse:

Unwanted pregnancy

  • Frequently, victims may not recognize what happened to them was rape. Some may remain in denial for years afterwardsConfusion over whether or not their experience constitutes rape is typical, especially for victims of psychologically coerced rape. Women may not identify their victimization as rape for many reasons such as feelings of shame, embarrassment, non-uniform legal definitions, reluctance to define the friend/partner as a rapist, or because they have internalized victim-blaming attitudesThe public perceives these behaviors as ‘counterintuitive’ and therefore, as evidence of a dishonest woman
  • During the assault, a person will respond with fight, flight, freeze, friend (sometimes called fawn)or flop. Victims may react in ways they did not anticipate. After the rape, they may be uncomfortable/frustrated with and not understand their reactions.Most victims respond by ‘freezing up’ or becoming compliant and cooperative during the rape. These are common survival responses of all mammals.This can cause confusion for others and the person assaulted. An assumption is that someone being raped would call for help or struggle. A struggle would result in torn clothes or injuries
  • Dissociation can occur during the assaultMemories may be fragmented especially immediately afterwards. They may consolidate with time and sleep.] A man or boy who is raped may be stimulated and even ejaculate during the experience of the rape. A woman or girl may orgasm during a sexual assault. This may become a source of shame and confusion for those assaulted along with those who were around them
  • Trauma symptoms may not show until years after the sexual assault occurred. Immediately following a rape, the survivor may react outwardly in a wide range of ways, from expressive to closed down; common emotions include distress, anxiety, shame, revulsion, helplessness, and guiltDenial is not uncommon.
  • In the weeks following the rape, the survivor may develop symptoms of post traumatic stress syndrome and may develop wide array of psychosomatic complaints. PTSD symptoms include re-experiencing of the rape, avoiding things associated with the rape, numbness, and increased anxiety and startle response The likelihood of sustained severe symptoms is higher if the rapist confined or restrained the person, if the person being raped believed the rapist would kill them, the person who was raped was very young or very old, and if the rapist was someone they knew The likelihood of sustained severe symptoms is also higher if people around the survivor ignore (or are ignorant of) the rape or blame the rape survivor
  • Most people recover from rape in three to four months, but many have persistent PTSD that may manifest in anxiety, depression, substance abuse, irritability, anger, flashbacks, or nightmares.In addition, rape survivors may have long term generalised anxiety disorder, may develop one or more specific phobias, major depressive disorder, and may experience difficulties with resuming their social life, and with sexual functioning People who have been raped are at higher risk of suicide
  • Men experience similar psychological effects of being raped, but they are less likely to seek counseling

Another effect of rape and sexual assault is the stress created in those who study rape or counsel the survivors. This is called vicarious traumatization

  • Physical
  • The presence or absence of physical injury may be used to determine whether a rape has occurredThose who have experienced sexual assault yet have no physical trauma may be less inclined to report to the authorities or to seek health care
  • While penetrative rape generally does not involve the use of a condom, in some cases a condom is used. Use of a condom significantly reduces the likelihood of pregnancy and disease transmission, both to the victim and to the rapist. Rationales for condom use include: avoiding contracting infections or diseases (particularly HIV), especially in cases of rape of sex workers or in gang rape (to avoid contracting infections or diseases from fellow rapists); eliminating evidence, making prosecution more difficult (and giving a sense of invulnerability); giving the appearance of consent (in cases of acquaintance rape); and thrill from planning and the use of the condom as an added prop. Concern for the victim is generally not considered a factor
  • Sexually transmitted infections
  • See also: Virgin cleansing myth and Prison rape in the United States § Sexually transmitted diseases
  • A street sign in South Africa, appealing to men not to rape children in the belief that it will cure them of HIV/AIDS.
  • Those who have been raped have relatively more reproductive tract infections than those not been raped HIV can be transmitted through rape. Acquiring AIDS through rape puts people risk of suffering psychological problems. Acquiring HIV through rape may lead to the in behaviors that create risk of injecting drugs.Acquiring sexually transmitted infections increases the risk of acquiring HIV. The belief that having sex with a virgin can cure HIV/AIDS exists in parts of Africa. This leads to the rape of girls and women. The claim that the myth drives either HIV infection or child sexual abuse in South Africa is disputed by researchers Rachel Jewkes and Helen Epstein
  • Victim blaming, secondary victimization and other mistreatment
  • Main articles: Victim blaming and Post-assault treatment of sexual assault victims
  • Society’s treatment of victims has the potential to exacerbate their trauma People who have been raped or sexually assaulted are sometimes blamed and considered responsible for the crime.[18] This refers to the just world fallacy and rape myth acceptance that certain victim behaviors (such as being intoxicated, flirting or wearing sexually provocative clothing) may encourage rape.[82][83] In many cases, victims are said to have “asked for it” because of not resisting their assault or violating female gender expectations.[84][83] A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. Women who have been raped are sometimes deemed to have behaved improperly. Usually, these are cultures where there is a significant social divide between the freedoms and status afforded to men and wome

Physical assessment

Many rapes do not result in serious injury.[96] The first medical response to sexual assault is a complete assessment. This general assessment will prioritize the treatment of injuries by the emergency room staff. Medical personnel involved are trained to assess and treat those assaulted or follow protocols established to ensure privacy and best treatment practices. Informed consent is always required prior to treatment unless the person who was assaulted is unconscious, intoxicated or does not have the mental capacity to give consent.Priorities governing the physical exam are the treatment of serious life-threatening emergencies and then a general and complete assessment.Some physical injuries are readily apparent such as, bites, broken teeth, swelling, bruising, lacerations and scratches. In more violent cases, the victim may need to have gunshot wounds or stab wounds treated The loss of consciousness is relevant to the medical history.If abrasions are found, immunization against tetanus is offered if 5 years have elapsed since the last immunization

Diagnostic testing

After the general assessment and treatment of serious injuries, further evaluation may include the use of additional diagnostic testing such as x-rays, CT or MRI image studies and blood work. The presence of infection is determined by sampling of body fluids from the mouth, throat, vagina, perineum, and anus

Forensic sampling

Main article: Rape investigation

Victims have the right to refuse any evidence collection. Victims advocates ensure the victims’ wishes are respected by hospital staff. After the physical injuries are addressed and treatment has begun, then forensic examination proceeds along with the gathering of evidence that can be used to identify and document the injuries. Such evidence-gathering is only done with the complete consent of the patient or the caregivers of the patient. Photographs of the injuries may be requested by staff. At this point in the treatment, if a victims’ advocate had not been requested earlier, experienced social support staff are made available to the patient and family.

If the patient or the caregivers, (typically parents) agree, the medical team utilizes standardized sampling and testing usually referred to a forensic evidence kit or “rape kit“.The patient is informed that submitting to the use of the rape kit does not obligate them to file criminal charges against the perpetrator. The patient is discouraged from bathing or showering for the purpose of obtaining samples from their hair. Evidence gathered within the past 72 hours is more likely to be valid.The sooner that samples are obtained after the assault, the more likely that evidence is present in the sample and provide valid results. Once the injuries of the patient have been treated and she or he is stabilized, the sample gathering will begin. Staff will encourage the presence of a rape/sexual assault counselor to provide an advocate and reassurance.

During the medical exam, evidence of bodily secretions is assessed. Dried semen that is on clothing and skin can be detected with a fluorescent lamp. Notes will be attached to those items on which semen has been found. These specimens are marked, placed in a paper bag,and be marked for later analysis for the presence of seminal vesicle-specific antigen. Though technically, medical staff are not part of the legal system, only trained medical personnel can obtain evidence that is admissible during a trial. The procedures have been standardized. Evidence is collected, signed, and locked in a secure place to guarantee that legal evidence procedures are maintained. This is known as the chain of evidence and is a legal term that describes a carefully monitored procedure of evidence collection and preservation. Maintaining the Chain of evidence from the medical examination, testing and tissue sampling from its origin of collection to court allows the results of the sampling to be admitted as evidence.The use of photography is often used for documentation

After the examination

Some physical effects of the rape are not immediately apparent. Follow up examinations also assess the patient for tension headaches, fatigue, sleep pattern disturbances, gastrointestinal irritability, chronic pelvic pain, menstrual pain or irregularity, pelvic inflammatory disease, multiple yeast infections, sexual dysfunction, premenstrual distress, fibromyalgia, vaginal discharge, vaginal itching, burning during urination, and generalized vaginal pain.

Women are typically offered contraceptive medications because about 5% of male-on-female rapes result in pregnancy.

Genital injuries

An internal pelvic exam is not recommended for sexually immature or prepubescent girls due to the probability that internal injuries do not exist in this age group. An internal exam may be recommended if significant bloody discharge is observed, though. A complete pelvic exam for rape (anal or vaginal) is conducted. An oral exam is done if there have been injuries to the mouth, teeth, gums or pharynx. Though the patient may have no complaints about genital pain signs of trauma can still be assessed. Prior to the complete bodily and genital exam, the patient is asked to undress, standing on a white sheet that collects any debris that may be in the clothing. The clothing and sheet are properly bagged and labeled along with other samples that can be removed from the body or clothing of the patient. Samples of fibers, mud, hair, leaves are gathered if present. Samples of fluids are collected to determine the presence of the perpetrator’s saliva and semen that may be present in the patients mouth, vagina or rectum. Sometimes the victim has scratched the perpetrator in defense and fingernail scrapings can be collected.

Injuries to the genital areas can be swelling, lacerations, and bruising. Common genital injuries are anal injury, labial abrasions, hymenal bruising, tears of the posterior fourchette and fossa.Bruises, tears, abrasions, inflammation and lacerations may be visible. If a foreign object was used during the assault, x-ray visualization will identify retained fragments. Genital injuries are more prevalent in post-menopausal women and prepubescent girls. Internal injuries to the cervix and vagina can be visualized using colposcopy. Using colposcopy has increased the detection of internal trauma from six percent to fifty-three percent. Genital injuries to children who have been raped or sexually assaulted differ in that the abuse may be on-going or it happened in the past after the injuries heal. Scarring is one sign of the sexual abuse of children.

Several studies have explored the association between skin color and genital injury among rape victims. Many studies found a difference in rape-related injury based on race, with more injuries being reported for white females and males than for black females and males. This may be because the dark skin color of some victims obscures bruising. Examiners paying attention to victims with darker skin, especially the thighs, labia majora, posterior fourchette, and fossa navicularis, can help remedy this.

Infections

The presence of a sexually contracted infection can not be confirmed after rape because it cannot be detected until 72 hours afterwards.

The person who was raped may already have a sexually transmitted bacterial, viral and other infections and if diagnosed, it is treated Prophylactic antibiotic treatment for vaginitis, gonorrhea, trichomoniasis and chlamydia may be done. Chlamydial and gonococcal infections in women are of particular concern due to the possibility of ascending infection. Immunization against hepatitis B is often considered.After prophylactic treatment is initiated, further testing is done to determine what other treatments may be necessary for other infections transmitted during the assault.[99] These are:

Treatment may include the administration of zidovudine/lamivudine, tenofovir/emtricitabine, ritonavir/lopinavir. Information regarding other treatment options are available from the CDC.

The transmission of HIV is frequently a major concern of the patient. Prophylactic treatment for HIV is not necessarily administered. Routine treatment for HIV after rape or sexual assault is controversial due to the low risk of infection after one sexual assault. Transmission of HIV after one exposure to penetrative anal sex is estimated to be 0.5 to 3.2 percent. Transmission of HIV after one exposure to penetrative vaginal intercourse is 0.05 to 0.15 percent. HIV can also be contracted through the oral route but is considered rare.Other recommendations are that the patient be treated prophylactically for HIV if the perpetrator is found to be infected.

Testing at the time of the initial exam does not typically have forensic value if patients are sexually active and have an STI since it could have been acquired prior to the assault. Rape shield laws protect the person who was raped and who has positive test results. These laws prevent having such evidence used against someone who was raped. Someone who was raped may be concerned that a prior infection may suggest sexual promiscuity. There may, however, be situations in which testing has the legal purpose, as in cases where the threat of transmission or actual transmission of an STI was part of the crime. In nonsexually active patients, an initial, baseline negative test that is followed by a subsequent STI could be used as evidence, if the perpetrator also had an STI.

Treatment failure is possible due to the emergence of antibiotic-resistant strains of pathogens.[109]

Emotional and psychiatric

Psychiatric and emotional consequences can be apparent immediately after rape and it may be necessary to treat these very early in the evaluation and treatment. Other treatable emotional and psychiatric disorders may not become evident after the rape. These can be eating disorders, anxiety, fear, intrusive thoughts, fear of crowds, avoidance, anger, depression, humiliation, post-traumatic stress disorder (PTSD) hyperarousal, sexual disorders (including fear of engaging in sexual activity), mood disorders, suicidal ideation, borderline personality disorder, nightmares, fear of situations that remind the patient of the rape and fear of being alone,agitation, numbness and emotional distance. Victims are able to receive help by using a telephone hotline, counseling, or shelters,Recovery from sexual assault is a complicated and controversial concept, but support groups, usually accessed by organizations are available to help in recovery. Professional counseling and on-going treatment by trained health care providers is often sought by the victim.

There are clinicians who are specially trained in the treatment of those who have experienced rape and sexual assault/abuse. Treatment can be lengthy and be challenging for both the counselor and the patient. Several treatment options exist and vary by accessibility, cost, or whether or not insurance coverage exists for the treatment. Treatment also varies dependent upon the expertise of the counselor—some have more experience and or have specialized in the treatment of sexual trauma and rape. To be the most effective, a treatment plan should developed based upon the struggles of the patient and not necessarily based upon the traumatic experience. An effective treatment plan will take the following into consideration: current stressors, coping skills, physical health, interpersonal conflicts, self-esteem, family issues, involvement of the guardian, and the presence of mental health symptoms. [111]

The degree of success for emotional and psychiatric treatments is often dependent upon the terminology used in the treatment, i.e. redefining the event and experience. Labels used like “rape victim” and “rape survivor” to describe the new identities of women who have been raped suggest that the event is the dominant and controlling influence on her life. These may have an effect on supportive personnel. The consequences of using these labels needs to be assessed.Positive outcomes of emotional and psychiatric treatment for rape exist; these can be an improved self-concept, the recognition of growth, and implementing new coping styles.

A perpetrator found guilty by the court is often required to receive treatment. There are many options for treatment, some more successful than others.The psychological factors that motivated the convicted perpetrator are complex but treatment can still be effective. A counselor will typically evaluate disorders that are currently present in the offender. Investigating the developmental background of the offender can help explain the origins of the abusive behavior occurred in the first place. Emotional and psychological treatment has the purpose of identifying predictors of recidivism, or the potential that the offender will commit rape again. In some instances neurological abnormalities have been identified in the perpetrators, and in some cases they have themselves experienced past trauma. Adolescents and other children can be the perpetrators of rape, although this is uncommon. In this instance, appropriate counseling and evaluation are usually conducted.

Short-term treatment with a benzodiazepine may help with anxiety and antidepressants may be helpful for symptoms of post traumatic stress disorder, depression and panic attacks.

Prevention

Main article: Initiatives to prevent sexual violence

As sexual violence affects all parts of society, the response to sexual violence is comprehensive. The responses can be categorized as: individual approaches, health care responses, community-based efforts and actions to prevent other forms of sexual violence.[citation needed]

Sexual assault may be prevented by secondary school, college, and workplace education programs. At least one program for fraternity men produced “sustained behavioral change.”With regard to campus sexual assault, nearly two thirds of students reported knowing victims of rape and over half reported knowing perpetrators of sexual assault in one study; one in ten reported knowing a victim of rape and nearly one in four reported knowing a victim of alcohol-facilitated rape.

Prosecution

Reporting

People in Bangalore, India demanding justice for young student who was gang-raped in Delhi in December 2012.

In 2005, sexual violence, and rape in particular, was considered the most under-reported violent crime in Great Britain. The number of reported rapes in Great Britain is lower than both incidence and prevalence rates Victims who do not act in an expected or stereotypical way may not be believed, as happened in the case of a Washington state woman raped in 2008 who withdrew her report after facing police skepticism.Her rapist went on to assault several more women before being identified.

The legal requirements for reporting rape vary by jurisdiction—each US state may have different requirements.[citation needed] New Zealand has less stringent limits.

In Italy, a 2006 National Statistic Institute survey on sexual violence against women found that 91.6% of women who suffered this did not report it to the police.

Conviction

In the United Kingdom, In 1970 there was a 33% rate of conviction, while by 1985 there was a 24 per cent conviction rate for rape trials in the UK, by 2004 the conviction rate reached 5% At that time the government report has expressed documented the year-on-year increase in attrition of reported rape cases, and pledged to address this “justice gap”.According to Amnesty International Ireland had the lowest rate of conviction for rape, (1%) among 21 European states, in 2003 In America as of 2012, there exists a noticeable discrepancy in conviction rates among women of various ethnic identities; an arrest was made in just 13% of the sexual assaults reported by American Indian women, compared with 35% for black women and 32% for whites.

Judicial bias due to rape myths and preconceived notions about rape is a salient issue in rape conviction, but voir dire intervention may be used to curb such bias.

 

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