Sexual Abuse and Domestic Violence
Answers
309
recount the details, and in fact may find this task therapeutic. Victims of sexual assault frequently see themselves as partially responsible for the crime, especially in cases where they might have used poor judgment. It is a legal requirement to obtain consent prior to treating a rape victim. The following are the initial laboratory tests that should be performed at the time of examining a rape victim: gonorrhea and chlamydia cultures from the vagina, anus, and throat; RPR; hepatitis antigens; HIV; U/A; urine C and S; and pregnancy test. Antibiotic prophylaxis for gonorrhea and chlamydia should be offered; Rocephin and doxycycline offer good coverage. Postcoital contraception (emergency contraception) should be offered to the patient to prevent ovulation/fertilization. This can best be achieved with high-dose combination oral contraceptive and is maximally effective within 3 days of unprotected intercourse. The patient should receive follow-up counseling within 24 to 48 h, and subsequent follow-up appointments can be arranged at 1 and 6 weeks. With ongoing counseling, it is possible for rape victims to fully recover. 472–475. The answers are 472-b, 473-b, 474-a, 475-b. (Beckmann, 4/e, p 621.) In 90% of cases of sexual assault against children, the child knows the perpetrator. The assailant is usually a parent, family member, or friend of the family. The physician should avoid using sedation when examining a child because it may cause the child to feel more helpless and fearful. A child who is sexually flirtatious or displays an advanced knowledge of sexual matters very often is a victim of sexual assault. If you are a health care provider taking care of a sexually abused child, you need to make the assessment regarding whether or not it is safe for the child to return home or whether the child should be placed in foster care. Any child thought to be a victim of sexual abuse should be offered prophylactic antibiotics. 476–480. The answers are 476-d, 477-a, 478-c, 479-b, 480-a. (Beckmann, 4/e, pp 621–623.) About three-fourths of women report that they have been victims of domestic violence. In fact, one in five women who present to the emergency room have been injured by their partner. About 10% of adolescents are battered by a parent. Domestic violence encompasses physical abuse, sexual abuse, and psychological abuse. Most women report that they would be willing to divulge their domestic abuse to a physician, if the physician would ask. Physical abuse in domestic violence