Valoración de las lesiones físicas en 702 casos de violencia sexual en la provincia de Alicante (2016-2020) / Analysis of injuries in 702 cases of sexual assault in Alicante (Spain) during the years (2016-2020)

Introducción: el objetivo principal de este trabajo es analizar las características de las víctimas y circunstancias de la violencia sexual asociadas con un mayor riesgo de presentar lesiones físicas, así como determinar la frecuencia y severidad de las mismas. Material y Métodos estudio descriptivo retrospectivo de 702 casos de violencia sexual atendidos en el Instituto de Medicina Legal y Ciencias Forenses de Alicante entre 2016 y 2020. Se ha realizado un estudio comparativo entre las víctimas de violencia sexual con lesiones físicas y sin lesiones, para analizar las variables asociadas que pueden influir en su presentación. Resultados del total de 702 víctimas de violencia sexual, 314 casos (44,8%) presentaban lesiones físicas. Las víctimas con lesiones físicas la mayoría eran mujeres (95,5%), entre 18 y 27 años (31,3%), que referían un consumo voluntario previo de sustancias, fundamentalmente de alcohol (50%). Las lesiones físicas más frecuentes fueron a nivel extragenital (38,6%), seguidas de lesiones a nivel anogenital (15%), de carácter leve en la mayoría de los casos (97,5%). Los días totales de curación fueron menores o iguales a una semana (83,4%). La mayoría se curó sin secuelas (97,1%). Las víctimas que presentaron secuelas (9 casos), las más frecuentes fueron de carácter psíquico (1,6%). Conclusiones la violencia sexual en el grupo de víctimas con lesiones físicas se asocia a factores de vulnerabilidad para la víctima: sexo femenino, edad entre 18 y 27 años y consumo previo de alcohol. Nuestro estudio confirma que las lesiones anogenitales son poco frecuentes en la mayoría de las víctimas de violencia sexual, por lo que su ausencia no puede descartar el haber sufrido violencia sexual. Las lesiones físicas encontradas fueron de carácter leve en la mayoría de los casos. La ausencia de secuelas psíquicas en muchas de las víctimas puede estar condicionado por el escaso seguimiento de las mismas. (AU)

Introduction: The aim of this paper is to analyze the characteristics of the victims and the circumstances of sexual violence related with the risk of physical lesions, as well as to determine the frequency and severity of the injuries. Material and methods Descriptive study of 702 cases of sexual assault attended at the Institute of Legal Medicine and Forensic Sciences of Alicante between the years 2016–2020. A comparative study was carried out between victims with and without injuries, to identify the variables associated to their presentation. Results 314 victims attended showed physical injuries (44,8%). Profile of the victims with injuries were women (95.5%), aged 18 to 27 years (31.3%), and previous alcohol consumption (50%). Injuries physical were mainly extragenital (38.6%), anogenital (15%), or both, and most cases were mild in severity (97.5%). Recovery was less to one week (83.4%) and without aftermath (97.1%). When the victim showed aftermath (9 cases), the most frequent were psychological type (1.6%). Conclusions Physical injuries in sexual violence is related with circumstances of victim vulnerability: women, age between 18 to 27 years, and previous alcohol consumption. Our study shows that anogenital lesions are absent in a significative number of victims of sexual assault, so this absence cannot exclude sexual violence. The lesions found are mild in severity, and the absence of physical aftermath in most of the victims may be conditioned by the scarce follow-up of them. (AU)

"There Is No One Way to Get Over It": An Examination of Psychotherapy and Complementary Therapy Use Within a Sample of Survivors Who Experienced Sexual Violence.

Literature on sexual violence survivors' service utilization is limited due to examination of singular therapies or narrow timeframes. Using surveys (n = 303) and interviews (n = 20), this study increases understanding of survivors' healing. Results show varied therapy use including psychotherapy (76.9%), yoga (50.2%), and massage (32.1%), among others. Mean number of therapies used was over three. Service utilization was delayed over a decade on average. Latent class analysis divided respondents into classes: psychotherapy and bodywork use (42.66%), high therapy use (9.14%), and minimal therapy use (48.20%). Interviews provide additional insight and describe barriers. Recommendations for policy, practice, and future research are discussed.

Sexual Assault of Women.

Sexual violence is a major public health and human rights issue affecting more than 40% of women in the United States during their lifetimes. Although men and women experience sexual assault, women are at greatest risk. Populations uniquely impacted by sexual assault include adolescents; lesbian, gay, bisexual, transgender, and queer people; and active-duty military service members. Health consequences of sexual assault include sexually transmitted infections, risk of unintended pregnancy, high rates of mental health conditions (e.g., posttraumatic stress disorder), and development of chronic medical conditions (e.g., chronic pelvic pain). Family physicians care for sexual assault survivors at the time of the assault and years after, and care should follow a survivor-centered and trauma-informed framework. Multiple organizations recommend screening all women for a history of sexual violence; however, the U.S. Preventive Services Task Force recommends only universal intimate partner violence screening in women of reproductive age. A validated tool, such as the Two-Question Screening Tool, can be implemented. Initial care should include treatment of physical injuries, prophylaxis for sexually transmitted infections, immunizations, and the sensitive management of psychological issues. Clinicians must comply with state and local requirements for the use of evidence-gathering kits. Many hospitals have developed collection protocols and employ certified Sexual Assault Nurse Examiners or Sexual Assault Forensic Examiners. Prevention of sexual violence requires a comprehensive approach to address individual, relational, community, and societal factors.

Sexual assault cases at a tertiary referral hospital in urban Ethiopia: One-year retrospective review.

INTRODUCTION: Sexual assault is an important health and social problem affecting young girls. The aim of the study is therefore to do a one-year retrospective review of documents of alleged sexual assaults managed at Saint Paulo's Hospital Millennium Medical College (SPHMMC) to determine survivors' characteristics, circumstances of the assault, and treatment offered. METHODS: This is a hospital-based one-year retrospective review of alleged sexual assault cases. The case records of survivors were retrieved, reviewed and information extracted analyzed using SPSS version 17. Characteristics of victims of the sexual assault, clinical presentation, and management provided were described by frequency and percentage distribution. RESULT: A total of 170 cases of alleged sexual assault who received care during the study period were identified. Around 96% of the survivors were female while there were 6 male cases. The mean age of the victims was 13 yrs. with a range from 2 to 25 yrs. About 23.6% of the victims were less than 10 years. Half of the victims were assaulted by neighbors (45%) followed by strangers (36.5%). The interval between the incident and presentation to the hospital ranged from 2 hours to 93 days (2224 hours) with an average of 98 hours. Most (93.0%) had one or more physical examination findings at presentation. Serology tests for HIV, Hepatitis B, and Syphilis were done in 97.3%, 88.7%, and 84.5% cases respectively. Urine pregnancy tests were done in 62.5% of the cases. Prophylaxis against HIV and STI prophylaxis was provided to 42% and 45% respectively. Social support/counseling was provided to 61% of the victims and legal evidence (certificate) was provided to 45.5% of the cases. CONCLUSION AND RECOMMENDATIONS: Although it is largely not reported by the victims, sexual assault is a grievous offense still happening constantly. Children and young girls remain the most vulnerable. There is inadequate forensic evidence collection, legal and medical care. There is also a delay in presentation to hospital by victims. Therefore, there is a need to have standardized protocols for comprehensive evaluation and care of the survivors. It is also imperative that a multidisciplinary approach like a one-stop clinic should be utilized to provide effective and efficient medical, social, psychological, and legal services. Finally, it is very necessary to increase public awareness and preventive interventions are required particularly to protect the vulnerable age group to enhance their safety.

Covariates of the Severity of Aggression in Sexual Crimes: Psychopathy and Borderline Characteristics.

Whereas risk assessment literature on sexual offending has primarily focused on prediction of subsequent sexual crimes, and not the severity of those crimes, the first aim of the present study was to identify variables that predict the amount of damage to victims in sexual crimes compared with those that predict general aggressiveness. The second aim was to ascertain whether adding emotional instability measurements, as in borderline personality disorder (BPD), would add incremental variance to that captured by the facets of the Psychopathy Checklist-Revised (PCL-R). Trained raters assessed on the PCL-R, BPD, and measures of severity of sexual and nonsexual violence 302 adults who had sexually offended. PCL-R's Antisociality and two externalizing BPD factors (one from the standard and one from the alternative criteria) were significant predictors of violence both in sexual and nonsexual crimes. In contrast, deficits in the PCL-R's Affective facet (2) predicted victim damage in sexual contexts only, whereas the Lifestyle Impulsivity facet (3) of the PCL-R predicted violence in nonsexual contexts only. These findings suggest that adding measures of emotional dysregulation to commonly used instruments like the PCL-R, which assesses callousness and antisociality, may be beneficial for predicting violence.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence.

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.

Protocol for the first large-scale emergency care-based longitudinal cohort study of recovery after sexual assault: the Women's Health Study.

INTRODUCTION: Worldwide, an estimated 10%-27% of women are sexually assaulted during their lifetime. Despite the enormity of sexual assault as a public health problem, to our knowledge, no large-scale prospective studies of experiences and recovery over time among women presenting for emergency care after sexual assault have been performed. METHODS AND ANALYSIS: Women ≥18 years of age who present for emergency care within 72 hours of sexual assault to a network of treatment centres across the USA are approached for study participation. Blood DNA and RNA samples and brief questionnaire and medical record data are obtained from women providing initial consent. Full consent is obtained at initial 1 week follow-up to analyse blood sample data and to perform assessments at 1 week, 6 weeks, 6 months and 1 year. These assessments include evaluation of survivor life history, current health and recovery and experiences with treatment providers, law enforcement and the legal system. ETHICS AND DISSEMINATION: This study is approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB) and the IRB of each participating study site. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Residual symptoms following empirically supported treatment for PTSD.

OBJECTIVE: Although there are several evidence-based treatments that are effective in mitigating the symptoms of posttraumatic stress disorder (PTSD), rates of nonresponse to treatment as well as treatment dropout remain high. In order to determine which symptoms remain most problematic at the end of treatment for PTSD, the present study examined residual symptoms in a treatment study that evaluated the effects of cognitive processing therapy (CPT) and prolonged exposure (PE). METHOD: The sample consisted of 108 female rape survivors who initially met criteria for PTSD and who were then randomized into and completed either CPT or PE. The sample was 71% White and 25% African American, with an average age of 32 years (SD = 9.98 years). RESULTS: Symptoms of PTSD, depression, guilt, and social adjustment were evaluated in the sample of treatment completers, and findings suggest that overall symptoms improved over the course of treatment. Results further suggested that distress related to trauma reminders, detachment, and insomnia were the most common residual PTSD symptoms at posttreatment, while self-blame, concerns about body image, and fatigue were the most common residual symptoms of depression. The most common residual symptom of guilt was lack of justification for actions that had to be taken during the index event. CONCLUSIONS: This pattern of findings is in line with past research suggesting that evidence-based practices are effective in the treatment of PTSD, but underscores the need to continue to evaluate residual symptoms to best assist clients in achieving full recovery. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Treatment Goals, Assessment, and Evaluation Practices in Rape Crisis Centers.

Counselors in Rape Crisis Centers (RCCs) provide crucial services to survivors of sexual violence. However, little is known about RCCs, including the treatment goals and assessment strategies of counselors. Counselors in all Texas RCCs (n = 83) were invited to participate in a web-based survey. Participants were asked to indicate which treatment goals they frequently identified and assessed, as well as their usual assessment techniques. Counselors endorsed treatment goals around self-esteem, empowerment, and relational functioning, along with trauma and mental health. Fewer counselors endorsed goals around drugs/alcohol or school/work/sexual functioning. Few counselors reported use of standardized measures. Counselors in urban settings were more likely to endorse goals related to mental health. There are discrepancies between counselors' goals and how often outcomes are assessed. Increased assessment could promote the provision of effective services and access to funding.

A Crisis of Care: The Politics and Therapeutics of a Rape Crisis Hotline.

This article explores the politics and contingencies of care provided to survivors of sexual assault on a rape crisis hotline in the U.S.'s mid-Atlantic region. The support provided to survivors on the hotline represents a crisis of care, one fomented by the victim services sector's failure to address the limitations of a crisis-oriented paradigm or survivors' chronic trauma. The tension between the survivor-centered model of the hotline and the mental health needs of clients represents a friction of utility-a misalignment between the care hotline advocates provide and the support survivors seek. The anonymous care and internal contradictions of the hotline also results in high rates of vicarious trauma for advocates. Given the polysemic dimensions of care exhibited on the hotline, the service represents a form of negative care, one that accounts for gaps in survivors' care yet still fails to empower proactive means of recovery.

In rape trauma PTSD, patient characteristics indicate which trauma-focused treatment they are most likely to complete.

BACKGROUND: Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments. METHODS: A multivariable model of dropout risk was constructed with randomized clinical trial data (n = 160) comparing prolonged exposure (PE) and cognitive processing therapy (CPT) for rape-induced PTSD. A two-step bootstrapped variable selection algorithm was applied to identify moderators of dropout as a function of treatment condition. Employing identified moderators in a model, fivefold cross-validation yielded estimates of dropout probability for each patient in each condition. Dropout rates between patients who did and did not receive their model-indicated treatment were compared. RESULTS: Despite equivalent dropout rates across treatments, patients assigned to their model-indicated treatment were significantly less likely to drop out relative to patients who did not (relative risk = 0.49 [95% CI: 0.29-0.82]). Moderators included in the model were: childhood physical abuse, current relationship conflict, anger, and being a racial minority, all of which were associated with higher likelihood of dropout in PE than CPT. CONCLUSIONS: Individual differences among patients affect the likelihood they will complete a particular treatment, and clinicians can consider these moderators in treatment planning. In the future, treatment selection models could be used to increase the percentage of patients who will receive a full course of treatment, but replication and extension of such models, and consideration of how best to integrate them into routine practice, are needed.

[An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units]. / Évaluation des coûts directs de la prise en charge en urgence d'une victime de violences sexuelles.

BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures. METHODS: The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses. RESULTS: The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92€, of which 41.5 % (279.90€) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02€), attributable mainly to the biological screening tests for sexually transmissible infections (STIs). CONCLUSION: These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization "Medicine, medical specialties part time day or night common regime", allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations.

Rape Aggression Defense: Unique Self-Efficacy Benefits for Survivors of Sexual Trauma.

Self-defense training is consistently linked to psychological benefits for survivors of sexual trauma, yet little is known about how training may uniquely benefit survivors compared with their nonsurvivor peers enrolled in the same course. Path analysis was used to examine how history of sexual trauma impacts pre- and post-training scores on three domains of self-efficacy using a national sample of Rape Aggression Defense (RAD) participants. All participants reported significant increases in self-efficacy domains, and sexual trauma history significantly predicted pre-training interpersonal self-efficacy and post-training self-defense self-efficacy, suggesting that self-defense training confers benefits for survivors above and beyond benefits for other participants.

I Said No: The Impact of Voicing Non-Consent on Women's Perceptions of and Responses to Rape.

The current study explored the impact of voicing non-consent in relation to rape. Aims of the study included determining (a) the prevalence of voicing non-consent, (b) the relationship of voicing non-consent to verbal and physical resistance, and (c) whether voicing non-consent predicts distress and rape acknowledgment. Out of 262 college women who experienced rape, 81% voiced non-consent. Voicing non-consent was related to verbal and physical resistance, but was distinct in prevalence and prediction of distress. Voicing non-consent was associated with trauma-related symptoms in multivariate models. Women who voiced non-consent were more likely to acknowledge their experience as rape or sexual assault. Implications are discussed.

Traits of vulnerability in repetitive sexual assaults of mentally disabled people.

The issue of sexual abuse, assault, rape and unwanted pregnancies among mentally disabled women is largely under-reported for many reasons. Several myths prevail including that mentally disabled women offer little interest to sexual predators, together with a negative public attitude and this contributes to the problem. We report the case of a single centre in Albania, where repetitive sexual assaults were perpetrated against three mentally disabled women. Three unwanted pregnancies followed. The issue gained public attention after three criminal abortions were performed secretly with the aim of covering up the story. Charges were raised against the director of the centre and an employee from the nursing staff. Proceedings are still ongoing. We discuss some details from the forensic investigation and consider several systemic weaknesses that have exposed this vulnerable target group to the risk of being severely and repetitively abused. We believe greater staff awareness, and a better medical and legal framework, are indispensable to deter further offences especially where facilities are under-resourced as here.

Neurobiology of Sexual Assault and Osteopathic Considerations for Trauma-Informed Care and Practice.

Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and emotional health. Sexual assault is associated with gastrointestinal, neurologic, and reproductive symptoms, as well as obesity, diabetes, and chronic pain. With 1 in 3 women and 1 in 6 men experiencing some form of unwanted sexual violence in their lifetime, sexual assault is a significant public health problem that necessitates attention in the medical community. This review discusses relevant literature on the neurobiologic changes that occur as a consequence of sexual assault, such as how the brain responds during a traumatic experience and the impact of trauma on memory. Osteopathic considerations for trauma-informed care and practice and how all physicians can better serve patients with a history of sexual assault are also discussed.