Screening for Sexual Assault

CLINICAL ACTIONS:

ACOG recommends that health care providers screen all women for a history of sexual assault. Screening should take place during routine wellness exams or when presented with symptoms that are suspicious for sexual assault (see ‘Red Flags’ below, in KEY POINTS).  

The National Sexual Violence Resource Center recommends the following to further engage women in a discussion regarding sexual assault  

    • Normalize the subject by including it within the sexual history; ACOG recommends the following introduction  
      • “Because sexual violence is an enormous problem for women in this country and can affect a woman’s health and well-being, I now ask all my patients about exposure to violence and about sexual assault.” 
    • Provide context by connecting the subject to the patient’s health and well-being 
    • Be nonjudgmental 
    • Validate the patient’s responses
  • Ask about sexual experiences that were uncomfortable or unwanted 
      • Have you been touched without your consent? 
      • Have you ever been pressured or forced to have sexual contact? 
    • Do you feel that you have control over your sexual relationships? 

SYNOPSIS:

Key findings of the National Intimate Partner and Sexual Violence Survey reveal that an estimated 1.3 million rape-related physical assaults occur against women annually. Early identification of victims can lead to prevention of long-term and persistent physical and mental health consequences of abuse.  

KEY POINTS:

  • Decide on appropriate interventions depending on each individual situation
  • Pay particular attention to those who report pelvic pain, dysmenorrhea, or sexual dysfunction
  • Red Flags’ for sexual assault include
    • Anxiety
    • Depression
    • Sudden-onset sleep disorders
    • Stress-related complaints
    • Requests for
      • Pregnancy testing
      • Emergency contraception
      • Testing for sexually transmitted diseases
      • Pelvic area trauma
      • Bruising that may be from restraints

Learn More – Primary Sources:

ACOG: Screening Tools – Sexual Assault

ACOG Committee Opinion 777: Sexual Assault

ACOG Committee Opinion 518: Intimate Partner Violence

National Sexual Violence Resource Center

Assessing Patients for Sexual Violence: A guide for health care providers (NSVRC)