Rape

Rape
The rape of noblewoman Lucretia was a starting point of events that led to the overthrow of the Roman Kingdom and establishment of the Roman Republic. As a direct result of rape, Lucretia committed suicide. Many artists and writers were inspired by the story, including Shakespeare, Botticelli, Rembrandt, Dürer, Artemisia Gentileschi, Geoffrey Chaucer, and Thomas Heywood.
Classification and external resources
Specialty	emergency medicine
ICD-10	T74.2
ICD-9-CM	E960.1
MedlinePlus	001955
eMedicine	article/806120
MeSH	D011902

Rape
Types
Acquaintance rape Date rape Gray rape Marital rape Statutory rape Prison rape Gang rape Serial rape Campus rape Corrective rape Genocidal rape Unacknowledged rape Rape by deception
Effects and motivations
Effects and aftermath Pregnancy from rape Rape trauma syndrome Causes Post-assault mistreatment Sociobiological theories Rape culture
By country
Afghanistan Belgium China Democratic Republic of the Congo Egypt Finland France Germany India Pakistan Papua New Guinea Philippines Saudi Arabia South Africa Sweden United Kingdom United States
During conflicts
Nanking Massacre Rape during the liberation of Poland Rape during the occupation of Germany Rape during the Bosnian War Rape during the Bangladesh Liberation War
Laws
Rape shield law False accusation of rape Rape investigation Rape kit
Statistics/ related
History of rape Date rape drug Rape statistics Rape by gender Rape of males Anti-rape device Rape crisis centers Rape investigation Rape myth Rape pornography Rape and revenge films Rape fantasy Rape schedule Anti-rape movement
Portals Criminal justice Law

Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration perpetrated 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.^[4]

The rate of reporting, prosecuting and convicting for rape varies between jurisdictions. Internationally, the incidence of rapes recorded by the police during 2008 ranged, per 100,000 people, from 0.2 in Azerbaijan to 92.9 in Botswana with 6.3 in Lithuania as the median.^[5] Rape by strangers is usually less common than rape by persons the victim knows, and male-on-male and female-on-female prison rapes are common and may be the least reported forms of rape.^[6][7][8]

Widespread and systematic rape and sexual slavery can occur during international conflict. These practices are crimes against humanity and war crimes. Rape is also recognized as an element of the crime of genocide when committed with the intent to destroy, in whole or in part, a targeted ethnic group.

People who have been raped can be traumatized and develop posttraumatic stress disorder.^[9] 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.^[10][11][12]

Etymology

The term rape originates in the Latin rapere (supine stem raptum), "to snatch, to grab, to carry off".^[13][14] Since the 14th century, the term has come to mean "to seize and take away by force".^[15] In Roman law the carrying off of a woman by force, with or without intercourse, constituted "raptus".^[14] In Medieval English law the same term could refer to either kidnapping or rape in the modern sense of "sexual violation".^[13] The original meaning of "carry off by force" is still found in some phrases, such as "rape and pillage" or in titles, such as the stories of the Rape of the Sabine Women and The Rape of Europa or the poem The Rape of the Lock, which is about the theft of a lock of hair.

Definitions

General

Rape is defined in most jurisdictions as sexual intercourse, or other forms of sexual penetration, initiated by a perpetrator against a victim without their consent.^[16] The definition of rape is inconsistent between governmental health organizations, law enforcement, health providers and legal professions.^[17] It has varied historically and culturally.^[16][17] 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".^[18][19] 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. In 1940, a husband could not be charged with raping his wife. In the 1950s, in some states, a white woman having consensual sex with a black man was considered rape.^[20]

Until 2012, the Federal Bureau of Investigation (FBI) still 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 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 assault,^[23] while 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).^[24]

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 assault.^[25][26] Scotland, for example, emphasizes penile penetration, requiring that the sexual assault must have been committed by use of a penis to qualify as rape.^[27][28] In some instances, as in the case of Germany, penetration is not required for the act to be defined as rape.^[16] The 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".^[16] 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.^[29] Some laws have eliminated the term rape altogether.^[30]

Scope

For research purposes, incidence of rapes are classified into a number of categories. These can be gender, age, ethnicity, geographical location, culture or historical periods. Other categories of rape describe the relationship of the perpetrator to the victim and the context of the sexual assault. Rape is categorized as date rape, gang rape, marital rape, incestual rape, child sexual abuse, prison rape, acquaintance rape, war rape and statutory rape.^[31] Victims of rape or sexual assault come from a wide range of sexual orientations, genders, ages, and degrees of impairment or disability. Perpetrators sometimes use objects for penetration, force the victim to penetrate the perpetrator, force the victim to perform oral sex or assault the victim with anal penetration. Those experiencing non-consensual, forced sexual experiences and sexual assault include women, heterosexual men, homosexual men, boys, adolescent males, spouses, girlfriends, boyfriends, prepubescent girls and boys, adolescent girls, children, the elderly, and even infants. Forced sexual experiences can be committed over a long period of time accompanied with little to no physical injury.^[32][33]

In an early study of U.S. 1,632 students from 79 different schools, boys and girls were surveyed and asked if they had, at some time, been asked to engage in unwelcome sexual behavior. 85% of the girls and 76% of the boys said that this had occurred. The boys and girls indicated that the behavior they experienced included pinching, grabbing, touching in a sexual manner. One fourth of the girls had been forced to kiss someone and 10% of both the girls and the boys reported having been forced against their wills to do something sexual other than kissing. Students reported that 80% of the unwelcome sexual behavior had come from other students with the remainder coming from teachers, coaches, or other adults.^[33] Out of the total of child abuse rates, slightly more than 75% were neglected, 18% were assaulted and slightly more than nine percent were sexually abused.^[34]

Consent

Lack of consent is key to the definition of rape.^[3] Consent is not always expressed verbally. It may be implied from the context and from the relationship of the parties, but the absence of objection does not of itself constitute consent. Lack of consent may result from either forcible compulsion by the perpetrator or an incapacity to consent on the part of the victim (such as persons who are asleep, intoxicated or otherwise mentally compromised).^[35] Sexual intercourse with a person below the age of consent, i.e., the age at which legal competence is established, is referred to as statutory rape.^[3] In certain jurisdictions, consent may also be negated if an individual agrees to have sex only on certain terms. An example is the case of a man who deliberately ejaculated in a woman's vagina although she consented to sex only on the clear understanding that he would not do so.^[36][37] Consent can be withdrawn at any time, so that any further sexual activity would constitute rape.

Duress is the situation when the person is threatened by overwhelming force or violence, and may result in the absence of an objection to intercourse. This can lead to the presumption of consent.^[35] Duress may be actual or threatened force or violence against the victim or someone close to the victim. Even blackmail may constitute duress. Abuse of power may constitute duress. For instance, in the Philippines, a man commits rape if he engages in sexual intercourse with a woman "By means of fraudulent machination or grave abuse of authority".^[38] The International Criminal Tribunal for Rwanda in its landmark 1998 judgment used a definition of rape which did not use the word 'consent': "a physical invasion of a sexual nature committed on a person under circumstances which are coercive."^[39]

Marital rape or spousal rape, is non-consensual sex in which the perpetrator is the victim's spouse. It is a form of partner rape, of domestic violence, and of sexual abuse. Once widely accepted or ignored by law, spousal rape is now denounced by international conventions and is increasingly criminalized. Still, in many countries, spousal rape either remains legal, or is illegal but widely tolerated and accepted as a husband's prerogative. In 2006, the UN Secretary-General's In-depth study on all forms of violence against women stated that (pg 113): "Marital rape may be prosecuted in at least 104 States. Of these, 32 have made marital rape a specific criminal offence, while the remaining 74 do not exempt marital rape from general rape provisions. Marital rape is not a prosecutable offence in at least 53 States. Four States criminalize marital rape only when the spouses are judicially separated. Four States are considering legislation that would allow marital rape to be prosecuted."^[40] Since 2006, several other states have outlawed marital rape (for example Thailand in 2007^[41]). In the US, the criminalization of marital rape started in the mid-1970s and in 1993 North Carolina became the last state to make marital rape illegal.^[42] In many countries, it is not clear if marital rape may or may not be prosecuted under ordinary rape laws. In the absence of a spousal rape law, it may be possible to bring prosecution for acts of forced sexual intercourse inside marriage by prosecuting, through the use of other criminal offenses (such as assault based offenses), the acts of violence or criminal threat that were used to obtain submission.^[43]

The issues of consent in sexual situations can be complicated by language, context, culture and sexual orientation. Refusal or lack of consent is interpreted by cultural expectations of women. A common view is that a woman's refusal of sex cannot be 'heard' in strict patriarchal culture. If a culture depersonalizes and sexualizes women, the refusal and non-consensual, verbalized 'no' to sex can be distorted and instead means 'keep trying', or even 'yes'. In this context, men are able to sincerely claim they did not understand the refusal. Women can then be blamed because they did not communicate their lack of consent clearly enough. When bruises or broken bones are not apparent, this is seen as proof that the woman consented.^[44]

In other contexts, men never say 'no' when confronted with female pressure to engage in sex. In this same situation the lack of consent would be a threat and identify him as homosexual. If the man unwillingly engages in sex, this can create an unusual situation in which the man must defend his claim by highlighting the physical unattractiveness of the female. Interestingly, situations like this can progress to one where continued interaction can prolong the encounter in hopes of reversing non-consent to a 'yes'.^[44]

Investigations into questions regarding the intentions behind non-consensual sex are sparse. One investigation in the early 1980s questioned 610 undergraduate women. They were asked if they had ever said no to sex, even though they fully intended to have sexual intercourse. The majority, 68.5% of these women answered 'no' when their intention was 'maybe'. The other 39.3% answered that when they have said 'no' really meant 'yes'. The explanations in support of their answers were that they were fearful of being considered promiscuous. Some claimed they were inhibited about sex. Others answered that they intended to manipulate the male because they were angry, wanted him to become more aroused or more aggressive.^[44]

Context changes again when a man solicits sex from another man. Some stereotypes identify men who 'pursue' other men are the most virile of all. This type of interaction often becomes erotic in nature and now can be interpreted as an invitation. Conversely, unwanted sexual advances have created a legal precedent: Homosexual Panic Defense. This is invoked when a man who has murdered another man who they claim made sexual advances towards them. This is an argument in which a sexual advance itself is an act of aggression, and that the defendant was justified in using violence.^[44]

Motives

The WHO states that the principal factors that lead to the perpetration of sexual violence against women, including rape, are:^[45]

• beliefs in family honor and sexual purity;
• ideologies of male sexual entitlement;
• weak legal sanctions for sexual violence.

No single theory explains the motivation for rape; the motives of rapists can be multi-factorial. Several factors have been proposed: anger; power; sadism; sexual gratification in tandem with evolutionary proclivities.^[46][47] American clinical psychologist David Lisak, co-author of a 2002 study of undetected rapists,^[48] says that compared with non-rapists, both undetected and convicted rapists are measurably more angry at women and more motivated by a desire to dominate and control them, are more impulsive, disinhibited, anti-social, hyper-masculine, and less empathic.^[49]

Sexual aggression is often perceived as masculine identity characteristic of manhood in some male groups and is significantly correlated to the desire to be held higher in esteem among male peers.^[50] Sexually aggressive behavior among young men has been correlated with gang or group membership as well as having other delinquent peers.^[51][52] Research also suggests that men with sexually aggressive peers have a higher chance of reporting coercive or forced sexual intercourse outside gang circles than men without such sexually aggressive peers.^[53] Gang rape is often perceived by male perpetrators as a justified method to discourage or punish what they consider as immoral behavior among women for example wearing short skirts or visiting bars. In some areas in Papua New Guinea, women can actually be punished by public gang rape usually through permission by elders.^[54]

Effects

One metric used by the WHO to determine the severity of global rates of coercive, forced sexual activity was the question "Have you ever been forced to have sexual intercourse against your will?" Asking this question produced higher positive response rates than being asked, whether they had ever been abused or raped.^[55]

The WHO report describes the negative consequences of sexual abuse:

Emotional and psychological

During the assault a person will generally act in one or more of five ways: fight, flight, freeze, friend, or flop; the way a person reacts is often not what he or she would have predicted, and after the rape is over, a rape survivor may be uncomfortable with and not understand how they reacted while it was occurring.^[56] Most people respond passively to the assault, which afterwards can cause confusion for people (including the survivor) who assume that someone being raped would call for help or struggle, resulting in their clothes being torn or there being injuries resulting from the survivor being subdued after resisting.^[56] People being raped often dissociate to some extent during the assault.^[56] Partly due to that, the memory of the experience will often be fragmented, especially immediately afterwards; memory generally consolidates with time, and especially following REM sleep.^[56] A man or boy who is raped may get an erection and may ejaculate during the experience, which may become a source of shame and confusion for him and people around him afterwards.^[57]

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 guilt.^[56] Denial is not uncommon.^[56]

In the weeks following the rape, the survivor may develop symptoms of post traumatic stress syndrome and may develop wide array of psychosomatic complaints.^[56][58]:310 PTSD symptoms include re-experiencing of the rape, avoiding things associated with the rape, numbness, and increased anxiety and startle response.^[56] 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 him or her, the person who was raped was very young or very old, and if the rapist was someone he or she knew.^[56] 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.^[56]

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.^[56] 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.^[56] People who have been raped are at higher risk of suicide.^[57][59]

Men experience similar psychological effects of being raped, but they are less likely to seek counseling.^[57]

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.^[60]

Physical

Rape and other sexual assault can result in physical trauma, tissue damage and infection, but most people will not suffer visible physical injury.^[61] Since the central issue in many cases of rape or other sexual assault is whether or not both parties consented to the sexual activity or whether or not both parties had the capacity to do so, physical force resulting in visible physical injury is not always seen. This stereotype can be damaging because people who have experienced sexual assault but have no physical trauma may be less inclined to report to the authorities or to seek health care.^[62]

While penetrative rape generally does not involve the use of a condom, in some cases a condom is used. This 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.^[63]

Sexually transmitted infections

Cuts and abrasions acquired during the rape or sexual assault can become infected. Sexually transmitted infections (STI) can be transmitted from the perpetrator to the victim. The presence of STIs in prepubescent children is an indicator of child sexual abuse. The risk of contracting an STI from being raped or sexually assaulted depends on a number of factors. The risk of infection is dependent upon the site of exposure, geographic region, the infection status of the perpetrator, and the type of assault. A pre-existing STI may be present in the patient.

Those who have been raped have relatively more reproductive tract infections than those who have not been raped.^[64] Trichomoniasis, bacterial vaginosis (BV), gonorrhea, and chlamydial infection are the most frequently diagnosed infections among sexually assaulted women.^[65] Hepatitis B is sometimes acquired.^[66] The HIV virus 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.^[67] Acquiring sexually transmitted infections also makes someone more likely to acquire HIV.^[64] In parts of Africa, there is a myth that sex with a virgin can cure HIV/AIDS; as such, girls and women are raped because of it.^{[68][69][70][71]} It is not known how common the myth is and to what degree rapes happen because of the belief in it. 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.^[72]

Victim blaming, bullying and other mistreatment

People who have been raped or sexually assaulted are sometimes blamed and considered responsible for the crime.^[17] This concept refers to the just world fallacy and attitudes that certain victim behaviors (such as flirting or wearing sexually provocative clothing) may encourage rape.^[73] In extreme cases, victims are said to have "asked for it" by not behaving demurely. In most Western countries, the defense of provocation is not accepted as a mitigation for rape.^[74] 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. Often, these are countries where there is a significant social divide between the freedoms and status afforded to men and women.^[75] Amy M. Buddie and Arthur G. Miller, in a review of studies of rape myths, state:

Rape victims are blamed more when they resist the attack later in the rape encounter rather than earlier (Kopper, 1996), which seems to suggest the stereotype that these women are engaging in token resistance (Malamuth & Brown, 1994; Muehlenhard & Rogers, 1998) or leading the man on because they have gone along with the sexual experience thus far. Finally, rape victims are blamed more when they are raped by an acquaintance or a date rather than by a stranger (e.g., Bell, Kuriloff, & Lottes, 1994; Bridges, 1991; Bridges & McGr ail, 1989; Check & Malamuth, 1983; Kanekar, Shaherwalla, Franco, Kunju, & Pinto, 1991; L'Armand & Pepitone, 1982; Tetreault & Barnett, 1987), which seems to evoke the stereotype that victims really want to have sex because they know their attacker and perhaps even went out on a date with him. The underlying message of this research seems to be that when certain stereotypical elements of rape are in place, rape victims are prone to being blamed.

They also state that "individuals may endorse rape myths and at the same time recognize the negative effects of rape."^[76] A number of gender role stereotypes can play a role in rationalization of rape. In the case of male-on-female rape, these include the idea that power is reserved to men whereas women are meant for sex and objectified, that women want forced sex and to be pushed around,^[77] and that male sexual impulses and behaviors are uncontrollable and must be satisfied.^[78]

Victim-blaming correlates with fear. Many rape victims blame themselves. Female jurors might look at the woman on the witness stand and believe she has done something to entice the defendant.^[79] Victims may become the target of slut-shaming and cyberbullying. In addition, their credibility may be challenged.

Honor killings and forced marriages

In many cultures, those who are raped are at very high risk of suffering additional violence or threats of violence after the rape. These acts may be perpetrated by the rapist or by friends and relatives of the rapist, as a way of preventing the victims from reporting the rape, of punishing them for reporting it, or of forcing them to withdraw the complaint; or they may be perpetrated by the relatives of the victim as a punishment for "bringing shame" to the family. This is especially the case in cultures where female virginity is highly valued and considered mandatory before marriage; in extreme cases, rape victims are killed in honor killings.^[10][11][12]

In some places, girls and women who are raped are often forced by their families to marry their rapist. Because being the victim of rape and losing virginity carry extreme social stigma, and the victims are deemed to have their "reputation" tarnished, a marriage with the rapist is arranged. This is claimed to be in the advantage of both the victim—who does not remain unmarried and doesn't lose social status—and of the rapist, who avoids punishment. In 2012, the suicide of a 16-year-old Moroccan girl—who, after having been forced by her family to marry her rapist at the suggestion of the prosecutor, and who subsequently endured abuse by the rapist after they married—sparked protests from activists against the law which allows the rapist to marry the victim in order to escape criminal sanctions, and against this social practice which is common in Morocco.^[80]

Treatment

Non-genital injuries

The first medical response to sexual assault is identifying serious or life-threatening injuries. An initial examination is performed by emergency room staff. The health care provider, often trained specifically to treat rape and sexual assault patients, examines the victim and looks for signs and symptoms of internal injuries and notes if the victim has experienced unconsciousness during or after the rape or sexual assault. The examiner notes the presence of broken bones,^[81] pregnancy, bites,^[82] swelling, bruising, lacerations and scratches. In more violent cases, the victim may need to have gunshot wounds or stab wounds treated. Staff that are trained to treat rape and sexual assault victims are careful to obtain full and explicit consent for every part of the physical examination acknowledging that the traumatic event needs to be handled sensitively and to allow the patient to regain a full sense of control over the procedures. It is during the physical examination that the treatment team begins to document the injuries and other information that can be used to identify and prosecute the perpetrator. Such evidence-gathering is only done with the complete consent of the patient or the caregivers of the patient. At this point in the treatment, experienced social support staff are made available to the patient and family.^[83]

If the patient or the caregivers, (typically parents) agree, the medical team utilizes standardized sampling and testing usually referred to a "rape kit".^[84] 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 his or her hair. The sooner that samples are obtained after the assault, the more likely that evidence is present in the sample and will 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.^[83]

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.^[81] Any victim with abrasions are immunized for tetanus if 5 years have elapsed since their last immunization.^[85]

Women are typically offered contraceptive medications because about 5% of male-on-female rapes result in pregnancy.^[85]

Genital injuries

A complete pelvic exam for rape (anal and/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. A wood lamp is a device that can detect semen on the skin. Sometimes the victim has scratched the perpetrator in defense and fingernail scrapings can be collected.^[83]

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. 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.^[83]

Infections

Sexually transmitted bacterial, viral and other infections, if diagnosed, are treated. This decision may be made by the clinician with prophylactic antibiotic treatment for vaginitis, gonorrhea, trichomoniasis and chlamydia. 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.^[85] These are:

• Serum hepatitis B surface antigen assay
• Microscopic evaluation of vaginal discharge (saline wash and staining)
• Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis from each penetrated location
• Serum Venereal Disease Research Laboratory test
• CBC
• Liver function tests
• Serum creatinine level

Treatment may include the administration of Zidovudine/lamivudine, Tenofovir/emtricitabine, Ritonavir/lopinvir. Additional treatment options are available from the CDC.^[83]

The transmission of HIV is frequently a major concern of the patient.^[65] 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.^[83][86] Other recommendations are that the patient be treated prophylactically for HIV if the perpetrator is found to be infected.^[82]

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.^[65]

Treatment failure is possible due to the emergence of antibiotic-resistant strains of pathogens.^[87]

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.^[65]

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,^[81] agitation, numbness and emotional distance.^[83] Victims are able to receive help by using a telephone hotline, counseling, or shelters.^[32] Recovery from sexual assault is a complicated and controversial concept,^[88] 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.^[89]

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. ^[89]

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.^[81] 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.^[81]

A perpetrator found guilty by the court is often required to receive treatment. There are many options for treatment, some more successful than others.^[90] 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.^[33]

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.^[85]

Evidence collection

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.^[83] The use of photography is often used for documentation.^[65]

The information derived from the analysis can often help determine whether sexual contact occurred, providing information regarding the circumstances of the incident, and be compared to reference samples collected from patients and suspects.

Prevention

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.

Sexual assault may be prevented by secondary school,^[91] college,^[92][93] and workplace education programs.^[94] At least one program for fraternity men produced "sustained behavioral change."^[92][95]

Statistics and epidemiology

Worldwide

International Crime on Statistics and Justice by the United Nations Office on Drugs and Crime (UNODC) find that worldwide, most victims of rape are women and most perpetrators male.^[96] The study also found that rapes against women are rarely reported to the police and that the number of female rape victims is significantly underestimated.^[96] Southern Africa, Oceania and North America also report the highest records of rape rates.^[96]

Most rape research and reports of rape are limited to male-female forms of rape. Research on male-on-male and female-on-male rape is rare. Fewer than one in ten male-male rapes are reported. As a group, males who have been raped by either gender often get little services and support, and legal systems are often ill equipped to deal with this type of crime.^[97] Instances in which the perpetrator is female, are not clear and lead to the denial of women being sexual aggressors. This could obscure the true dimensions of the problem.^[98] It is likely under-reported illustrating a double standard.^[99] Forty-three percent of high school and young college men reported being coerced into sexual behavior and, of those, 95% reported that a female was the aggressor.^[100]

The humanitarian news organization IRIN claims that an estimated "500,000 rapes are committed annually in South Africa",^[101] once called 'the world's rape capital.'^[102] The country has some of the highest incidences of child sexual abuse in the world with more than 67,000 cases of rape and sexual assaults against children reported in 2000, with welfare groups believing that unreported incidents could be up to 10 times higher.^[68] Current data suggest that the incidence of rape has risen significantly in India.^[103]

United States

FBI sex offense victims in 2012:^[104]

• 67,354 female
• 12,000 male.

FBI convicted sex offenders in 2012:^[105]

• 78,500 male
• 4394 female.

Statistics maintained by the CDC include:

• 27% of women and 12% of men have experienced sexual violence, including rape
• 50% of bisexual women have been raped at least once in their life.
• 12.5% of lesbians have been raped at least once in their life.
• 17% of heterosexual women have been raped at least once in their life.
• 50% of bisexual men have experienced sexual violence other than rape in their lifetime
• 50% of gay men have experienced sexual violence other than rape in their lifetime
• 20% of heterosexual men have experienced sexual violence other than rape in their lifetime
• 75% of female rape victims report that they were raped before age 25.
• 28% of male rape victims report that they were raped before age ten.^[106]

Risk factors vary among different ethnicities. About one third of African American adolescent females report encountering some form of sexual assault including rape.^[107] One in three Native American women will experience sexual assault, more than twice the national average for American women.^[108]

More than 250,000 cases of rape or attempted rape were recorded by police annually in 65 countries in 2001 through 2002.^[109] In 2007, 40% of the 90,427 forcible rapes reported were cleared by arrest or "exceptional means." Exceptional refers to situations where the person refuses to provide information or assistance necessary to obtain an arrest, the defendant dies before being arrested, or the defendant cannot be extradited from another state.^[110]

Prosecution

Reporting

In 2005, sexual violence, and rape in particular, was considered the most under-reported violent crime in Great Britain.^[111] The number of reported rapes in Great Britain is lower than both incidence and prevalence rates.^[112] The legal requirements for reporting rape vary by jurisdiction — each U.S. state may have different requirements. while one country, New Zealand has less stringent limits.^[113]

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.^[114]

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%.^[115] 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".^[111] According to Amnesty International Ireland had the lowest rate of conviction for rape, (1%) among 21 European states, in 2003.^[116] 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.^[108]

False accusation

Eight percent of 2,643 sexual assault cases were classified as false reports by the police in one study. The researchers noted that some of these classifications were based on the personal judgments of the police investigators and were made in violation of official criteria for establishing a false allegation. Closer analysis of this category applying the Home Office counting rules for establishing a false allegation and excluding cases where the application of the cases where confirmation of the designation was uncertain reduced the percentage of false reports to 3%. The researchers concluded that "one cannot take all police designations at face value" and that "[t]here is an over-estimation of the scale of false allegations by both police officers and prosecutors." Moreover, they added:

The interviews with police officers and complainants' responses show that despite the focus on victim care, a culture of suspicion remains within the police, even amongst some of those who are specialists in rape investigations. There is also a tendency to conflate false allegations with retractions and withdrawals, as if in all such cases no sexual assault occurred. This reproduces an investigative culture in which elements that might permit a designation of a false complaint are emphasized (later sections reveal how this also feeds into withdrawals and designation of 'insufficient evidence'), at the expense of a careful investigation, in which the evidence collected is evaluated.^[117][118]

Another large-scale study was conducted in Australia, with the 850 rapes reported to the Victoria police between 2000 and 2003 (Heenan & Murray, 2006). Using both quantitative and qualitative methods, the researchers examined 812 cases with sufficient information to make an appropriate determination, and found that 2.1% of these were classified by police as false reports. All of these complainants were then charged or threatened with charges for filing a false police report.^[119]

FBI reports consistently put the number of "unfounded" rape accusations around 8%. The unfounded rate is higher for forcible rape than for any other Index crime. The average rate of unfounded reports for Index crimes is 2%.^[120] "Unfounded" is not synonymous with false allegation^[121] and as Bruce Gross of the Forensic Examiner explains,

This statistic is almost meaningless, as many of the jurisdictions from which the FBI collects data on crime use different definitions of, or criteria for, "unfounded." That is, a report of rape might be classified as unfounded (rather than as forcible rape) if the alleged victim did not try to fight off the suspect, if the alleged perpetrator did not use physical force or a weapon of some sort, if the alleged victim did not sustain any physical injuries, or if the alleged victim and the accused had a prior sexual relationship. Similarly, a report might be deemed unfounded if there is no physical evidence or too many inconsistencies between the accuser's statement and what evidence does exist. As such, although some unfounded cases of rape may be false or fabricated, not all unfounded cases are false.^[110]

Other studies have suggested that the rate of false allegations in America may be much higher. A nine-year study by Eugene J. Kanin of Purdue University in a small metropolitan area in the Midwestern United States found that 41% of rape accusations were false.^[122] However David Lisak, an associate professor of psychology and director of the Men's Sexual Trauma Research Project at the University of Massachusetts Boston states that quote "Kanin's 1994 article on false allegations is a provocative opinion piece, but it is not a scientific study of the issue of false reporting of rape". He further states that Kanin's study has significantly poor systematic methodology and had no independent definition of a false report. Instead, Kanin classified reports that the police department classified as false also as false.^[123] The criterion for falsehood was simply a denial of a polygraph test of the accuser.^[122] A 1998 report by the National Institute of Justice found that DNA evidence excluded the primary suspect in 26% of rape cases and concluded that this "strongly suggests that postarrest and postconviction DNA exonerations are tied to some strong, underlying systemic problems that generate erroneous accusations and convictions."^[124]

A 2010 study by David Lisak, Lori Gardinier and other researchers published in the journal of Violence against Women found that out of 136 cases reported in a ten-year period, only 5.9% were found false.^[125]

History

Definitions and evolution of laws

Augustus Caesar enacted reforms for the crime of rape under the assault statute Lex Iulia de vi publica, which bears his family name, Iulia. It was under this statute rather than the adultery statute of Lex Iulia de adulteriis that Rome prosecuted this crime.^[126]

Like theft or robbery, rape was originally considered a "private wrong" iniuria privita, a crime between the abductor and the legal guardian of the woman in question. It was made into a "public wrong" (iniuria publica) by the Roman Emperor Constantine.^[127][128]

Emperor Justinian continued the use of the statute to prosecute rape during the sixth century in the Eastern Roman Empire.^[129] By late antiquity, the general term raptus had referred to abduction, elopement, robbery, or rape in its modern meaning. Confusion over the term led ecclesiastical commentators on the law to differentiate it into raptus seductionis (elopement without parental consent) and raptus violentiae (ravishment). Both of these forms of raptus had a civil penalty and possible excommunication for the family and village receiving the abducted woman, although raptus violentiae also incurred punishments of mutilation or death.^[130]

Virtually all societies have had a concept of the crime of rape. Although what constituted this crime has varied by historical period and culture, until quite recently, the definitions tended to focus around an act of forced vaginal intercourse perpetrated through physical violence or imminent threat of death or severe bodily injury, by a man, on a woman or a girl, not his wife. These definitions differ significantly from the modern definitions of rape in Western countries today. For example, the actus reus of the crime, was, in most societies, the insertion of the penis into the vagina, and, until the 19th century, many jurisdictions required ejaculation for the act to constitute the offense of rape.^[131][132] Acts other than vaginal intercourse did not constitute rape in common law countries and in many other societies. In many cultures, such acts were illegal, even if they were consensual and performed between married couples (see sodomy laws). In England, for example, the Buggery Act 1533, which remained in force until 1828, provided for the death penalty for "buggery". Many countries criminalized "non-traditional" forms of sexual activity well into the modern era: notably, in the U.S. state of Idaho, sodomy between consensual partners was punishable by a term of five years to life in prison as late as 2003, and this law was only ruled to be inapplicable to married couples in 1995.^[133] Today, in many countries, the definition of the actus reus has been extended to all forms of penetration of the vagina and anus (e.g. penetration with objects, fingers or other body parts) as well as insertion of the penis in the mouth. Throughout much of the history, rape was a crime that could only be perpetrated by a male on a female. The way sexuality was conceptualized in many societies rejected the very notion that a woman could force a man into sex — women were often seen as passive while men were deemed to be assertive and aggressive. Sexual penetration of a male by another male fell under the legal domain of "sodomy".

One of the most distinctive features of rape historically was the fact that not all incidents of forced intercourse constituted this crime. An incident could be excluded from the definition of rape due to the relation between the parties, such as marriage (until a few decades ago wives were nearly universally excluded, and in many countries they continue to be so) or due to the background of the victim (in many cultures forced sex on prostitute, slave, war enemy, member of a racial minority, etc., was not rape). For instance, in 17th century Scandinavia, Christian V's law of 1687 stipulated that rape could only be committed on three categories of women: somebody else's wife, a widow, or an honest virgin. Women who did not fit in any of these categories were not considered legal victims of the crime of rape.^[134]

Social issues

In ancient history, rape was viewed less as a type of assault on the female, than a serious property crime against the man to whom she belonged, typically the father or husband. The loss of virginity was an especially serious matter. The damage due to loss of virginity was reflected in her reduced prospects in finding a husband and in her bride price. This was especially true in the case of betrothed virgins, as the loss of chastity was perceived as severely depreciating her value to a prospective husband. In such cases, the law would void the betrothal and demand financial compensation from the rapist, payable to the woman's household, whose "goods" were "damaged".^[135] Under biblical law, the rapist might be compelled to marry the unmarried woman instead of receiving the civil penalty if her father agreed. This was especially prevalent in laws where the crime of rape did not include, as a necessary element, the violation of the woman's body, thus dividing the crime in the current meaning of rape and a means for a man and woman to force their families to permit marriage. (See Deuteronomy 22:28–29.)

From the classical antiquity of Greece and Rome into the Colonial period, rape along with arson, treason and murder was a capital offense. "Those committing rape were subject to a wide range of capital punishments that were seemingly brutal, frequently bloody, and at times spectacular." In the 12th century, kinsmen of the victim were given the option of executing the punishment themselves. "In England in the early fourteenth century, a victim of rape might be expected to gouge out the eyes and/or sever the offender's testicles herself."^[136] Despite the harshness of these laws, actual punishments were usually far less severe: in late Medieval Europe, cases concerning rapes of marriageable women, wives, widows, or members of the lower class were rarely brought forward, and usually ended with only a small monetary fine or a marriage between the victim and the rapist.^[137] In the 15 and 16th centuries, rape in the Basque charters (Enkarterri, Durangaldea) was punished with death for the offender and the person who was helping him.^[138]

Adult women were often extremely reluctant to bring up charges of rape: public admission of having been raped was severely damaging to one's social standing, courts tended to be skeptical of the charges, conviction rates were low, and, in the event that the accusation could not be proved, the victim could then be accused of committing adultery with the rapist (traditionally a serious offense that could have been punished by mutilation^[139] or even death). Certain classes of women, such as prostitutes, were banned from raising accusations of rape altogether.^[140]

The ius primae noctis ("law of the first night") is a term now popularly used to describe an alleged legal right allowing the lord of an estate to take the virginity of his serfs' maiden daughters. Little or no historical evidence has been unearthed from the Middle Ages to support the idea that such a right ever actually existed.^[141][142]

The medieval theologian Thomas Aquinas argued that rape, though sinful, was much less sinful than masturbation or coitus interruptus, because it fulfilled the procreative function of sex, while the other acts violated the purpose of sex.^{[143][144][145][notes 1]}

In Medieval Europe, a woman could be legally married by her parents to a stranger without her consent, and, once she was married, she could no longer refuse to consent to sex: the medieval concept of rape did not allow for the possibility of being raped by one's husband. In 1563, the Council of Trent expressly declared that legal Catholic marriages had to be done with consent of both parties, but did not require parental consent, essentially declaring forced marriages invalid.^[146] This was not universally accepted: for example, in France, women were not granted the right to marry without parental consent until 1793.^[147]

The criminal justice system of many countries was widely regarded as unfair to sexual assault victims. Both sexist stereotypes and common law combined to make rape a "criminal proceeding on which the victim and her behavior were tried rather than the defendant".^[148] Additionally, gender neutral laws have combated the older perception that rape never occurs to men,^[149]

Since the 1970s, many changes have occurred in the perception of sexual assault due in large part to the feminist movement and its public characterization of rape as a crime of power and control rather than purely of sex. In some countries the women's liberation movement of the 1970s created the first rape crisis centers. One of the first two rape crisis centers, the D.C. Rape Crisis Center, opened in 1972. It was created to promote sensitivity and understanding of rape and its effects on the victim. In 1960 law enforcement cited false reporting rates at 20%. By 1973 the statistics had dropped to 15%.

In war

In 1998, Judge Navanethem Pillay of the International Criminal Tribunal for Rwanda said: "From time immemorial, rape has been regarded as spoils of war. Now it will be considered a war crime. We want to send out a strong message that rape is no longer a trophy of war."^[150] Rape, in the course of war, dates back to antiquity, ancient enough to have been mentioned in the Bible.^[151] The Israelite, Persian, Greek and Roman armies reportedly engaged in war rape.^[152] The Mongols, who established the Mongol Empire across much of Eurasia, caused much destruction during their invasions.^[153] Contemporary documents say that after a conquest, the Mongol soldiers looted, pillaged and raped.^[154] According to Rogerius of Apulia, a monk who survived the Mongol invasion of Hungary, the Mongol warriors "found pleasure" in humiliating local women.^[155]

The systematic rape of as many as 80,000 women by the Japanese soldiers during the six weeks of the Nanking Massacre is an example of such atrocities.^[156] During World War II an estimated 200,000 Korean and Chinese women were forced into prostitution in Japanese military brothels, as so-called "Comfort women".^[157] French Moroccan troops known as Goumiers committed rapes and other war crimes after the Battle of Monte Cassino. (See Marocchinate.)^[158] French women in Normandy complained about rapes during the liberation of Normandy.^[159][160] Soldiers raping women and girls was common in many areas occupied by the Red Army. A female Soviet war correspondent described what she had witnessed: "The Russian soldiers were raping every German female from eight to eighty. It was an army of rapists."^[161]

According to researcher and author Krisztián Ungváry, some 38,000 civilians were killed during the Siege of Budapest: about 13,000 from military action and 25,000 from starvation, disease and other causes. Included in the latter figure are about 15,000 Jews, largely victims of executions by Hungarian Arrow Cross Party militia. When the Soviets finally claimed victory, they initiated an orgy of violence, including the wholesale theft of anything they could lay their hands on, random executions and mass rape. An estimated 50,000 women and girls were raped,^{[162]:348–350[163][notes 2]} although estimates vary from 5,000 to 200,000.^[164]:129 Hungarian girls were kidnapped and taken to Red Army quarters, where they were imprisoned, repeatedly raped and sometimes murdered.^{[165]:70–71}

See also

Notes

References

Further reading

External links

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