Crimes of a sexual nature occur constantly and everywhere. Nowadays, the problem of sexual assault stands very acutely. A sexual assault, including rape, is any sexual act committed in relation to a person who does not want to participate in it and does not agree to it freely and without coercion. It should be emphasized that from a psychological point of view, an attempt of rape or sexual abuse is perceived as a completed rape. In such a way, it is also a serious offense. After an attempt or committed act of sexual violence, a person needs the help of a health worker. To treat victims of violence is an ethical duty of health workers. The aim of the paper is to study the notion of sexual assault and the role of nurses in treating patients after it.
Sexual Health and Sexual Assault
The World Health Organization gave the definition of the concept of sexual health. According to the WHO, sexual health is “The integration of the somatic, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love” (“Defining sexual health: Report”, 2006, p. 4). In the article “Promoting Sexual Health and Responsible Sexual Behavior: An Introduction”, the author states: “Fundamental to the concept of sexual health is the right to sexual information and the right to pleasure” (Coleman, 2002, p. 3). The concept of sexual health includes three main elements. The first element is the capability of enjoyment and control of sexual conduct in compliance with the standards of personal and social ethics. The second element is freedom from false beliefs, guilt, fear, and other psychological factors restraining sexual reactions and disturbing sexual relations with people. The last element is the absence of diseases and disorders disturbing sexual relations. In connection with the serious socio-economic changes, there are objective changes in the sexual behavior of the population resulting in promiscuity, early onset of sexual activity contributing to the outbreak of sexually transmitted diseases including AIDS, as well as increased sexual violence (Coleman, 2002).
In recent decades, the attention to the problem of sexual assault has raised significantly around the world. This problem acquires the prevalent nature, and it is seen as a socially important one. The daily life of modern society demonstrates widespread forms of assault such as rape, domestic violence, sexual exploitation of young people, and incest. Sexual assault is a crime, for which a person by force, threat, or deception is compelled against his/her will to any form of sexual relationship. According to the WHO, in the world, at least one out of five women was raped once in a lifetime (Welch & Mason, 2007).
Statistics of rape in different countries vary considerably. Thus, in the United States, 36 women out of 100 thousand are raped per year, in Turkey – 14, Japan – 12, England – 3, Norway – 1 (Welch & Mason, 2007). The research in Canada has shown that one in four girls is abused before the age of 18 years old (Welch & Mason, 2007). According to an anonymous survey conducted among 53 women, 30% of them pointed to the experience of suffering sexual assault (Welch & Mason, 2007). According to various sociological surveys and psychological researches, the percentage of victims of sexual violence varies from 13% to 33% (Welch & Mason, 2007). Herewith, 85-90% of offenders are familiar to a child and about 40% of offenders are brothers, fathers, and grandfathers (Welch & Mason, 2007). Nearly 50% constitute neighbors and friends, while strangers constitute only 10%. Studies have also shown that children with disabilities are abused more often (Welch & Mason, 2007). At the same time, according to the same statistics, only one out of four women goes to the police. Raped women also seek for medical help extremely seldom. Unlike victims of other crimes, victims of sexual assault often do not want to report the incident to avoid publicity. Frequently, they do not want to face a continuation of the traumatic experience. However, medical assistance for victims of sexual assault is essential. For a victim, sexual abuse is associated with the severe psychological trauma violating mental balance. After the introduction of the Diagnostic and Statistical Test (DSM) by the American Psychiatric Association, the position was legalized that victims of sexual assault experienced the same shock as people affected by the earthquake, trauma on the war, or a car accident. In such a way, they have a post-traumatic stress disorder.
Consequences of Sexual Assault
Any sexual assault has consequences of various nature. Firstly, there are psychological consequences, including the development of border reactive states, depression, psychosomatic, and psychosexual disorders. There are also medical after-effects such as bodily injuries of varying severity that can even lead to death. A victim of sexual assault might attempt to commit suicide attempts or use psychoactive substances to ease suffering. There are also social consequences such as vagrancy, social exclusion, prostitution, joining the sects, breach of the learning process, and committing of various offenses (Esposito, 2006). Gynecological problems because of sexual assault can be both immediate and remote. Immediate problems include damage of the genitals, pregnancy and abortion, sexually transmitted infections, vaginal bleeding, and urinary tract infections. Remote problems of the gynecological character include ovarian dysfunction, chronic pelvic pain, dysmenorrheal, and infertility. Early pregnancy and childbirth can lead to a variety of medical problems, including the impact of unsafe abortions. Girls at the age of 15 are five times more likely to die in childbirth than women between the ages of twenty to thirty years (Esposito, 2006). For them, there is also an increased risk of obstetric fistula because of prolonged or obstructed labor (Esposito, 2006). In such a way, people surviving sexual assault should seek for medical help. Only medical workers can help them with the consequences of sexual abuse.
The Role of Nurses
In the United States, the network of institutions providing practical assistance to victims of sexual violence is developed rather well. Medical institutions play a special role in the system of state institutions capable of assisting victims of sexual assault. As it is known, a sexual assault causes damage to health and it is often associated with serious injuries. In such cases, the victims of sexual abuse seek for medical help. Nurses can play an important role in the prevention of violence cases and provide informational assistance to victims. The medical establishment may be the only place where the victim asks for help. According to the research, only 5% of the pregnant women responded affirmatively to the question of whether they were subjected to sexual assault (Welch & Mason, 2007). However, when medical personnel that observed the course of pregnancy asked the same question, about 20% of patients admitted that they had been subjected to sexual abuse (Welch & Mason, 2007).
The after-effects of sexual assault against women are extremely serious, interconnected, and long-term. Medical workers have the opportunity and responsibility to identify cases of abuse. For many women in the developing countries, a visit to the clinic about reproductive health or child’s health may be the only contact with the health system. The health sector can take the opportunity providing supportive and secure environment for patients. It helps health professionals ask about sexual violence.
The main goal for a nurse who works with the victims of violence is to reduce and eliminate the consequences of traumatic experiences. Working with victims of sexual violence, the nurse should remember that during the examination, bodily injuries requiring treatment should be identified in addition to the information that the patient reports. It is essential to state the damages immediately after the incident of sexual assault. When examining the victims of violence, the nurse should examine the patient and evaluate his/her mental state, behavior, and appearance. The nurse must examine the victim on the presence of injuries. As Ort (2002) writes, “Examining a rape victim involves a complete physical assessment, which includes identifying injuries and obtaining evidence” (p. 24). The task of a nurse is to examine the patient, including the genital area and the anus. The hospital nurse must also mention all the physical damages and possibly take photos of them. A health worker prescribes diagnostic tests for the diagnosis of head and neck injuries, fractures, as well as the spine and abdominal injuries. Tasks faced by the personnel also include the reduction of a sense of powerlessness, resentment, and shame in a victim, as well as the promotion of the interaction with other people. Apart from physical health, the nurse should examine the psychological state of the victim. Ort (2002) mentions that “Nurses offer emotional support, ensure availability of both post-exposure prophylaxis for sexually transmitted infections and emergency contraception, and make sure victims have access to counseling services” (p. 24).
Treatment of victims of sexual assault has many factors. It requires both medical and preventive measures. The revealed pathology should be assessed and treated in the same way as any other urgent conditions. To one degree or another, crisis intervention is necessary to all the victims of sexual assault. Counseling, prescription of drugs, and the subsequent rehabilitation should be individual. The nurse must discuss the possibility of pregnancy with every victim of violence in the reproductive age. The probability of pregnancy from a single sexual intercourse in the middle of the cycle is 30% (Ort, 2002). On average, in case of the accidental single contact, about 4% of women become pregnant (Ort, 2002). In the case of possible pregnancy, the nurse must hold alternative ways to prevent pregnancy such as conducting of post-coital contraception, repeated pregnancy test in the absence of menstruation, examination of women in disturbance of the menstrual cycle, prevention of sexually transmitted diseases, and introduction of spirals in the first 5 days after sexual assault.
To treat victims of sexual assault is ethical duty of health workers. However, the medical personnel should change the practice of treating only the physical damage, which leads to the fact that the victims are again vulnerable to assault, as there is no proper intervention. The task of nurses is to help the victims realize that none of them deserves abuse, attacks, and insults. It should be the cornerstone of treatment. Health care providers should coordinate their efforts with other social organizations to help the victims of sexual assault. The work of nurses should not be limited to the observation room or hospital ward. The medical personnel are respected in the community, which makes their opinions of great value. Nurses and doctors use their positions of leadership and universal respect by entering into public coalitions and fighting for better laws and relations, full respect, without cruelty, and violence.
Sexual assault is a form of interpersonal violence, which is a serious public health problem around the world. It is not a problem of one family or a victim of the assault. It is a problem of the whole society. The medical personnel cannot remain aloof in dealing with this problem. Thus, the role of nurses in prevention and treatment of victims of sexual abuse is extremely important. Sexual assault is one of the most important questions of public health. Therefore, it is necessary to take certain steps to solve this problem.