Dr. Rotimi Adesanya
The
incidence of rape in Nigeria and worldwide has been on the increase!
What could be wrong with the modern society? There is epidemic of rape,
hence the need for continuous health education.
‘How are the mighty fallen!’ is a popular
biblical saying. The mighty are really falling daily, as respected men
in the society have been implicated in one rape issue or the other.
From monarch to physician, musician,
clergy, imam, teacher, father, and men who are role models in the
society — they have all been implicated in the past few weeks.
The physician’s responsibilities in an
alleged rape involve the following: documentation of events/medical
history, careful physical examination, prompt treatment of physical
injuries, psychological support and arrangements for follow-up
counseling; collection of legal evidence, prevention of venereal disease
and prevention of pregnancy, if desired by the patient.
Examination
After assisting the patient to become as
comfortable as possible, a meticulous physical examination should be
performed. The purpose of the examination is to assess and treat
physical injuries, as well as collect evidence that could be submitted
in court proceedings.
Evidence not collected within 48 to 72 hours of the incident is likely to be invalid.
All of the victim’s clothes should be sent to a crime laboratory in carefully labeled and sealed bags.
The patient should be evaluated for
abrasions, bruises and lacerations and extra-genital trauma to the
mouth, throat, wrists, arms, breasts and thighs.
The vaginal examination should be
performed with a speculum. After noting the condition of the hymen, the
vaginal walls and cervix should be examined for lacerations or
abrasions.
Vaginal secretions should be aspirated or collected on cotton swabs.
Medical implication
Pregnancy: Pregnancy as a result of rape
occurs in about five per cent of fertile female victims. Preexisting
pregnancy should be determined, preferably by a blood pregnancy test,
and treatment for the prevention of pregnancy should be offered to the
patient.
All post coital pregnancy interventions are effective within the first 72 hours of the act.
Sexually Transmitted Diseases: Detection
and treatment of sexually transmitted diseases are the responsibility of
the physician. Baseline Hepatitis B Virus and Syphilis serology should
be determined at the time of the examination, and the test should be
repeated three months after the sexual contact.
Human Immunodeficiency Virus (HIV)
testing is controversial and should be discussed with the patient. If
the patient desires testing and baseline results are negative, repeat
testing is recommended in three to six months.
Laboratory testing
Testing for Chlamydia, gonorrhea, trichomonas, Hepatitis B and HIV is recommended.
The remaining vaginal aspirate should be
sent to a forensic laboratory to determine the presence of acid
phosphatase. The presence of acid phosphatase is a good indicator of
recent coitus.
Cultures for Neisseria gonorrhoeae and
Chlamydia trachomatis should be obtained from the cervix, rectum or
mouth, based on the assault history.
Follow-up care
It is recommended that you have a
follow-up visit with a health care provider within two weeks of the
assault, then monthly for three to six months. During this visit, you
can have follow-up testing, get treatment if needed, and discuss how you
are recovering.
Testing for gonorrhoea, Chlamydia,
trichomonas, and bacterial vaginosis may be recommended after the
assault if you did not take preventive treatments at the initial
evaluation.
Testing for pregnancy is recommended four weeks after the initial examination if you took an emergency contraceptive pill.
Testing for HIV is usually repeated at
six weeks, three months and six months after the assault. This schedule
of testing is recommended because, in some cases, it takes up to six
months for the blood test to become positive.
The victim may know, or even live or work
with a person who sexually assaulted them. It is essential that rape
victims get help to find an environment where they feel safe after the
attack.
Prevention
To stem the tide, non-governmental
organisations, women affairs and social welfare departments at the
federal, state and local government levels must commence enlightenment
campaigns to alert parents and their children to this crime and how to
avoid/prevent being violated
Parents also have to spend more time with their children, be closer to them and teach them about sex education early in life
The campaign should be intense and sustained; it should warn prospective offenders that severe punishment awaits them
In conclusion, rape is both a legal and
medical term; hence readers are encouraged to seek knowledge about the
legal aspects of rape.
Concluded.
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