ACOG Calls for Routine Sexual Assault Screening

Laurie Barclay, MD

July 21, 2011

July 21, 2011 — Healthcare providers should screen routinely for a history of sexual assault and appropriately address accompanying medical and legal issues, according to an American College of Obstetricians and Gynecologists (ACOG) Committee Opinion reported in the August issue of Obstetrics & Gynecology.

"When ob-gyns routinely screen patients for a history of sexual assault, women who have been or are currently being assaulted may be more likely to report their abuse," said coauthor Veronica Gillispie, MD, a member of The College's Committee on Health Care for Underserved Women, in a news release. "There is a long list of physical and emotional health problems that follow a history of abuse. By identifying victims of sexual assault and encouraging them to report their abuse, these problems can be better addressed and even prevented."

Women who are of reproductive age and have been sexually assaulted are at risk for unintended pregnancy as well as for sexually transmitted diseases. These women should therefore be offered and provided with emergency contraception and prophylaxis for sexually transmitted diseases. Posttraumatic stress disorder and other psychiatric disorders may also accompany or occur after a sexual assault and should be appropriately evaluated and managed.

Any provider who examines women who have been sexually assaulted must be knowledgeable regarding state and local statutory or policy requirements that may mandate the use of assessment kits to gather forensic evidence.

Medical issues to be addressed by the healthcare provider include obtaining informed consent, evaluating and treating physical injuries, and obtaining gynecologic history. The physical examination should include a pelvic examination in the presence of an appropriate chaperone.

Specimens and serologic tests should be collected for sexually transmitted disease testing, and infectious disease prophylaxis should be provided as indicated. Emergency contraception should be offered or arranged as indicated. The patient should be counseled about the findings, recommendations, and prognosis, and follow-up medical care and referrals for psychosocial needs should be arranged.

Regarding the legal issues, the healthcare provider must accurately record the events, document injuries, and collect samples as required by local protocol or regulation. The presence or absence of sperm in vaginal fluids should be documented and slides made as appropriate. The healthcare provider should report the sexual assault to authorities as required and ensure the security of the chain of evidence.

"Ob-gyns can be instrumental in stopping the cycle of abuse," Dr. Gillispie said. "Providers should understand their role in treating patients with a history of sexual assault and how important they can be in helping these women heal."

Obstet Gynecol. 2011;118:396-399.

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