Medical Care Following a Sexual Assault

This is your choice. Often it is a good idea to see a doctor as soon as possible to make sure you are OK and to talk about any concerns you have about your health.

That depends on the service you want. The doctor can assist you best if she/he knows why you are there.

That depends on what your concerns are and what you want to have happen. A doctor can provide you with:

• information about your medical care and answers to your questions
• a health check to:
  • check for possible injuries and their treatment
  • talk about and provide medication to help prevent a pregnancy and to conduct pregnancy testing
  • talk about sexually transmitted infections including testing and treatment to prevent infections and/or treat infections if they are found
  • talk about the effects of the rape and sexual assault on your wellbeing, including feeling depressed or suicidal, eating and sleeping patterns, or level of anxiety
  • provide a medical certificate if you need some time off work, school or university.

If you are thinking about reporting to the police, the doctor can collect evidence for the police with your consent – you can find more information under Forensic medical examination after a sexual assault. It is important that this done soon as possible.

The following information is about seeing a doctor or nurse at Yarrow Place, and the sorts of things they might talk with you about.

The doctor or nurse will talk with you about your health concerns. The doctor or nurse will ask you if you want to be examined and talk with you about the examination. You will need to give consent for the examination, and may need to sign a consent form. Even after giving consent you can change your mind at any time and say ‘yes’ to some parts of the examination and ‘no’ to other parts. In South Australia, you can give consent and sign the consent form yourself when you are 16 years and older.

A lot of people who have been raped or sexually assaulted will have no injuries as a result of the assault. Some people will have injuries such as bruises, scratches and grazes. A small number of people will have serious injuries that need to be treated in hospital.

Bruising, aches, pain and stiffness may be more noticeable in the first few days after the assault.

Treatment for general injuries

Serious injuries such as broken bones and head injuries need to be assessed and treated in the Emergency Department at your local hospital. For less serious injuries such as bruises and abrasions, simple pain killers such as paracetamol may help. If you have concerns please speak to a Yarrow Place worker.

For bruises and other soft tissue injuries, ice packs (covered by a towel), and resting, bandaging and elevating the injured area can be helpful.

Abrasions should be kept clean and dry. If you have not recently had at tetanus vaccination, please see the doctor to organise a booster shot.

Warm baths or showers can help ease general muscle aches and pains. Please be aware that forensic evidence which can be collected to help the police investigate the assault, can be lost if you shower or bath before you have the evidence collected.

Please note: New bruises may appear after you have been examined by the doctor or nurse. If this happens and you are taking or thinking about legal action, you should contact the doctor or nurse to organise documentation of these injuries.

Injuries to this area can cause soreness, pain, bleeding or stinging when going to the toilet. These injuries generally heal quickly but new or heavier bleeding, abdominal pain or any other worrying symptoms need to be checked by a doctor.

Treatment for genital and anal injuries

Ice packs and firm padding can ease soreness. A small covered ice pack can be placed between a sanitary pad and the sore area. It should only be left in place until the ice has melted, for about 10 to 15 minutes and then removed. If the anal/genital injury is quite painful, you could talk to the doctor about using a local anaesthetic (numbing) gel on the area for a few days.

Anal injuries can be helped with ice-packs as above, salt baths, taking Coloxyl 240 mg at night to help prevent constipation, drinking 2 litres of fluid a day and using a numbing gel before opening your bowels.

Some people experience pain or tenderness when having sex after the assault. You may find that talking to your partner about your concerns, taking it slowly and using a lubricating gel may make it more comfortable.

Strangulation can occur during sexual assault and in domestic violence situations. Strangulation is potentially a very serious injury that should be evaluated by a doctor. If you lost consciousness or had a seizure when you were being strangled, or have neck or throat soreness, hoarseness, difficulty or pain swallowing, difficulty breathing or shortness of breath, vision changes, a continuous cough, and/or weakness in your arm or leg after being strangled, you should be medically assessed at the hospital. Pregnant women should also go to the hospital to check on the baby.

Please be aware that you can experience delayed onset of symptoms after being strangled. These are usually within 72 hours so it is best if you can be in a supported environment at least up to this time.

Sexual assault can occur in the context of domestic violence. Information for women and men who are in a domestic violence situation can be found by calling or accessing the 1800RESPECT website, Australia's National Sexual Assault, Domestic and Family Violence Counselling Service, available 24 hours, 7 days a week 1800 737 732.

The Office for Women in South Australia has developed the Family Safety Framework which provides assessment tools that can be used by your doctor and a referral procedure to fortnightly safety meetings which can improve your safety.

For women, if you were not using contraception at the time of the rape, you may want to take the emergency contraceptive pill. This will reduce your risk of pregnancy. You can get the emergency contraceptive pill from the chemist without a script. It is also available from Yarrow Place.

There are now 2 different types of Emergency Contraceptive Pill. Talk to the chemist or Yarrow Place doctor or nurse to see which pill would be best for you. The Emergency Contraceptive Pill works best when taken as soon as possible after unprotected sex but can be taken, depending on the pill recommended for you, up to 3 or 5 days after the unprotected sex. The Emergency Contraceptive Pill is generally well tolerated but can sometimes cause nausea or vomiting. If vomiting occurs within 2 to 3 hours of taking the tablet(s), the medication will need to be taken again. Less common side effects are abdominal pain, vaginal bleeding, headache, breast tenderness and dizziness.

Even though the Emergency Contraceptive Pill is effective at preventing pregnancy, it is important to have a follow up pregnancy test to be sure. Talk to your doctor if your next period is lighter than normal or is late or if you have any symptoms of pregnancy or pain in the lower abdomen.

If you are pregnant at the time of the assault you may be worried about your baby. It is unlikely that your baby will have been harmed but you can ask the doctor to check that your baby is OK. If you have any bleeding or abdominal pain it is very important to see your doctor.

If you are pregnant as a result of a rape, please see your doctor or phone Yarrow Place to discuss the options you have in relation to the pregnancy.

Many people who have been sexually assaulted are concerned about sexually transmitted infections (STIs). In South Australia getting an infection after a sexual assault is uncommon, however it is still important to check. Testing for sexually transmitted infections can be done in the first few days after an assault (called baseline testing). Testing at this time generally shows whether or not you had an infection before the sexual assault. It is not necessary to have testing at this time but some people want baseline tests taken. Infections that the doctor or nurse might test for are chlamydia, gonorrhoea, hepatitis B, hepatitis C, HIV, syphilis and vaginal infections such as thrush.

For more information about the above STIs please visit the Adelaide Sexual Health Centre.

The best time to test for infections after the assault are:

• 2 to 3 weeks for chlamydia, gonorrhoea and vaginal infections; and
• 3 months for a blood test for HIV, hepatitis B and C, and syphilis

There are medications available that may reduce your risk of developing a sexually transmitted infection. The doctor or nurse will talk with you about the risks of infection and the type of medication that you can take to help reduce this risk.

The psychological impacts of rape and sexual assault are often very significant. Trouble sleeping, anxiety, depression and thoughts of self-harm or suicide are common reactions. Changes in sexual desire may occur. Remember, people do recover from the impact of rape. It is good to think about what you can do to help your recovery and how to keep safe in this process.

Some people have problems with drugs and alcohol, eating disorders and hurting themselves after being sexually assaulted. These coping strategies may harm your health. Please think about safe ways to deal with the effects of the assault, such as talking to a friend, writing in a journal, and seeing a counsellor or your doctor.

Suicidal thoughts in particular can be very distressing. Talk to a trusted person about these thoughts and seek help from a health practitioner or a mental health service, so that you can be safe until the thoughts are no longer a problem. In South Australia, Mental Health Triage, 13 14 65 can be contacted 24 hours a day, 7 days a week.

Sometimes people are concerned that they have been drugged and sexually assaulted. There are many ways that drugs and/or alcohol may be involved in sexual assaults. You may have been sexually assaulted when:

• you were under the influence of a drug that you were using for recreational purposes
• you were using prescription drugs and drinking alcohol and were unaware of the combined effects
• your drink was spiked for the purpose of sexual assault
• your drinks were a higher alcohol content than you were led to believe.

Typically, a person has been out to a club or party and feels intoxicated out of proportion to the amount of alcohol they have had. You may have gaps in your memory and wake up in a strange place and in circumstances that make you believe that you have been sexually assaulted.

If you are worried that this has happened to you, see your doctor or contact Yarrow Place to talk about what you can do in this situation.

Another appointment with the doctor or nurse can be made to offer you:

• pregnancy testing
• testing for sexually transmitted infections
• a check to see how your injuries are healing
• an opportunity to talk about other problems that have been caused by the assault such as sleep disturbance and depression and
• time to talk about ways of coping with the effects of the assault.