Assistant Professor of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI.
Obstet Gynecol Surv. 2017 Jan;72(1):39-53. doi: 10.1097/OGX.0000000000000390.
Sexual assault is characterized by any sexual contact or behavior that occurs without explicit consent. Classifications vary based on the status of the perpetrator's relationship to the victim (eg, stranger, acquaintance) and characteristics of the victim herself (eg, child, elder adult, mentally disabled adult). Regardless of the classification, sexual assault is a significant individual as well as public health issue affecting women of all ages. While the majority of sexual assault cases are not initially reported to law enforcement, the best available data suggest the lifetime prevalence of sexual assault in the United States is approximately 20% among adult women. With such a significant proportion of women affected by sexual assault, women's health care providers in both ambulatory and emergency care settings play key roles in the evaluation, management, and advocacy of these victims. Establishing standard protocols based on state laws and on victim-centered practices to avoid revictimization of the patient is critical. The primary goals of care include the assessment and treatment of physical injuries, psychological assessment and support, pregnancy assessment and prevention, and therapy for prevention of sexually transmitted infections. In addition, evidentiary collection is a critical component of the sexual assault evaluation and subsequent legal proceedings. This report focuses specifically on the immediate evaluation and management of adult female victims of sexual assault. Best practices include the utility of the Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner programs, as well as standardized treatment protocols.
性侵犯的特征是任何未经明确同意而发生的性接触或行为。根据施害者与受害者关系的状态（例如陌生人、熟人）和受害者自身的特征（例如儿童、成年老年人、智力残疾成年人）对其进行分类。无论如何分类，性侵犯都是一个严重的个人和公共卫生问题，影响着各个年龄段的女性。尽管大多数性侵犯案件最初并未向执法部门报告，但现有最佳数据表明，美国成年女性一生中遭受性侵犯的比例约为 20%。鉴于如此大比例的女性受到性侵犯的影响，在门诊和急诊环境中，女性保健提供者在这些受害者的评估、管理和倡导方面发挥着关键作用。根据州法律和以受害者为中心的实践制定标准协议以避免患者再次受害至关重要。护理的主要目标包括评估和治疗身体伤害、进行心理评估和支持、进行妊娠评估和预防以及预防性传播感染的治疗。此外，证据收集是性侵犯评估和随后法律程序的重要组成部分。本报告专门针对成年女性性侵犯受害者的即时评估和管理。最佳实践包括性侵犯护士检查和性侵犯法医检查计划的实用性，以及标准化治疗方案。
