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Rape

Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. 

Rape may be carried out by physical force, coercion, abuse of authority, or against a person who is incapable of giving valid consent.

Virtually all societies have had a concept of the crime of rape. 

Its definitions tend to focus around an act of forced vaginal intercourse perpetrated through physical violence or imminent threat of death or severe bodily injury, by a man, on a woman, or a girl, not his wife. 

The rate of reporting, prosecuting and convicting for rape varies between jurisdictions: ranging from Internationally,  the incidence ranges from from 0.2/100,000 to 92.9 with 6.3 as the median.

Worldwide, sexual violence, including rape, is primarily committed by males against females.

Rape by strangers is usually less common than rape by people the victim knows.

Male-on-male and female-on-female prison rapes are common and may be the least reported forms of rape.

Widespread and systematic rape and sexual slavery can occur during international conflict. 

These practices are crimes against humanity and war crimes. 

Rape is an element of the crime of genocide when committed with the intent to destroy, in whole or in part, a targeted ethnic group.

Rape individuals can be traumatized and develop post-traumatic stress disorder.

Rape may be associated with serious injuries and the risk of pregnancy and sexually transmitted infections. 

Rape victims may face violence or threats from the rapist, and, sometimes, from the victim’s family and relatives.

The definition of rape is inconsistent between governmental health organizations, law enforcement, health providers, and legal profession.

The World Health Organization (WHO) defines rape as a form of sexual assault.

The CDC includes rape in their definition of sexual assault; they term rape a form of sexual violence. 

The CDC lists other acts of coercive, non-consensual sexual activity that may or may not include rape, including drug-facilitated sexual assault, acts in which a victim is made to penetrate a perpetrator or someone else, intoxication where the victim is unable to consent,  non-physically forced penetration which occurs after a person is pressured verbally by intimidation or misuse of authority to force to consent, or completed or attempted forced penetration of a victim via unwanted physical force.

Some jurisdictions differentiate between rape and sexual assault by defining rape as involving penile penetration of the vagina, or solely penetration involving the penis, while other types of non-consensual sexual activity are called sexual assault.

In other cases, the term rape has been phased out of legal use in favor of terms such as sexual assault or criminal sexual conduct.

Victims of rape or sexual assault come from a wide range of genders, ages, sexual orientations, ethnicities, geographical locations, cultures, and degrees of impairment or disability. 

Rape classification is based on  a number of categories describing the relationship of the perpetrator to the victim and the context of the sexual assault: date rape, gang rape, marital rape, incestual rape, child sexual abuse, prison rape, acquaintance rape, war rape and statutory rape. 

Forced sexual activity can be committed over a long period of time with little to no physical injury.

Lack of consent is key to the definition of rape.

The absence of objection does not constitute consent: Lack of consent may result from either forcible compulsion by the perpetrator or an inability to consent on the part of the victim;people who are asleep, intoxicated or mentally compromised.

Sexual intercourse with a person below the age of consent, is referred to as statutory rape.

Duress occurs when the person is threatened, (or someone close to the victim),  by force or violence and may result in the absence of an objection to sexual activity. 

Blackmail or abuse of power may constitute duress. 

Marital rape, is non-consensual sex in which the perpetrator is the victim’s spouse: a form of partner rape, domestic violence, and sexual abuse.

Consent may be complicated by law, language, context, culture and sexual orientation.

Men consistently perceive women’s actions as more sexual than they intend.

The main  factors that lead to the perpetration of sexual violence against women, including rape, are:

beliefs in family honor and sexual purity;

attitudes of male sexual entitlement;

weak legal sanctions for sexual violence.

Underlying motives of rapists can be: anger, power,sadism, sexual gratification, or evolutionary proclivities.

Compared with non-rapists, rapists are measurably more angry at women and more motivated by a desire to dominate and control them, are more impulsive, disinhibited, anti-social, hypermasculine, and less empathic.

Sexual aggression is often considered a masculine identity characteristic of manhood in some male groups.

Sexually aggressive behavior among young men is correlated with gang or group membership as well as having other delinquent peers.

Gang rape is often perceived by male perpetrators as a justified method of discouraging or punishing what they consider as immoral behavior among women.

Gang rape and mass rape are often used as a means of male bonding. 

Gang rape accounts for about three quarters or more of war rape, while gang rape accounts for less than a quarter of rapes during peacetime. 

Rebellious commanders sometimes push recruits to rape, to build loyalty among those involved. 

Rebel groups who have forced recruitment as opposed to volunteer recruits are more involved in rape.

Urban gangs often require raping women for initiation reasons.

Perpetrators of sex trafficking and cybersex trafficking allow or carry out rape for financial gain and or sexual gratification.

Rape pornography, including child pornography, is created for profit and other reasons.

Consequences of sexual abuse:

Gynecological disorders

Reproductive disorders

Sexual disorders

Infertility

Pelvic inflammatory disease

Pregnancy complications

Miscarriage

Sexual dysfunction

Acquiring sexually transmitted infections, including HIV/AIDS

Mortality from injuries

Increased risk of suicide

Depression

Chronic pain

Psychosomatic disorders

Unsafe abortion

Unwanted pregnancy 

Emotional and psychological

Victims may remain in denial for years afterwards.

Confusion may exist in some victims over whether or not their experience constitutes rape is typical. 

This is especially true for victims of psychologically coerced rape. 

Women may not identify their victimization as rape due to feelings of shame, embarrassment, non-uniform legal definitions, reluctance to define the friend/partner as a rapist, or because they have internalized victim-blaming attitudes.

Victims of  rape may be uncomfortable/frustrated with and not understand their reactions, and may respond by freezing up, or becoming compliant and cooperative during the rape. 

IDH reactions  can cause confusion for others and the person assaulted. 

Dissociation can occur during rape.

Memories of the event may be fragmented immediately afterwards. 

A male who is raped may be stimulated and even ejaculate during the experience of the rape, and a woman or girl may orgasm during a sexual assault: source of shame and confusion for those assaulted along with those who were around them.

Trauma symptoms after a rape may not appear until years after the sexual assault occurred. 

Following a rape, a wide range of responses may occur: from expressive to closed down to distress, anxiety, shame, revulsion, helplessness, and guilt and denial.

Following rape, the survivor may develop symptoms of post-traumatic stress syndrome and may develop a wide array of psychosomatic complaints.

The likelihood of sustained severe symptoms is higher if the rapist confined or restrained the person, if the person being raped believed the rapist would kill them, the person who was raped was very young or very old, and if the rapist was someone they knew, and 

 if people around the survivor ignore (or are ignorant of) the rape or blame the rape survivor.

Most people recover from rape in three to four months.

Many rape victim have persistent PTSD that may manifest in anxiety, depression, substance abuse, irritability, anger, flashbacks, or nightmares.

Rape survivors may have long-term generalized anxiety disorder, may develop specific phobias, major depressive disorder, and may experience difficulties with resuming their social life and with sexual functioning.

People who have been raped are at higher risk of suicide.

Men experience similar psychological effects of being raped, but they are less likely to seek counseling.

Those women who have experienced sexual assault yet have no physical trauma may be less inclined to report to the authorities or to seek health care.

Penetrative rape generally does not involve the use of a condom.

The use of a condom in rape significantly reduces the likelihood of pregnancy and disease transmission, both to the victim and the rapist. 

Rationales for condom use include: avoiding contracting infections or diseases, especially in cases of rape of sex workers or in gang rape, eliminating evidence, making prosecution more difficult, giving the appearance of consent and thrill from planning and the use of the condom as an added prop. 

Individuals who have been raped have relatively more reproductive tract infections than those who have not.

Acquiring sexually transmitted infections increases the risk of acquiring HIV.

The belief that having sex with a virgin can cure HIV/AIDS exists in parts of Africa, leading to the rape of girls and women: this is disputed.

Societal treatment of victims has the potential to exacerbate rape victim trauma: some people who have been raped or sexually assaulted are sometimes blamed and considered responsible for the crime.

The fallacy and rape myth that certain victim behaviors may encourage rape.

Such victim-blaming concepts are at least partially accepted in many countries: these are cultures where there is a significant social divide between the freedoms and status afforded to men and women.

Rape victims are blamed more when they resist the attack later in the rape encounter rather than earlier: suggesting the stereotype that these women are engaging in token resistance, or leading the man on because they have gone along with the sexual experience thus far. 

Victims are blamed more when they are raped by an acquaintance/date rather than by a stranger.

With certain stereotypical elements of rape are in place, rape victims are prone to being blamed.

A number of gender role stereotypes can play a role in rationalization of rape: power is reserved to men whereas women are meant for sex and objectified, that women want forced sex and to be pushed around, and that male sexual impulses and behaviors are uncontrollable and must be satisfied.

For females, victim-blaming correlates with fear, as many rape victims blame themselves. 

In many cultures, raped women have a high risk of suffering additional violence or threats of violence after the rape. 

Such violence can be perpetrated by the rapist, friends, or relatives of the rapist. 

The intent can be to prevent the victim from reporting the rape, to punish them for reporting it, or of forcing them to withdraw the complaint. 

The relatives of the raped victim may wish to prevent bringing shame to the family and may also threaten them, especially in cultures where female virginity is highly valued and considered mandatory before marriage.

In extreme cases, rape victims are killed in honor killings.

Many rapes do not result in serious physical injury.

The first medical response to sexual assault is a complete general assessment will prioritize the treatment of injuries by the emergency room staff. 

Medical personnel are trained to assess and treat those assaulted or follow protocols established to ensure privacy and best treatment practices. 

Informed consent is always required prior to treatment unless the person who was assaulted is unconscious, intoxicated or does not have the mental capacity to give consent.

Victims have the right to refuse any evidence collection. 

After physical injuries are addressed and treatment has begun, forensic examination proceeds along with the gathering of evidence that can be used to identify and document the injuries.

Such evidence-gathering is only done with the complete consent of the patient or the caregivers, and photographs of the injuries may be requested.

Experienced social support staff are made available to the patient and family.

The medical team utilizes standardized sampling and testing usually referred to as a forensic evidence kit or “rape kit”.

The patient is discouraged from bathing or showering to obtain samples from their hair.

Evidence gathered within 72 hours is more likely to be valid, but the sooner that samples are obtained after the assault, the more likely that evidence is present in the sample and provides valid results. 

The presence of a rape/sexual assault counselor to provide an advocate and reassurance.

Evidence of bodily secretions is assessed. 

Dried semen on clothing and skin can be detected with a fluorescent lamp.

Specimens are analyzed for the presence of seminal vesicle-specific antigen.

Because physical effects of the rape are not immediately apparent, follow up examinations assess the patient for multiple issues: tension headaches, fatigue, sleep disturbances, gastrointestinal irritability, chronic pelvic pain, menstrual pain or irregularity, pelvic inflammatory disease, sexual dysfunction, premenstrual distress, fibromyalgia, vaginal discharge, vaginal itching, burning during urination, generalized vaginal pain, and pregnancy.

World Health Organization recommends offering prompt access to emergency contraceptive medications which can significantly reduce risk of an undesired pregnancy if used within 5 days of rape.

It is estimated that about 5% of male-on-female rapes result in pregnancy.

When rape results in pregnancy, abortion pills can be safely and effectively used to end a pregnancy up to 10 weeks from the last menstrual period.

An internal pelvic exam is not recommended for sexually immature or prepubescent girls due to the probability that internal injuries do not exist in this age group. 

An internal exam may be recommended if significant bloody discharge is observed.

A complete pelvic exam for rape, anal or vaginal, is conducted. 

An oral exam is done if there have been injuries to the mouth, teeth, gums, or pharynx. 

If the victim has scratched the perpetrator in defense, fingernail scrapings can be collected.

Injuries to the genital areas can include swelling, lacerations, and bruising, anal injury, labial abrasions, hymenal bruising, and tears of the posterior fourchette and fossa.

Genital injuries are more prevalent in post-menopausal women and prepubescent girls. 

Internal injuries to the cervix and vagina can be visualized using colposcopy, which increases the detection of internal trauma from six percent to fifty-three percent. 

The presence of a sexually contracted infection can not be confirmed after rape because it cannot be detected until 72 hours afterwards.

Prophylactic antibiotic treatment for vaginitis, gonorrhea, trichomoniasis and chlamydia may be performed.

 Immunization against hepatitis B is often considered.

Treatment may include the administration of zidovudine/lamivudine, tenofovir/emtricitabine, or ritonavir/lopinavir.

Prophylactic treatment for HIV is not necessarily administered. 

Routine treatment for HIV after rape or sexual assault is controversial due to the low risk of infection after one sexual assault. 

Transmission of HIV after one exposure to penetrative anal sex is estimated to be 0.5 to 3.2 percent. 

Transmission of HIV after one exposure to penetrative vaginal intercourse is 0.05 to 0.15 percent. 

HIV can also be contracted through the oral route but this is considered rare.

Other recommendations are that the patient be treated prophylactically for HIV if the perpetrator is found to be infected.

Psychiatric and emotional consequences can be apparent immediately after the rape and it may be necessary to treat these.

Other treatable emotional and psychiatric disorders may manifest evident some time after the rape: eating disorders, anxiety, fear, intrusive thoughts, fear of crowds, avoidance, anger, depression, humiliation, post-traumatic stress disorder (PTSD) hyperarousal, sexual disorders, mood disorders, suicidal ideation, borderline personality disorder, nightmares, fear of situations that remind the patient of the rape and fear of being alone, agitation, numbness and emotional distance.

Recovery from sexual assault is difficult and support groups, usually are available to help in recovery. 

Professional counseling and ongoing treatment by trained health care providers are often utilized by the victim.

An effective treatment plan considers current stressors, coping skills, physical health, interpersonal conflicts, self-esteem, family issues, involvement of the guardian, and the presence of mental health symptoms. 

Short-term treatment with a benzodiazepine may help with anxiety and antidepressants may be helpful for symptoms of post traumatic stress disorder, depression and panic attacks.

With regard to campus sexual assault, nearly two thirds of students reported knowing victims of rape, and in one study over half reported knowing perpetrators of sexual assault; one in ten reported knowing a victim of rape; and nearly one in four reported knowing a victim of alcohol-facilitated rape.

Worldwide, most victims of rape are women and most perpetrators male.

Rapes against women are rarely reported to the police and the number of female rape victims is significantly underestimated.

Southern Africa, Oceania, and North America report the highest numbers of rape.

Most rape is committed by someone the victim knows.

By contrast, rape committed by strangers is relatively uncommon. 

7 out of 10 cases of sexual assault involve a perpetrator known to the victim.

Fewer than one in ten male–male rapes are reported. 

About one third of African American adolescent females report encountering some form of sexual assault including rape.

One in three Native American women will experience sexual assault, more than twice the national average for American women.

Rape accusations are false about 2% to 10% of the time.

In most cases, a false accusation will not name a specific suspect.

Eight percent of sexual assault cases were classified as false reports by the police in one study. 

It is extremely rare that a suspect deliberately makes a false allegation of rape or domestic violence purely out of malice.

The unfounded rate is higher for forcible rape than for any other Index crime. 

The average rate of unfounded reports for Index crimes is 2%.

Unfounded is not synonymous with a false allegation:there is no physical evidence or the alleged victim did not sustain any physical injuries.

No more than 3–4% are reportedly fabricated rapes.

Rape is a common manifestation of war.

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