Female sexual assault: medical and legal implications

To assess the medical and legal effectiveness of this institution's existing adult female sexual assault protocol.

Retrospective review.

Urban public hospital.

One hundred eighty-two adult female sexual assault victims undergoing evaluation within 36 hours of assault.

Each case was reviewed with specific attention to associated injuries, sexually transmitted disease, compliance with medical follow-up, pregnancy, and legal outcome. Half of all cases had associated injuries. Nine percent of the women were found to have genital trauma on pelvic examination, although only 29% of these women had complaints of genital pain or bleeding. Ten percent of all women had positive gonorrhea cultures at initial examination. Thirty percent of the women completed the follow-up protocol. None of the women given postcoital estrogen therapy is known to have become pregnant. Only 53 of the 182 cases had the potential for successful prosecution with both a victim willing to cooperate in prosecution and an identified assailant. Thirty-four percent of these cases resulted in a successful prosecution. Evidence of genital or nongenital trauma was significantly associated with a successful legal outcome.

A physical and evidentiary examination, including pelvic examination and assays for sperm and acid phosphatase, is warranted in all cases of female sexual assault presenting within 36 hours of the assault. Institutions dealing with victims from a transient, lower socioeconomic population should offer prophylactic treatment for sexually transmitted disease and pregnancy rather than rely on compliance with follow-up schedules.