Clinical findings and legal resolution in sexual assault

Female sexual assault victims who received medical evaluation at Detroit Receiving Hospital from July to December 1980 and were seen by the Rape Counseling Center (RCC) were evaluated. Data were abstracted from the emergency department record, RCC file, and gynecology clinic; 372 patients were evaluated. One hundred twenty-seven patients (34%) were given DES, including 17 women who had been raped at least once before. Data regarding DES dosage were available only on 34 patients, with 27 stating they took the entire course; 5, an incomplete course; and 2 refusing to answer. DES is still approved for post-coital contraception in rape. However, if there is one major concern about its administration, it is that close follow-up be provided to anticipate or eliminate complications, especially those associated with inadvertent pregnancy. The extremely poor medical follow-up, the surprising lack of an "appropriate chief complaint" when follow-up does occur, the large number of sexual assault victim repeaters in an inner city population, and the socioeconomic and demographic characteristics of an urban, inner-city sexual assault victim population which make it impossible to determine the effectiveness of DES are strong arguments for the severe restriction of use of DES in the urban, inner city setting. There is no need for pretreatment GC cultures or VDRL assays. Patients should be treated in conformity with current CDC recommendations. Where a rape counseling center is available, it is suggested that the unit assume close and direct responsibility of directing patients for medical follow-up, regardless of emergency department treatment.