The rate of reporting, prosecuting and convicting for rape varies between jurisdictions. Internationally, the incidence of rapes recorded by the police during 2008 ranged, per 100,000 people, from 0.2 in Azerbaijan to 92.9 in Botswana with 6.3 in Lithuania as the median.[4] Worldwide, sexual violence, including rape, is primarily committed by males against females.[5] Rape by strangers is usually less common than rape by people the victim knows, and male-on-male and female-on-female prison rapes are common and may be the least reported forms of rape.[6][7][8]
female murder rape victim has genital exam during autopsy
Until 2012, the Federal Bureau of Investigation (FBI) considered rape a crime solely committed by men against women. In 2012, they changed their definition from "The carnal knowledge of a female forcibly and against her will" to "The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." The previous definition, which had remained unchanged since 1927, was considered outdated and narrow. The updated definition includes recognizing any gender of victim and perpetrator and that rape with an object can be as traumatic as penile/vaginal rape. The bureau further describes instances when the victim is unable to give consent because of mental or physical incapacity. It recognizes that a victim can be incapacitated by drugs and alcohol and unable to give valid consent. The definition does not change federal or state criminal codes or impact charging and prosecution on the federal, state, or local level; it rather means that rape will be more accurately reported nationwide.[21][22]
Marital rape, or spousal rape, is non-consensual sex in which the perpetrator is the victim's spouse. It is a form of partner rape, domestic violence, and sexual abuse. Once widely accepted or ignored by law, marital rape is now denounced by international conventions and is increasingly criminalized. Still, in many countries, marital rape either remains legal or is illegal but widely tolerated and accepted as a husband's prerogative. In 2006, the UN Secretary-General's In-depth study on all forms of violence against women stated that (pg 113): "Marital rape may be prosecuted in at least 104 states. Of these, 32 have made marital rape a specific criminal offense, while the remaining 74 do not exempt marital rape from general rape provisions. Marital rape is not a prosecutable offense in at least 53 States. Four States criminalize marital rape only when the spouses are judicially separated. Four States are considering legislation that would allow marital rape to be prosecuted."[42] Since 2006, several other states have outlawed marital rape (for example Thailand in 2007[43]).
Victims may react in ways they did not anticipate. After the rape, they may be uncomfortable/frustrated with and not understand their reactions.[72][73] Most victims respond by 'freezing up' or becoming compliant and cooperative during the rape. These are common survival responses of all mammals.[74] This can cause confusion for others and the person assaulted. An assumption is that someone being raped would call for help or struggle. A struggle would result in torn clothes or injuries.[72]
Society's treatment of victims has the potential to exacerbate their trauma.[71] People who have been raped or sexually assaulted are sometimes blamed and considered responsible for the crime.[17] This refers to the just world fallacy and rape myth acceptance that certain victim behaviors (such as being intoxicated, flirting or wearing sexually provocative clothing) may encourage rape.[91][92] In many cases, victims are said to have "asked for it" because of not resisting their assault or violating female gender expectations.[93][92] A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. Women who have been raped are sometimes deemed to have behaved improperly. Usually, these are cultures where there is a significant social divide between the freedoms and status afforded to men and women.[94]
For females, victim-blaming correlates with fear. Many rape victims blame themselves. Female jurors might look at the woman on the witness stand and believe she had done something to entice the defendant.[98] In Chinese culture, victim-blaming is often associated with the crime of rape, as women are expected to resist rape using physical force. Thus, if rape occurs, it is considered to be at least partly the woman's fault, and her virtue is called into question.[99]
In many cultures, those who are raped have a high risk of suffering additional violence or threats of violence after the rape. This can be perpetrated by the rapist, friends, or relatives of the rapist. The intent can be to prevent the victim from reporting the rape. Other reasons for threats against those assaulted is to punish them for reporting it, or of forcing them to withdraw the complaint. The relatives of the person who has been raped may wish to prevent "bringing shame" to the family and may also threaten them. This is especially the case in cultures where female virginity is highly valued and considered mandatory before marriage; in extreme cases, rape victims are killed in honor killings.[10][11][12][100]
In the US, victims' rights include the right to have a victims advocate preside over every step of the medical/legal exam to ensure sensitivity towards victims, provide emotional support, and minimize the risk of re-traumatization. Victims are to be informed of this immediately by law enforcement or medical service providers.[101][102] Emergency rooms of many hospitals employ sexual assault nurse/forensic examiners (SAN/FEs) with specific training to care for those who have experienced a rape or sexual assault. They are able to conduct a focused medical-legal exam. If such a trained clinician is not available, the emergency department has a sexual assault protocol that has been established for treatment and the collection of evidence.[25][103] Staff are also trained to explain the examinations in detail, the documentation and the rights associated with the requirement for informed consent. Emphasis is placed on performing the examinations at a pace that is appropriate for the person, their family, their age, and their level of understanding.[103] Privacy is recommended to prevent self-harm.[104]
Many rapes do not result in serious physical injury.[105] The first medical response to sexual assault is a complete assessment. This general assessment will prioritize the treatment of injuries by the emergency room staff. Medical personnel involved 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.[25][103] Priorities governing the physical exam are the treatment of serious life-threatening emergencies and then a general and complete assessment.[106] Some physical injuries are readily apparent such as, bites,[107] broken teeth, swelling, bruising, lacerations and scratches. In more violent cases, the victim may need to have gunshot wounds or stab wounds treated.[25] The loss of consciousness is relevant to the medical history.[103] If abrasions are found, immunization against tetanus is offered if 5 years have elapsed since the last immunization.[108]
Some physical effects of the rape are not immediately apparent. Follow up examinations also assess the patient for tension headaches, fatigue, sleep pattern 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, and generalized vaginal pain.[106]
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. However, an internal exam may be recommended if significant bloody discharge is observed.[103] 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. Though the patient may have no complaints about genital pain signs of trauma can still be assessed. Before the complete bodily and genital exam, the patient is asked to undress, standing on a white sheet that collects any debris that may be in the clothing. The clothing and sheet are properly bagged and labeled along with other samples that can be removed from the body or clothing of the patient. Samples of fibers, mud, hair, or leaves are gathered if present. Samples of fluids are collected to determine the presence of the perpetrator's saliva and semen that may be present in the patients mouth, vagina or rectum. Sometimes the victim has scratched the perpetrator in defense and fingernail scrapings can be collected.[109]
Injuries to the genital areas can include swelling, lacerations, and bruising.[109][118] Common genital injuries are anal injury, labial abrasions, hymenal bruising, and tears of the posterior fourchette and fossa.[109] Bruises, tears, abrasions, inflammation and lacerations may be visible. If a foreign object was used during the assault, x-ray visualization will identify retained fragments.[119] Genital injuries are more prevalent in post-menopausal women and prepubescent girls. Internal injuries to the cervix and vagina can be visualized using colposcopy. Using colposcopy has increased the detection of internal trauma from six percent to fifty-three percent. Genital injuries to children who have been raped or sexually assaulted differ in that the abuse may be on-going or may have happened in the past after the injuries heal. Scarring is one sign of the sexual abuse of children.[109] 2ff7e9595c
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