The typical rape victim is a 16-24 year-old woman -- however, anyone, man or woman, adult or child, can be the victim of rape. Most commonly, the assaillant is a 25-44 year-old man who premeditates his attack. He usually choses a woman of the same race; nearly half of the time the rapist is known to the victim, at least casually, or works or lives near the victim. Alcohol is involved more than 1 out of 3 times.

Over 50% of rapes occur in the victim's home with the rapist either breaking into the home or gaining access under false pretenses (such as asking to use the phone, posing as a repairman or salesman).

Rape is usually a violent act by a male upon a female; however, some cases of rape have been reported where the woman is the rapist and the man is the victim. Rape may occur between members of the same sex. This is more prevalent in situations where access to the opposite sex is restricted (such as prisons, military settings, and single sex schools).

Rape is not primarily about sex. It is a violent crime linked to feelings of rage or hatred in the assaillant.

People who are targeted for some form of discrimination (including racial discrimination) are believed to be at higher risk for sexual assault. This may be attributed to increased vulnerability because of decreased ability to call for help (for example, those with limited language skills or disabilities), decreased "perceived" credibility (prostitutes or convicted prisoners), and any women whose "male protectors" are either nonexistent, less socially powerful, or not readily visible.

PREVENTION
The most useful means of prevention available currently is to make women more aware of the sad reality of rape. Law enforcement agencies strongly advocate protection as the best form of prevention. The following safety tips may help women minimize the chance of being victimized:

• Keep doors/ windows secured with locks.
• If walking or jogging, stay out of secluded or isolated areas and arrange to do activity with at least one other friend, rather than alone. It is best to engage in activities during daylight hours.
• Try to appear strong, confident, aware, and secure in your surroundings.
• Keep car doors locked while driving, check back of car for intruders prior to getting in, and park in open, well-lighted areas.
• On public transportation, sit near the driver or up front if possible; avoid sitting near groups of young men obviously associated with one another.
• Learn the basics of self-defense. Self-defense may include a variety of activities that promote self-confidence, self-reliance, and self-knowledge (such as assertiveness training, sports conditioning and participation, and martial arts).
• Carry items that could potentially be used as weapons (for example, a roll of coins, an umbrella or a cane, a spray bottle filled with ammonia, or a cigarette lighter) and those that can call attention to you if needed (whistles, personal alarms, etc.)
• If an assault attempt is initiated, scream loudly and/or blow a whistle.
• Do not hitchhike. If your vehicle breaks down and someone offers to give you a ride, ask the person to call for help while you stay locked in your vehicle.

Numerous studies have shown that people (especially women) who respond to the situation quickly and actively resist the attacker are more likely to avoid being raped than those who exhibit either passive behavior or no resistance.

SYMPTOMS
Rape is a very traumatic event. The victim may or may not be able to verbalize that she was actually raped or may come to medical attention for a different complaint. Emotional reactions differ greatly and may include: confusion, social withdrawal, tearfulness, nervousness or seemingly inappropriate laughter, numbness, hostility, and fear.

The victim may have a variety of other physical concerns needing to be addressed. Physical abuse is often present as well. Emergency room staff are specially trained to deal with all of these situations.

SIGNS AND TESTS
A history will be obtained in a supportive and non-judgemental way. This will include the details of the attack: the date and time of the rape, setting where it occurred and what the victim has done since the attack occurred (for example, showered and changed clothes as opposed to coming directly to the hospital). If possible, this should be done with both medical and investigating police present, to eliminate the need to have the victim repeatedly recall the incident.

Additional medical history information that should be obtained includes: any possibility of pregnancy prior to the attack; the date of the last menstrual period; a pertinent gynecological history, including any prior sexual abuse or assault; and the presence of chronic illness or recent illness or injury, as well as current medications.

A complete physical examination should be done to document any objective signs of trauma. Pictures may be taken to note bruises, scrapes, or cuts. X-rays will be taken if fractures are suspected.

Numerous samples and specimens may be collected for evidence including clothing, pubic hair samples (particularly if foreign materials are noted within it), fingernail scrapings, and vaginal (and mouth or anal, if indicated) samples to examine for evidence of sperm and test for sexually transmitted diseases.

TREATMENT
In many cities, rape cases are referred to specific emergency rooms. This has allowed those sites to provide more specialized care for the unique needs of the rape victim and assure proper procedures are followed to maintain the "chain of evidence" necessary for a case that may go to trial. Such sexual assault treatment centers may also employ, or have available on-call, a team specialized in assessing and dealing with the psychosocial, physical, and legal issues a rape victim faces. Most state laws require that the victim be evaluated in the emergency room prior to the rape being officially reported. It is recommended that a rape victim go to the hospital immediately after the rape incident occurs, without changing clothes, showering douching, or urinating since such activities may alter or destroy evidence helpful in identifying and prosecuting the rapist.

Treatment focuses upon providing sufficient emotional support while attempting to collect adequate objective evidence to verify the victim's complaint of rape. If the victim has a support person she wants present, efforts should be made to make that possible; otherwise someone (such as a nurse) should be "assigned" to stay with the victim throughout the interviews and examination. The victim should not be left alone unless she wishes to be. She should be offered the choice of being initially interviewed in street clothes rather than being directed to disrobe and put on a patient gown. The examination and collection of specimens should be fully explained beforehand to the victim, and whenever possible, the victim should be given choices in an attempt to regain a sense of control. Maintaining a supportive environment, free from any judgmental statements, may encourage the victim to express whatever feelings arise.

Treatment includes addressing any potential for pregnancy or sexually transmitted diseases, offering information pertinent to those possibilities, and providing care for the immediate physical and emotional trauma incurred as well as planning follow-up care. If there is a chance that the rapist is HIV-infected, post-exposure prophylaxis (PEP, a way to reduce the odds of infection by immediate use of antiretroviral medications) should be explained and offered.  Referral to a local rape crisis center may be helpful for the victim to receive peer support and advice necessary for adequate healing from the trauma.

PROGNOSIS AND OUTCOME
Recovery from a rape typically includes the acute phase (immediate period of physical pain and wound healing, emotional reactions and coping mechanisms put into action) and the reorganization phase (occurring about one week after the rape and lasting months to years, as the victim attempts to restructure and "get on with life").

Group psychotherapy with other rape survivors as been show to be the most effective treatment.

COMPLICATIONS
Some women are never fully able to emotionally recover from a rape. Post-traumatic stress disorder (PTSD) is a common complication. Symptoms include recurrent nightmares or intrusive memories (flashbacks) of the event, social withdrawal, depression, anxiety and numbing of emotions. Cognitive psychotherapy and antidepressant medications have been shown to be effective treatments for PTSD.

More than 50% of rape victims have some difficulty in re-establishing relationships with spouses or partners or, if unattached, re-entering the "dating scene."

Any pre-existing psychiatric disorders may be exacerbated. Suicidal behaviors, depression and substance abuse may develop or become more prominent.

CALL YOUR HEALTH CARE PROVIDER IF

• you are the victim of past sexual assault but never sought or received adequate care.
• you have been raped (recently or in the past) and are experiencing personal or relationship problems.
• If you have been raped: go to the nearest emergency room right away.

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