Ob Gyn Assault - New committee opinion updates obstetrics/gynecology on correctly identifying and treating survivors according to medical and legal requirements.
New American College of Obstetricians and Gynecologists (ACOG) Opinion (#777) addresses the role of the OB/GYN in the evaluation and management of survivors of sexual assault. The opinion replaces the Committee's Opinion No. 592 (April 2014) and includes model review procedures and questions, relevant recommendations from other medical associations, and trauma-informed care.
Ob Gyn Assault
The opinion notes that sexual assault ("a crime of violence and aggression and involving sexual activities ranging from sexual assault to contact with abuse amounts to rape") and rape ("penetration of the vagina or anus, whether minor." part or object of another person's genitals, or oral penetration without the victim's consent") is a widespread problem in the United States and approximately 1.47 million physical assaults related to rape occur against women each year.
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Medical findings to look for in victims include severe injuries such as abrasions, scratches, and welts, as well as injuries to the vulva or vagina that are severe enough to require surgical intervention. About 5% of rapes among women between the ages of 12 and 45 lead to pregnancy and the accident is especially high among teenagers who survive due to relatively low access to contraception.
The committee's opinion recommends that ob/gyns use a trauma-informed approach to the care of victims of sexual assault. Key principles of this approach include ensuring physical and mental safety, maximizing credibility, prioritizing personal choice and control, empowering individuals, and encouraging peer support.
Many women will not personally discuss a history of sexual assault, but there may be symptoms that indicate an assault, including chronic abdominal pain, menstrual cramps, and sexual dysfunction. Therefore, the Committee's opinion recommends that obstetricians/gynecologists have a role and responsibility in screening all women for a history of sexual abuse, paying particular attention to those reporting specific symptoms. Clinics that evaluate survivors of sexual assault must comply with certain medical and legal requirements.
Obstetricians/gynecologists should be aware that survivors of medical procedures such as pelvic, rectal, and breast exams may cause panic and anxiety related to post-traumatic stress disorder. When called upon to investigate sexual abuse, clinicians with little or no experience should request the assistance of trained hospital staff to ensure appropriate evidence collection. If trained personnel are not available, the Committee's opinion recommends the use of a protocol from the Department of Justice's Office of Violence Against Women, titled, "National Protocol for the Medical Examination of Adult/Adolescent Sexual Abuse."
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When a victim of sexual assault communicates with the OB/GYN's office, emergency department, or clinic prior to evaluation, the main point of communication should be to encourage the patient to go to a medical facility immediately and to provide information about bathing, changing, showering, Should be instructed. , urinate, defecate. Wash your mouth, clean your nails, smoke, eat or drink alcohol.
Jurisdictions vary in the time frame for gathering evidence in sexual assault cases; Many people use 72 hours. However, if attacks are reported after the deadline, obstetricians should conduct an examination and provide appropriate care and counselling. The ob/gyn must also be aware of jurisdictional policies regarding the integrity of evidence; These policies include details on the packaging, labeling and sealing of evidence and details on the transfer, storage, handling and distribution of evidence.
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