GROUP 16

RAPE AND SEXUAL VIOLENCE

Group 16 MEMBERS
1.BELLE KINYA H151-01-2391/2022.

2. MARY MWANGI H151-01-2388/2022.

3.NICOLE ARWA H151-01-2354/2022.

4.REUBEN COLLINS H151-01-2395/2022.

5.IAN MUNENE H151-01-2419/2022

OBJECTIVES
Definition
Statistics
Types /classes
Causes
Pathophysiology
Signs and symptoms
Forensic considerations
Management
Complications
 Definitions
• Rape and sexual violence refer to any non-consensual sexual
act or attempt to obtain sexual contact through coercion, force,
or intimidation.
• In healthcare, these are considered forms of gender-based
violence.
Definition
• Gender-based violence is defined as any act of violence
that results in physical, sexual, economic, or
psychological harm or suffering to women, girls, men, and
boys, as well as threats of such acts, coercion, or the
arbitrary deprivation of liberty. This definition covers
violence by both current and former spouses and
partners.
Definitions
• Rape: Specifically involves sexual penetration (vaginal,
anal, or oral) without the individual's consent, achieved
through force, threats, coercion, or when the person is
incapable of consenting (due to age, mental status, or
intoxication).
• Sexual Violence: Includes a broader range of acts, such
as sexual assault, sexual harassment, molestation, or
forced marriage.
Statistics by Kenya Demographic and Health
Survey 2022.
• In the 2022 KDHS, information was obtained from
women and men age 15–49 on their experience of
violence committed by any perpetrator, including
current and former husbands, wives, or other
intimate partners.
Statistics by Kenya Demographic and Health
Survey 2022.
• To capture intimate partner violence, ever-married
respondents were asked about experiences of
violence committed by their current and former
husbands/wives, and, if applicable, never-married
respondents were asked about experiences of
violence committed by their current and former
intimate partners.
 Prevalence of Sexual Violence
• 13 % percent of women reported that they had experienced
sexual violence at some point in their lives,and 7% reported
that they had experienced sexual violence in the last 12
months
• A slightly lower proportion of men reported experiencing
sexual violence; 7% have ever experienced sexual violence,
and 4% experienced sexual violence in the 12 months
preceding the survey.
Prevalence of Sexual Violence

• The percentage of women who have experienced sexual

violence increases with age, from 7% among those age 15–
19 to 18% among those age 40–49.
• By county, the percentages of women who have
experienced sexual violence are highest in Bungoma
(30%), Murang’a (24%), Homa Bay (23%), and Embu
(22%).
Types/Classes of Rape and Sexual Violence:
1. Stranger Rape: Occurs when the perpetrator is
unknown to the victim.
2. Acquaintance/Date Rape: The perpetrator is someone
known to the victim, such as a friend, partner, or
colleague.
3. Marital Rape: Non-consensual sexual activity within
marriage or a long-term partnership.
4. Gang Rape: When multiple perpetrators are involved in
the assault.
Types/Classes of Rape and Sexual Violence:

5. SexTrafficking-Related Rape: Sexual exploitation of

victims for profit.
6.Child Sexual Abuse: Involves sexual activity with a
minor who cannot legally give consent.
7.Incest: Sexual assault perpetrated by a family member.
8.War Rape: Systematic use of rape as a weapon of war,
often for the purpose of dehumanizing individuals and
communities.
Causes/Risk Factors:
 Cultural and Societal Factors:
- Gender inequality and patriarchal norms.
- Cultural acceptance of violence or dominance over women.
- Social stigma surrounding discussions of sexual violence.
 Individual Factors:
- History of abuse, including childhood sexual trauma.
- Substance abuse by either the perpetrator or the victim.
- Mental health disorders.
Causes/Risk Factors:
 Situational Factors:
- Alcohol or drug intoxication, making the victim more
vulnerable.
- Presence in high-risk environments such as isolated
areas or social gatherings.
- Power imbalances in relationships or workplace
dynamics.
 Community Factors:
- Lack of legal protection or ineffective justice systems.
- Poor education on consent and gender-based violence.
Pathophysiology.

Pathophysiology:
The pathophysiology of rape and sexual violence involves a
complex interplay of physical trauma, psychological stress, and
emotional distress:
1. Physical Trauma:
- Injuries to the genital and reproductive system (tears,
lacerations, bruising).
- Risk of sexually transmitted infections (STIs) including HIV,
hepatitis B, and HPV.
- Potential unwanted pregnancy.
Pathophysiology
2. Psychological Response:
- Post-Traumatic Stress Disorder (PTSD): Common in survivors,
characterized by flashbacks, nightmares, and severe anxiety.
- Depression and anxiety.
- Disassociation or avoidance behaviors as coping mechanism
3. Neurological Impact:
- Acute stress response triggering the hypothalamic-pituitary-adrenal
(HPA) axis.
- Increased release of stress hormones like cortisol and adrenaline.
- Long-term effects may include changes in brain structure and
function related to memory and emotion regulation.
Signs and Symptoms
 Physical Signs:
- Genital or anal injuries such as swelling, bruising, or lacerations.
- Unexplained pregnancy.
- Signs of STIs, including unusual discharge, sores, or pain.

Psychological and Emotional Symptoms:

- Anxiety, fear, depression, guilt, or shame.
- Withdrawal from social interaction or personal relationships.
- Difficulty concentrating or making decisions.
Signs and Symptoms
 Behavioral Changes:
- Self-harm or suicidal ideation.
- Sleep disturbances, including insomnia or nightmares.
- Drug or alcohol misuse as a coping mechanism.
 PTSD-related Symptoms:
- Hypervigilance or heightened startle response.
- Flashbacks or intrusive memories of the assault.
- Emotional numbness or detachment from reality.
Forensic considerations
• The medicolegal issues should be seriously considered
even if the victim does not wish to report the case or
press for prosecution.
• Rape is a legal diagnosis. The medical evidences and
examinations are of value only to the court.
• Referral may be through police hospital doctor or by self
referral.
• The physician should examine her as early as possible
following rape.
Forensic considerations

• Due consent is to be taken from the victim and the

examination is made in presence of a third party or
chaperone. Confidentiality is to be maintained.
• Detailed statement from the victim, examination findings
are recorded. Collected materials are labeled properly
and should be submitted for expert examination.
• Sperm are rarely detected in the vagina later than 72
hours and motile sperm later than 4 hours. Rarely non-
motile sperm may be present in vagina even after 12-20
hours of the of the attack.
Forensic considerations
• . It should be borne in mind while interpretating the
findings that about 10% adult males are azoospermic or
oligospermic. It is also observed that in one third, sperm
are not ejaculated in the vagina and millions are
vasectomized and that many rape victims douche before
reporting for examination
MEDICOLEGAL PROCEDURES AND
DOCUMENTATION
♦ to document history in detail.
♦ to examine her thoroughly (genital/non-genital) and to
note the injuries.
♦ to collect the clothing, hair samples by combing pubic
hair and finger nail scrapings.
♦ to collect samples for sperm, acid phosphatase from the
affected site (vagina, rectum, pharynx). Photographs of
injuries are taken for forensic evidence.
♦ to send specimens to forensic authorities with record.
Management
1. Immediate Medical Care:
 Triage and Stabilization: Prioritize the victim’s immediate
physical health, including addressing any life-threatening injuries.
 Forensic Examination: If the victim consents, perform a forensic
exam to collect evidence (rape kit), including documentation of
injuries, collection of bodily fluids, and clothing analysis.
 STI and Pregnancy Prophylaxis:
- Administer post-exposure prophylaxis (PEP) for HIV.
- Provide emergency contraception to prevent pregnancy.
- Offer treatment or preventive measures for other STIs like
gonorrhea, chlamydia, and syphilis.
Management.
Psychological First Aid: Initiate supportive care, ensuring the victim feels
safe and believed. Avoid pressuring the victim for details until they are ready
to talk.
2. Ongoing Care:
- Medical Follow-Up:
- Ensure follow-up testing for STIs and pregnancy.
- Monitor for complications like infection or chronic pain.
- Psychological Support:
- Referral to a mental health specialist for trauma counseling or
psychotherapy.
- Cognitive Behavioral Therapy (CBT) or Eye Movement Desensitization
and Reprocessing (EMDR) for PTSD.
Management.

Social Support:
- Referral to support groups or rape crisis centers.
- Legal assistance if the victim wishes to pursue
charges.
- Involving family or friends as part of a broader support
system.
Complications.
1. Physical Complications:
- Pregnancy: Unintended pregnancy, which may require
decisions regarding abortion, adoption, or raising the child.
- Infections: Long-term consequences of untreated STIs
can lead to pelvic inflammatory disease (PID), infertility, or
chronic pain.
- Genital Trauma: May result in chronic pain, scarring, or
complications in future sexual relationships or childbirth.
Psychological Complications:

2. Psychological Complications:
- Chronic PTSD(post traumatic stress disorder):
Untreated, PTSD can lead to lasting issues with trust,
relationships, and functioning in daily life.
-Depression and Anxiety: Long-term mood disorders are
common, often requiring ongoing therapy and medication.
- Suicidal Ideation: Survivors may feel overwhelmed by
feelings of guilt, shame, or powerlessness, increasing
suicide risk.
Social and Economic Complications
3. Social and Economic Complications:
- Isolation: Survivors may withdraw from social and family
circles, impacting their ability to maintain healthy
relationships.
- Workplace or Academic Impact: Impaired
concentration, absenteeism, or job loss can result from the
emotional aftermath of the trauma.
-Stigma and Re-victimization: Societal stigma may lead
to victim-blaming, further traumatizing survivors and
discouraging them from seeking help or justice.
Conclusion
• Rape and sexual violence are complex issues in
reproductive health and gynecology, with far-reaching
physical, psychological, and social effects. Health care
providers must take a multidisciplinary approach to
provide comprehensive care, including immediate medical
attention, long-term psychological support, and
assistance in navigating legal and social challenges. Early
intervention and ongoing support can significantly
improve the long-term outcomes for survivors.
REFERENCES
o DC DUTTA’s textbook of gynecology Enlarged & Revised
Reprint of Sixth Edition.
o Kenya Demographic and Health Survey 2022 Key
Indicators Report.