Rape is defined as sexual intercourse forced on a person without his or her permission.

According to most estimates, 80 - 90% of rapes are not reported to police. Current trends project that 1 in 3 American women will be sexually assaulted at some point during her life.

The typical rape victim is a 16 - 24-year-old woman. Anyone, however -- man or woman, adult or child -- can be the victim of rape. Most commonly, the rapist is a 25 - 44-year-old man who plans his attack. He usually chooses a woman of the same race. Nearly half the time, the victim knows the rapist from working or living near him. Alcohol is involved in more than 1 out of 3 rapes.

Date rape occurs when someone forces another person they are dating or spending time with to have sex.

Over 50% of rapes occur in the victim's home. The rapist breaks into the victim's home or gains access under false pretenses, such as asking to use the phone or posing as a repairman or salesman.

Rape is a violent act, and is most often committed by a male upon a female. However, some cases of rape have been reported in which a woman has raped a man. Rape also may occur between members of the same sex. This is more common in places where there is limited access to the opposite sex (such as prisons, military settings, and single-sex schools).

Rape is an act of violence expressed through sex, but it is not mainly about sex.

Those who face some form of discrimination are believed to be at higher risk of sexual assault. For example, those with disabilities or limited language skills are less able to call for help; prostitutes or convicted prisoners have less credibility.

PREVENTION

The most useful prevention tool currently available is to be more aware about rape. Law enforcement agencies say prevention is the best form of protection. The following safety tips may help reduce your chances of being raped:

• Carry items that can call attention to you if needed (whistles, personal alarms, etc.).
• Consider taking a self-defense class, which can give you self-confidence and provide useful skills and strategies for different situations.
• 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.
• If someone tries to assault you, scream loudly or blow a whistle.
• If you are walking or jogging, stay out of secluded or isolated areas and arrange to do the activity with at least one other friend, rather than alone. It is best to do these kinds of activities during daylight hours.
• Keep car doors locked while driving, check the back of your car for intruders before getting in, and park in open, well-lit areas.
• Keep doors and windows locked.
• On public transportation, sit near the driver or up front if possible; avoid sitting near groups of young men who are obviously with one another.
• Try to appear strong, confident, aware, and secure in your surroundings.

It is better to respond quickly and actively to an attack, according to many studies. People, especially women, who resist the attacker this way are more likely to avoid being raped, compared with those who act passive or offer no resistance.

SYMPTOMS

Rape is a traumatic event. People who are raped may or may not be able to say that they were raped, or may seek medical help for a different complaint. Emotional reactions differ greatly and may include:

• Confusion
• Crying
• Fear
• Hostility
• Nervousness or inappropriate laughter
• Numbness
• Social withdrawal

Other physical problems are often present as well. Emergency room staff are specially trained to deal with all of these situations.

SIGNS AND TESTS

The health care providers will take a history in a supportive and nonjudgmental way. This will include the details of the attack:

• The date and time of the rape
• Where it occurred
• What you have done since the attack (for example, showered and changed clothes or came directly to the hospital)

If possible, this interview should be done with both health care providers and police present.

Other medical history information that is taken includes:

• Any possibility of pregnancy before the attack
• Current medications
• Gynecological history, including any previous sexual abuse or assault
• The date of the last menstrual period
• The presence of chronic illness or recent illness or injury

A complete physical examination should be done to document any signs of trauma. Pictures may be taken to note bruises, scrapes, or cuts. X-rays will be taken if the health care provider suspects fractures.

Many samples may be collected for evidence including:

• Clothing
• Fingernail scrapings
• Pubic hair samples (especially if there are foreign materials in it)
• Vaginal samples for evidence of sperm and sexually transmitted diseases (mouth or anal samples may also be required)

TREATMENT

In many cities, rape cases are referred to specific emergency rooms. This provides more specialized care, and assures that 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 hire, or have available on-call, a team that is specialized in dealing with the emotional, physical, and legal issues faced by a person who was raped. Most state laws require that the person be evaluated in the emergency room before the rape is officially reported.

Experts recommend going to the hospital immediately after the rape occurs, without changing clothes, showering, douching, or urinating. Such activities may change or destroy evidence helpful for identifying and prosecuting the rapist.

Treatment focuses on providing emotional support, while attempting to collect enough evidence to confirm the rape complaint. The treatment team should try to provide a support person -- either a friend or family member, or someone (such as a nurse) who is "assigned" to stay with you throughout the interviews and examination.

If you were attacked, you should not be left alone unless you want to be. You should be offered the choice of being interviewed in street clothes rather than in a patient gown.

The examination and collection of specimens should be fully explained beforehand, and whenever possible, you should be given choices in an attempt to give you back a sense of control. Maintaining a supportive environment, without any judgment, may encourage you to express whatever feelings arise.

Treatment includes:

• Addressing the possibility of pregnancy or sexually transmitted diseases
• Offering information on those possibilities
• Planning follow-up care
• Providing care for the immediate physical and emotional trauma

If there is a chance that the rapist is HIV-infected, the health care providers should explain and offer postexposure prophylaxis (PEP, a way to reduce the odds of infection immediately using antiretroviral medications). Referral to a local rape crisis center may be helpful. These centers offer peer support and advice to help in recovery from the trauma.

OUTLOOK

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 you attempt to "get on with life").

Group psychotherapy with other rape survivors has been shown to be the most effective treatment.

COMPLICATIONS

Some people are never fully able to recover emotionally from a rape. Posttraumatic stress disorder (PTSD) is a common complication. Symptoms include:

• Anxiety
• Depression
• Memories (flashbacks) of the event
• Numbing of emotions
• Recurrent nightmares
• Social withdrawal

Therapy 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, in re-entering the "dating scene."

Rape may worsen any pre-existing psychiatric disorders. Suicidal behaviors, depression, and substance abuse may develop or become more prominent.

CALL YOUR HEALTH CARE PROVIDER IF

• You have been raped: Go to the nearest emergency room right away. Do not shower or change your clothes.
• You were sexually assaulted in the past but never asked for or received proper care.
• You have been raped (recently or in the past) and are experiencing personal or relationship problems.

RESOURCES:

• Rape, Abuse & Incest National Network - www.rainn.org