45.    Rape.  

This is a very depressing subject and another illustration that evolution has not gone anything like far enough.

It is reckoned that up to 25% will be subjected to rape in the West.

The incidence in war zones, where it can be a deliberate policy rather that a manifestation of individual wickedness, is nightmarishly high.

It is defined as unlawful sexual intercourse, “unlawful” meaning without consent. 

It comprises any penile penetration of the vagina or anus.

Being married does not imply consent to intercourse and a husband can be charged with rape.

Other acts, such as inserting objects into the vagina or anus fall into the category of “indecent assault”.

These women may have sustained serious general injuries as well as damage to the genitalia and other sexual organs.

Unless subdued by drugs to render them less aware, they will have been terrorised, humiliated and emotionally and psychologically traumatised.

Even if drug subdued, the experience and its aftermath are likely to be horrendous.

Pregnancy may be a possibility:

“d” if “false” as she could be sterilised or post-menopausal.

Sexually transmitted infection is a possibility, including hepatitis B. If we get a vaccine for hepatitis C, I assume that this will be included in the package.

Ideally the woman should be dealt with in a rape centre.

Most areas now have these established in hospitals or police stations.

She will normally be encouraged to have the police involved.

The staff who deal with her should have been specifically trained and use standard protocols, medical notes and equipment kits.

It is essential that proper consent be obtained for all stages of the procedure.

Medical note taking must be of the highest standard and in a form that will be useful to a court.

The immediate need will be to deal with any serious general or genital injuries.

This could mean involvement of A&E, surgical, orthopaedic or gynaecological specialists.

A detailed history should be taken by a trained police officer and supplemented with appropriate medical information ascertained by a trained doctor.

Thereafter she needs to have detailed examination pertaining to the rape itself, with collection of specimens for forensic purposes and to exclude infection.

The list is huge and the containers specific to their purpose.

Correction labelling is essential.

This highlights the need for trained staff, protocols and standard equipment kits.

Attention should be paid to the possibility of sexually transmitted infection.

Screening should take place and antibiotic prophylaxis should be offered.

Hepatitis B vaccine should be offered.

In most of the UK the incidence of HIV carrier status is low, so the risk of infection with rape is thought to be small.

Nonetheless, prophylaxis should be offered, usually in the form of zidovudine + lamivudine for at least a month.

A baseline HIV blood test should be done.

All of this needs appropriate counselling, consent and supervision and the use of standard protocols.