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Affiliation
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Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. |
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Abstract
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Lipton GL, Roth EI. J Pediatr 1969;75:859-66
This 1969 article is one of the first to describe the range of presentations and complexities of the management of adolescent rape victims in the emergency department (ED). Rape is common, with 11.3% of female and 3.5% of male high school students reporting some form of sexual assault. The article also highlights ways in which ED care of rape victims has advanced. In contrast to Lipton et al, the role of today’s ED provider is not to diagnose “rape,” but instead to provide appropriate medical and psychological care, as well as legal/law enforcement referrals.1 Rape is very traumatic for a young person. Best practices require respect for an adolescent’s privacy and confidentiality, including taking the history in a quiet, comfortable setting prior to the physical examination, interviewing the patient with and without parents present, and limiting the number of people to whom the patient must tell their story by referring for a single forensic interview.2 The examination itself is very low yield in the diagnosis of rape, with the most common finding a normal physical.
We must also trust our adolescents. What Lipton et al did not appreciate was that adolescent rape victims may have unpredictable emotional responses and unstable testimony, neither of which indicates that they are not truthful. ED providers and staff must guard against subtle “blaming the victim.” Prior consensual sexual experience (even with the alleged perpetrator), provocative dress, or appearing older than their age do not imply complicity.2 Finally, rape is an area of marked racial and sex inequities in incidence and care, and as providers we must be aware of our own implicit biases. Adolescents of color and lesbian, gay, bisexual, transgender and intersex (LGBTI) adolescents are disproportionately vulnerable to sexual abuse because of discrimination and the historical sexualization of women of color...
Language: en |