Rape, Incest AND Domestic Violence: Dr. Renna Cristina B. de Leon

RAPE, INCEST
AND
DOMESTIC VIOLENCE
Dr. Renna Cristina B. de Leon

RAPE
• Sexual assault of children, women and men
• Sexual violence
• Any sexual act performed by one person on

another without that person’s consent
• includes nonphysical distressing acts of sexual

harassment, threats, peeping, and taking nude
photos without consent
• Survey:
• 10.6% of women reported a sexual assault at some time in
their lives
• one in six women reported experienced attempted or
completed rape
• 11% of high school adolescents reported having been
forced to have sex
• for first rape experience in women

• 30.4% of the time the perpetrator was known to be an intimate
partner
• 23.7% a family member
• 20% an acquaintance
• Victims are reluctant to report sexual assault to the
authorities because of:
• Embarrassment
• Fear of retribution
• Feelings of guilt
• Assumptions that little will be done
• Lack of knowledge of their rights
• Vulnerable to Sexual assault:

• Very young and very old
• Homeless women
• Women who are physically and mentally handicapped
• misconceptions about the rape victim:
• individual encouraged the rape by specific behavior
or dress
• no person who did not wish to be raped could be raped
• the feeling that rape was an indication of basic
promiscuity
Variants of rape
• Marital rape
• involves forced coitus or related acts without consent but
within the marital relationship
• “Date rape”
• woman may voluntarily participate in sexual play, but coitus is
performed, often forcibly, without her consent
• Date rape is often not reported:
• victim may believe she contributed by partially participating
• Statutory rape
• coitus with females under certain specified ages
Rape-Trauma syndrome
• Immediate/Acute phase
• lasts from hours to days
• may be associated with a paralysis of the individual’s usual coping
mechanisms
• complete loss of emotional control to a well-controlled behavior
pattern
• actual reaction may depend on a number of factors:
• relationship of the victim to the attacker
• whether force was used
• Length of time the victim was held against his or her will
• victim appears disorganized and may complain of both physical and
emotional symptoms
• Physical complaints include:
• specific injuries
• general complaints of soreness
• eating problems
• headaches
• sleep disturbances
• Behavior patterns may include:
• fear
• mood swings
• Irritability
• Guilt
• Anger
• Depression
• difficulties in concentrating
• flashbacks of the attack
• Medical care, emotional support and reassurance
• Reorganization phase:
• Involves long-term adjustment
• flashbacks and nightmares may continue
• phobias may also develop
• may be directed against:
• members of the offending sex
• the sex act itself
• or nonrelated circumstances, such as a newly developed fear
of crowds or heights
• important lifestyle changes, including job, residence, friends, and
significant others
• major complications of rape:
• pregnancy
• sexually transmitted disease
• may last from months to years
Physician’s responsibility in caring for the rape-trauma
victim
Medical responsibility
• Treat injuries
• Diagnose and treat STDs
Treatment of STDs (prophylaxis – for high
risk cases)
Cefpodoxime, 400 mg PO SD for

gonorrhea prophylaxis
plus azithromycin, 1 g PO SD for
chlamydia prophylaxis
• Prevent pregnancy
• Emergency contraception – YUZPE METHOD 4 tabs Ethinyl estradiol, 0.05 mg,
+ dl-norgestrel, 0.5 mg, combination oral contraceptive , given in doses of 2
tablets 12 hours apart
Medicolegal responsibility
• medicolegal material must be collected shortly after the assault
takes place and definitely within 96 hours
• Victims should be encouraged to come immediately to a center
where they can be evaluated before bathing, urinating, defecating,
washing out their mouths, changing clothes, or cleaning their
fingernails.
• evidence for coitus will be present in the vagina for as long as 48
hours after the attack
• in other orifices the evidence may last only up to 6 hours
• To document that force was used, the physician should
carefully describe each injury noted and illustrate with
either drawings or photographs
• Because rape and sexual assault are legal terms, they

should not be stated as diagnoses; rather the physician
should report findings as “consistent with use of force.”
Incest
• child sexual abuse
• two types of victims:
• By a stranger
• By a family member or friend
• ~80% of all sexual abuse cases of children involve a

family member
• 75%  Father-daughter incest
• 25%  mother-son, father-son, mother-daughter,
brother-sister, or incest involving another close family
member
• In father-daughter incestuous relationships:
• father is frequently a passive, introspective person who
experiences a weak sexual relationship with the child’s
mother
• turn his attentions to his daughter or daughters out of
loneliness and the sexual activity may be quite affectionate
• Frequently, the mother is aware of the situation, but

both parents agree consciously or subconsciously that
the incestuous relationship is more acceptable than
an extramarital one
Intimate partner violence
• Domestic violence, partner abuse, battered woman, or
spouse abuse
• Battered woman > any woman over the age of 16 with

evidence of physical abuse on at least one occasion at the
hands of an intimate male partner
• Battered wife syndrome > symptom complex occurring as

a result of violence in which a woman has at any time
received deliberate, severe, or repeated (more than three
times) physical abuse from her husband or significant
male partner in which the minimal injury is bruising
• is the CDC’s currently preferred term because it allows

for males or females to be the victim and intimate
partners can be the same or opposite sex
• Actual or threatened physical, sexual, or psychological

abuse by a current or former spouse (including common-
law spouses), dating partner, boyfriend, or girlfriend
• AMA  “pattern of coercive behaviors that may include
repeated battering and injury, psychological or
emotional abuse, sexual assault, progressive societal
isolation, economic deprivation, intimidation and
stalking”
• 3 phases of Battering:
• first phase - tension building
• Name calling, intimidating remarks, meanness, mild

physical abuse such as pushing
• Batterer often expresses dissatisfaction and hostility

in a somewhat chronic form
victim may attempt to placate the batterer in hopes
of pleasing him or calming him
• 2nd phase – Act of Violence
• Withdrawal is the signal for the batterer to become

more aggressive
• acute battering takes place
• an uncontrollable discharge of tension that has built up

through the first phase
• both verbal and physical abuse
• 3rd phase – Apology and Forgiveness phase
• Batterer apologizes, asks forgiveness, and frequently

shows kindness and remorse, showering the victim with
gifts and promises.
• gives the victim hope that the relationship can be saved

and that the violence will not recur
Exit plan
Have a change of clothes packed for both her and her children including toilet articles,
necessary medications, and an extra set of keys to the house and car. These can be placed
in a suitcase and left with a friend or family member.
Keep some cash, a checkbook, and a savings account book with the friend or family member.
Other identification papers, such as birth certificates, social security cards, voter registration
cards, utility bills, and driver’s license, should be kept available, because children will
need to be enrolled in school and the woman may have to seek financial assistance.
Have something special, such as a toy or book, for each child.

Have financial records available, such as mortgage papers, rent receipts, and an automobile
title.
Determine a plan on exactly where to go regardless of the time of day or night. This may be to
a friend or relative’s house or to a shelter for battered women and children.
Ask neighbors to call police if violence begins.
Remove weapons.
Teach children to call 9-1-1.
THANK YOU!!!

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RAPE, INCEST

Dr. Renna Cristina B. de Leon

• Any sexual act performed by one person on

• includes nonphysical distressing acts of sexual

• for first rape experience in women

• Vulnerable to Sexual assault:

Cefpodoxime, 400 mg PO SD for

• Because rape and sexual assault are legal terms, they

• ~80% of all sexual abuse cases of children involve a

• Frequently, the mother is aware of the situation, but

• Battered woman > any woman over the age of 16 with

• Battered wife syndrome > symptom complex occurring as

• is the CDC’s currently preferred term because it allows

• Actual or threatened physical, sexual, or psychological

• Name calling, intimidating remarks, meanness, mild

• Batterer often expresses dissatisfaction and hostility

• Withdrawal is the signal for the batterer to become

• acute battering takes place

• an uncontrollable discharge of tension that has built up

• Batterer apologizes, asks forgiveness, and frequently

• gives the victim hope that the relationship can be saved

Have something special, such as a toy or book, for each child.

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