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08 May 2005

Management of rape survivors

This article covers the steps you need to take if you have been raped.

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If you have been raped:

  • You must see a doctor as soon as possible. You can go to a hospital, a special rape centre, a district surgeon or your GP. If you first go to a police station the police must organise for you to see a doctor as soon as possible.
  • Don’t change your clothes, bath/shower or douche before you see the doctor since this might remove evidence.

The doctor should do the following:

  • Speak to you in a private place; you may have a companion or family member present.
  • Make notes of all details of the rape such as when and where it happened, how many people were involved, the type of sexual act(s) performed, whether a weapon was used and if you lost consciousness.
  • Examine you generally and do a thorough genital examination.
  • Make notes and drawings of any injuries you have.
  • Take swabs from your mouth, your genitals both outside and inside (labia, vagina, cervix) and also your anus if you were sodomised (subjected to forced anal sex). This is so that the forensic (police) laboratory can try to collect semen or saliva from the rapist and do DNA tests, which can be used to prove the rapist’s identity. Other samples that may be collected for the same reason are scrapings from under your fingernails and pubic hair.
  • Keep your clothing, if possible, or just your underwear for forensic investigation.
  • Discuss with you and get your permission to do an HIV test, a test for syphilis (VDRL), a test to see if you are immune to Hepatitis B and possibly other tests. These tests are to see if you need protection against infections that can be transmitted to you by the rapist. Even if the rapist cannot be found or does not agree to be tested for HIV it is best to take precautions against HIV since up to one in three adults in South Africa is HIV positive and can transmit the virus through sex or injury where bleeding occurs.

Treatment

  • Any injuries you have will need to be treated e.g. cleaning and stitching.
  • If you are not using a contraceptive, then, depending on the sexual act, you may need emergency contraception (“the morning after pill”) to prevent an unwanted pregnancy. Since the emergency contraception is a high dose of hormones, you are very likely to feel nauseous and therefore you should get anti-nausea medication to take at the same time.
  • You should receive antibiotics to prevent sexual diseases such as gonorrhoea. You will need to take the antibiotics for seven days.
  • You should receive antiretroviral medication to help prevent HIV infection if you are HIV negative or waiting for your test results. Most specialists believe that taking antiretroviral medication will certainly cut down the risk of HIV infection after rape. Note that it is very important to start the antiretroviral medication as soon as possible after the rape, preferably within six to 24 hours. You will need to take antiretroviral medication for four weeks: this could be just one drug or two drugs, taken twice a day. Try to finish the treatment and if you have bad side-effects such as headache, nausea and tiredness, it may be possible to get alternative medication if you return to discuss this with the doctor.
  • If you are bruised or have other painful injuries you should receive some anti-inflammatory painkillers.
  • If you have been sodomised you may need an anti-inflammatory cream for the anus. If it is painful to have a bowel motion it will help to take a mild laxative to soften the stool.
  • If you are not immune to hepatitis B, you should get your first vaccination straight away and then two more vaccinations about a month or two apart.
  • You will need to return to the doctor within a week for a check-up and then again for check-ups and blood tests (such as a repeat HIV test) about six weeks and three months after the rape.
  • If you find that you are extremely anxious and not able to sleep, work or carry out your normal daily activities, tell the doctor about this. It may be helpful to take anti-anxiety medication for a few weeks, in addition to getting help from a counsellor and support group.
 
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