If you have been raped you must see a doctor as soon as possible. You can go to a hospital, a special rape centre or a district surgeon. Most private hospitals and government hospitals in large centres are adequately equipped to deal with rape cases.
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Few GPs have rape or forensic training and most doctors may not have a copy of the J88 form which needs to be completed at the time of examination. The examining doctor must also have a crime kit for forensic information such as DNA, which needs to be done at the time of first examination. If you would like to lay a rape charge, only go to a doctor who is prepared to testify in court.
If you first go to a police station, the police must organise for you to see a doctor as soon as possible. Take note of the following:
Don’t change your clothes, bath/shower or douche, or go to the toilet before you see the doctor since this might remove evidence.
Don't brush your hair because evidence may be contained in it and don't wash off blood.
Do not clean your teeth or rinse your mouth if forced to perform oral sex.
Don't put a disposable nappy on a baby who was raped.
Never put any evidence, including tape or rope used to bind you in a plastic bag because plastic destroys evidence, including fingerprints. Only use paper bags.
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.
Complete a J88 form at the time of examination.
Use a crime kit provided by the police. The crime kit must be sealed properly and taken to the forensice laboratory by the police. If the kit isn't sealed properly, it will not be admitted as evidence.
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 all your clothing for forensic investigation.
Discuss with you and get your permission to do an HIV test. A rapid HIV test is usually done. This is a pinprick test which gives results within 20 minutes. Other tests may also be done 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.
You should be given 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 72 hours after first penetration. Rape survivors are given Combivir which is AZT and 3TC combined, to be taken twice a day for a duration of one month. It is important to finish the treatment. Discuss any side-effects 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 have not been vaccinated against hepatitis B, you should get your first vaccination straight away and then two more vaccinations a month apart. In the unusual circumstance that the perpetrator is known to be a hepatitis B carrier, hepatitis B immune globulin should be given along with the vaccine.
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 repeat HIV tests) at about six weeks, three months, six months and one year 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.
Note that it is common for women to have a very heavy period a week to 10 days after the rape. This is not due to the medication or physical trauma.
Make use of the help from people you trust, a counsellor or support group.
Learn about Post-Traumatic Stress Disorder - a common response after rape. If you know how to identify early symptoms, you will be able to seek help and manage the condition optimally.
Treatment information reviewed by Dr Craig Corcoran, Clinical Virologist, National Health Laboratory Service and University of Cape Town, November 2006.
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