These rapists may have a thought disorder and often exhibit other forms of psychopathology. This type of assault is calculated and planned. The victim is often a stranger. The rape may involve bondage, torture, or bizarre acts and may occur over an extended period of time. The victim often suffers both genital and nongenital injuries and may be murdered or mutilated. Other rapists may act out of impulse, as when they encounter a victim during the course of another crime such as burglary. Some rapists believe they are entitled to their victim, as in acquaintance rape or father–daughter incest (116). A consistent finding among all types of rapists is a lack of empathy for the survivor.
Even when sexual assaults are reported (only 16% of rapes are reported to the police), few rapists are arrested, and even fewer are brought to trial and convicted. Less than 1% of rapists serve a prison term (144,146). Successful prosecution of rapists is often dependent on the extent of the survivor’s injuries and the completion of a detailed forensic examination (147). Many women do not report the assault to the police because they are concerned about their name being disclosed by the news media, they fear retaliation from the perpetrator, are afraid they will not be believed, or do not trust the judicial process (148). Assault is more likely to be repeated if survivors in abusive relationships do not seek medical care, report the incident to police, or seek an order of protection (116).
Only 26% of rape survivors seek medical attention after an assault (116). Women are more likely to immediately seek treatment after sexual assault if weapons were involved, serious physical injury occurred, or physical coercion or confinement was used in the assault (149). Many rape survivors do not inform their physicians about the assault and may never volunteer information about the assault unless they are directly asked. When obtaining a medical history, physicians should routinely ask, “Has anyone ever forced you to have sexual relations?”
Effects of Rape Following sexual assault, women have many concerns, including pregnancy, STDs (including human immunodeficiency virus [HIV] infection), being blamed for the assault, having their name made public, and having their family and friends find out about the assault.
The initial reactions to sexual assault may be shock, numbness, withdrawal, and possibly denial. It is difficult to predict how an assaulted individual will react. Despite their recent trauma, women presenting for medical care may appear calm and detached (147).
The rape trauma syndrome is a constellation of physical and psychological symptoms, including fear, helplessness, disbelief, shock, guilt, humiliation, embarrassment, anger, and self-blame. The acute, or disorganization, phase of the syndrome lasts from days to weeks. Survivors may experience intrusive memories of the assault, blunting of affect, and hypersensitivity to environmental stimuli. They are anxious, do not feel safe, have difficulty sleeping and eating, and experience nightmares and a variety of somatic symptoms (116,150,151). They may fear that their assailant will return to retaliate or rape them again.
In the weeks to months following the sexual assault, survivors often return to normal activities and routines. They may appear to have dealt successfully with the assault, but they may be repressing strong feelings of anger, fear, guilt, and embarrassment. In the months following the assault, survivors begin the process of integration and resolution. During this phase, they begin to accept the assault as part of their life experience, and somatic and emotional symptoms may decrease progressively in severity. However, the sequelae of rape are often persistent and long lasting (124). Over the long term, survivors may have difficulty with work and with family relationships. Disruption of existing relationships is not uncommon. Nearly half of the survivors lose their jobs or are forced to quit in the year following the rape, and half change their place of residency (133).