Coping After A Sexual Assault

he word rape evokes images of being accosted by a strange man carrying a weapon, attacked by an intruder in your home, or kidnapped and forced at knife­point to perform degrading sexual acts against your will. The reality, however, is that in many cases the rapist is someone the victim knows—most likely a family member or a date. One researcher found that in more than 40 percent of rape cases, the victim identified her husband or friend as her attacker. Another study found that 84 percent knew the attacker. Many rapes occur at the place where the victim and the attacker meet—often one or the other's home—instead of a secluded parking lot or dark alley.

The odds are that one of every four women you know has been the victim of a sexual assault at some time in her life. If you've been raped yourself, you know that the pain doesn't end with the attack. You face the possibility of medical complications and of continuing emotional trauma. You also face decisions about whether to tell your family and friends, and whether you want to report the attack to the police.

Should You Tell?

Despite volumes of scientific evidence proving that rape is an act of assault, many people—jurors, professionals, and even attackers themselves—hold on to a false belief that the victim is somehow at fault. For these people, rape is a purely sexual act. They believe the woman, through her dress and behavior, must surely have provoked the assault, and that she merely got what she asked for. Of course, that's not true. One study found that more than 50 percent of rape survivors did not physically try to resist their victims, not because they were enjoying the attack, but out of fear of being more seriously injured or even killed. Less than 20 percent had dared to fight back.

Rape is not just an act of sex. It is an act of violence and aggression in which one person attempts to exert absolute control and domination over another. Women who flirt are not asking to be attacked. Rape victims are not “bad girls.” They're pretty and unattractive, thin and overweight, healthy and disabled, very young and very old.

The fact that you did not fight back during a rape does not mean that you encouraged or enjoyed it. Even a spontaneous orgasm is not a sign of consent, it's simply a biological response.

At a time like this you need the support of your family and friends. But even though they mean well, they may not be there for you. Those closest to you may be so enraged over the mere fact that the assault could have happened that they lash out in all directions. They may even turn their anger on you. Some may say you “got what you deserved.” Others may suspect you of lying about your role in the attack.

Only about 1 in 10 rapes is reported to the police. If the attacker was someone you know, making a report can be especially troubling. Fortunately, many police officers are especially trained to help you through this difficult time, so don't be afraid to tell them your story.

Your First Priority: Medical Treatment

Even if you think you're all right, see your own doctor or go to the hospital emergency room as soon as possible after the rape. The assault may have left you with undetected injuries that need prompt treatment. After examining you thoroughly, the physician will perform tests for sexually transmitted diseases and pregnancy and will collect evidence you'll need if you decide to prosecute the attacker. Since some of this evidence is lost after 36 hours, it's especially important to get immediate medical attention.

Do not shower, douche, change clothes, or otherwise try to clean up before going to the emergency room. Bring along a change of clothes; the ones you were wearing during the attack will be kept for evidence. You may want to take a trusted friend, a family member, or a rape crisis worker with you for support.

What to Expect in the Emergency Room

You will probably speak to a nurse or other emergency room personnel before the doctor sees you. First they will ask routine questions about your vital statistics, medical insurance, allergies, and the type of birth control you use. They also need to know whether you're in pain, when you last had sex before the rape, and the date of your last period. By finding out how recently you menstruated, they can determine how likely it is that the attacker made you pregnant.

They will also ask questions about the assault; for example, whether the rapist used a condom, whether he bled or had an ejaculation, and whether you scratched him. Tell the doctor or nurses everything you recall. If you're not sure of the details, simply say you don't remember. The answers you give to their questions may become part of the record if you go to court.

A nurse may also take pictures of your visible injuries. (Sometimes it takes several days for bruises and other injuries to appear, so you will want to ask a friend to take instant photographs of anything that shows up after your hospital visit.)

The Examination

Next, a doctor will examine your vagina and treat anything that needs attention. He or she will also look for semen or other signs of sexual intercourse and take samples of secretions from all areas involved in the attack.

A doctor, nurse, or technician will trim and comb your pubic hair to check for foreign tissue or fluids. You may be asked for a blood sample to test for the presence of alcohol or other drugs and a urine sample to find out if you were pregnant before the assault.

The Danger of Sexually Transmitted Disease

You'll also be tested for sexually transmitted diseases (STDs), including gonorrhea, chlamydia, genital herpes, syphilis, and AIDS. If the rapist has an STD, there's a reasonable chance that he has passed it on to you through his semen or blood.

It takes 3 to 5 days to get the results back from initial STD testing. You'll also need follow­up tests 90 days later. Because of the chance that you were exposed to gonorrhea or chlamydia, the doctor will probably start treatment without waiting for the test results.

Symptoms of gonorrhea, if left untreated may be very mild, and you might not even notice them. You may have some abdominal pain, burning during urination, and a vaginal discharge. It is possible to get a gonorrhea infection in your mouth or anus, as well as in your vagina.

With chlamydia, you may notice a thin discharge from your vagina, as well as stomach pain and a burning sensation when you urinate some time after the exposure.

Trichomoniasis and vaginosis are forms of vaginal inflammation that can be caused by sexually transmitted organisms. They produce burning and itching sensations, odor, and a discharge.

In women, STD symptoms are not as noticeable as they are in men, and some types show no early warning signs at all. You should report anything unusual—discomfort or discharge, for example—to your doctor.

Syphilis begins with genital sores—which may go unnoticed—and progresses into flu­like symptoms. This disease is so contagious that it can be passed on just by kissing, and, if left untreated, it will eventually attack other organs, causing heart trouble, blindness, and severe mental illness. For more on this and other STDs, turn to chapter 11, “Coming to Terms with Sexually Transmitted Disease.”

AIDS—acquired immune deficiency syndrome—leads to the total destruction of the immune system, but unless you get tested, you can carry the HIV virus that causes it for years without knowing it. You may be tested for the virus at the emergency room, but because this infection is slow to show up in tests, you will have to be retested again 6 months later and again after a year. Finding out that you have this terminal illness could be devastating, but it's still better to know. Doctors do have drugs that can improve and prolong your life. For more information, see chapter 13, “The Growing Danger of AIDS.”

If there is even a remote chance that you have gotten HIV or another STD, it's best to abstain completely from sex until you're sure you don't have it. If you do have sex, be sure to use a condom to help avoid the possibility of passing on HIV or other serious STDs to your partner.

Avoiding Unwanted Pregnancy

Unless you were using birth control at the time of the rape, there is a risk of pregnancy. If you choose not to carry an unwanted fetus to term, you have several options. For example, your doctor can give you emergency, or “morning after,” hormonal treatment or insert an intrauterine device (IUD) to prevent a fertilized egg from developing in your uterus. Fortunately your chance of pregnancy is extremely low—between 2 and 4 percent—unless the attack took place in the middle of your menstrual cycle.

The Emotional Toll

Most if not all women experience some sort of emotional trauma after a sexual assault. These disturbances may not show up for months—or even years—but they can be a very real disruption in your life.

For half of all rape victims, emotional symptoms persist for months or years; so it is never too late to seek medical or emotional support if you feel you need it. In fact, some childhood victims continue to experience problems well into their adulthood.

Sexual assault victims are at higher risk than other women of developing a serious depression, substance abuse, and emotional problems. Indeed, survivors of sexual assault are 2 to 4 times more likely to have serious emotional problems as a result of the attack.

Two of the most common reactions are depression and what has come to be called posttraumatic stress disorder, or PTSD. How the rape affects you depends in part on the type of attack, the level of violence, how long it has been since the attack, whether you have a history of emotional problems, and the type of person you are.

First Reactions

Immediately after the attack, you'll probably feel confused and extremely afraid. A few hours later, these feelings will give way to depression, exhaustion, and restlessness. In about two weeks, you'll begin to feel better emotionally; but three weeks later, your symptoms may worsen again.

You may experience severe bouts of fear and depression and have problems with self­esteem, social adjustment, and sexual dysfunction for up to 18 months after the assault. These symptoms will probably last at least 6 years. Women who were raped as children may repress the memory, only to have it resurface full force years later.

It's important to talk with a professional about your assault and your reactions to it. A psychiatrist, therapist, or counselor specially trained to work with rape victims can help you understand that you really are the victim and not to blame for what happened. Vent your anger, fear, desperation, even guilt—and discuss how you feel about the attack at the present time. In that way you can learn how to deal with your emotions and get on with your life.

Posttraumatic Stress Disorder

First recognized in soldiers returning from battle, PTSD is also known as shell­shock and battle fatigue. This anxiety disorder is a common response of people who have been exposed to extreme violence, such as assault and rape.

Posttraumatic stress disorder can take several forms:

Posttraumatic stress response, an early form of PTSD, may go almost unnoticed. Rape victims sometimes develop generalized fears associated with the rape. Fear of being alone or going out after dark can keep you from participating in your normal activities. You may become afraid of all men or find it hard to trust or be intimate with anyone.

Posttraumatic stress disorder develops when these systems persist. If left untreated, anxiety can turn into full­blown depression.

Two of the most common signs of PTSD are insomnia and severe nightmares. You might relive the assault over and over; flashbacks and nightmares may be so strong that you actually seem to be experiencing the event. You may become obsessed with the encounter and what could happen if you see the rapist again.

Panic attacks can accompany PTSD. They usually occur in response to a specific stimulus, such as a frightening environment. Your fear may make you hyperventilate and may even convince you that you are dying. Relaxation exercises and other coping techniques, such as deep breathing, can help you control the panic attacks.

Depression

Many cases of depression are thought to be the result of chemical imbalances in the brain. However, people can also develop a crippling depression in response to an outside event such as rape.

If you are a rape victim, fear that no one will believe you, problems with a relationship, or feelings of self­blame are all reason enough for profound depression. You may feel helplessness, hopelessness, and worthlessness. The very act of rape is dehumanizing. In all probability, the person who assaulted you said demeaning things to convince you that you deserved the attack.

Clinical depression is not the same as “the blues.” It is often so debilitating that its sufferers cannot manage to get out of bed or feed themselves, much less participate in the routine of work, family and school. Unfortunately, it can lead to self­destructive behavior, substance abuse, even suicide. If you find yourself sliding into a deep depression, you owe it to yourself to fight back. See a specialist and get the treatment you need.

Sexual Dysfunction

Rape victims often have sexual problems after an attack. Reactions range from wild promiscuity to a complete lack of desire and a total inability to respond. Even the thought of having sex may be disgusting. However, most women regain their normal sex drive within a few months after the rape.

Treatment for Emotional Problems

If you don't talk with a counselor or therapist in the emergency room, you will probably want to contact one later as you sort through your emotions following the attack. Ask your doctor, religious advisor, friends, or rape crisis center for a referral; call one of the mental health associations listed in your telephone book.

Some people still believe you have to be “crazy” to need or want therapy, or that seeking help is a sign of weakness. Don't be led astray by such misconceptions; some problems are too serious to handle alone.

Like everyone else, doctors and therapists have their own beliefs about sexual assault, rapists, and their victims. Look for a counselor with experience treating women like you, and ask up front how he or she feels about rape perpetrators and victims.

It is also appropriate to ask about how much therapy will cost, when payments are due, and whether treatment is covered by insurance. Counseling can be expensive, particularly if you must continue for a long time; but low cost or free services are available if you cannot afford the usual fees. You are under no obligation to continue treatment if the therapist makes you feel uncomfortable.

Both psychotherapy and medical therapy can help you deal with emotional problems. The most common medical treatment employs prescription drugs, such as antidepressants, to relieve your symptoms. Antidepressants work by changing the level of chemicals in the brain that are believed to be responsible for moods. If you are prescribed an antidepressant, be prepared to wait. Most of these drugs take time to work, and it may be weeks before you feel any improvement. Anxiety disorders, such as PTSD or panic attacks, respond to tranquilizers, psychotherapy, or a combination of the two.

Only a doctor can prescribe these drugs for you. He or she needs to monitor your response to make sure they are helping you and not causing unpleasant or dangerous side effects. Discuss all medications and your reactions to them with your doctor, and be sure to call the office if you have questions or concerns.

Physicians, psychologists, social workers, and licensed counselors all can provide psychotherapy. You may choose one­on­one, family, or group counseling. (Some women's centers have groups for survivors of rape or incest.) “Behavior Therapy” is often helpful in treating conditions such as fears and phobias.

In therapy, you will have a chance to talk about what has happened to you and to vent your anger. You may also learn coping skills, relaxation techniques, communication skills, and techniques for controlling your rage.

Therapy doesn't have to be formal. Some women find that reading, self­help programs, volunteer work, and social activities help them recover. Others need to confront their rapists. Sometimes writing about the attack and your feelings during and after it can be therapeutic. If you decide to prosecute your attacker, keeping a journal can also help you sort out what to tell the police or your lawyer.

Will therapy cure your problems? There are no guarantees. It helps to know that you're not alone, that someone understands what you're going through and knows how to deal with it. Chances are you'll begin to feel better after a few sessions, although most rape victims find that time in itself is also a great healer. Give therapy a try and see if it enables you to regain control over your body and your life.

The Police and the Courts

The judicial system sometimes appears unsympathetic and even hostile to a victim of sexual assault, especially when the rapist is her husband or lover. The legal definition of rape varies from state to state; and in some places a man cannot legally rape his wife. Though the law may not always have a definition for marital rape, it most certainly does occur—often together with other types of violence and emotional abuse. Regardless of your relationship to the attacker, you always have the right to say no to sex.

Many advocates for rape victims believe that everyone who is sexually assaulted should report the incident to the authorities. You've probably heard of women who have followed that advice and feel as if they were raped all over again by the judicial system. Others say they just want to get on with their lives, and telling and re­telling their story to investigators, attorneys and jurors keeps them from putting the experience behind them. Nevertheless, making a police report may be the best course for the sake of both your personal safety and your emotional well­being.

If you decide to report the crime, it's best to do it soon after the attack. The police may even come to the emergency room to talk to you and collect evidence. They will ask you to give information about yourself, the person or people who assaulted you and the place where the rape occurred. Be sure to tell them whether you think your assailant will attack you again, so they can set up a plan to protect you. The police will also ask you for an exact description of the assailant and will have you sign a statement. They should also explain about your state's procedures for pressing charges. (You probably will not have to do so if you choose not to.)

The fact that you press charges does not mean the case will ever be prosecuted or that you will have to appear on the witness stand. If the case does go to court, it may be months or even years before it is heard; and your attacker's attorney probably will do everything possible to postpone the trial.

When you press charges, the attacker will be jailed, then in all probability released on bond. He'll be given a couple of hearings in which a judge will formally tell him the charge, assign him a lawyer if he can't afford one, and determine whether there is enough evidence for the case to go to a grand jury.

If the case goes forward, the grand jury will decide whether the evidence warrants an indictment. At several points in this process, the accused will have an opportunity to enter a plea; he may opt to plead guilty, perhaps to a lesser offense, in exchange for a lighter sentence.

If the case does go to trial, you will probably have to testify in open court. However, it isn't as degrading as it once was. Most states now have laws that prevent the defense attorney from bringing up the victim's sexual history in an attempt to discredit her, and the law in general seems to be growing more sensitive to victims' rights.

That is definitely not to say that you'll have an easy time. It is the defense attorney's job to try to convince the jury that his client—your attacker—is innocent and should be released without punishment. In doing so, he may insist that you consented to have sex; that you were at fault because you did something “wrong,” such as going back to the man's apartment or having too much to drink; that you are blaming his client for something someone else did; or that no sexual activity occurred.

Rape can be hard to prove. You should understand that if the district attorney declines to prosecute, if the case is thrown out of court, or if your attacker is found not guilty, it doesn't mean you weren't raped or that you did something wrong. A “not guilty” verdict doesn't prove the rapist's innocence; it simply means the prosecution didn't have enough evidence to meet the level of proof required for a conviction.

You may also be able to sue your attacker in civil court for damages (mental and physical) that he has caused you. Talk to an attorney about your options. Many states and counties have referral services that can put you in touch with a lawyer if you need one.

Moving On

Though the road ahead may be long and difficult, you can recover from sexual assault. You can't expect things to ever be exactly the same as they were before, but you still can be certain that your life will return to normal. Do give yourself a few days to start sorting things out before going back to your routine activities. Don't dwell on the attack to the exclusion of all else. Always remember that you are not the guilty one, and that it's okay to feel anger and grief. Remember, too, that a strong support network of family, friends, and professionals can help you regain the most important component for your recovery—your sense of control. More Women's Health...