Case records and commentaries in obstetrics and gynaecology
Abstract
Sexual assaultlnon consensual sex undermines sexual health. Strong associations
between various forms of sexual coercion and adverse reproductive health consequences
have been identified. Sexual assault therefore may underlie some of the most tenacious
and often life-threatening reproductive health problems of our time: genital injuries,
unintended pregnancy (and its complications) and the acquisition of not only HIV but
also other sexually transmitted infections (STIs) and attendant sequelae.
? Objectives
The objective of this study was to determine the immediate gynecological morbidity in
women and female children presenting with sexual assault at the Gender Violence
Recovery Centre (GVRC) at Nairobi Women's Hospital (NWH).
Methodology .•
A cross-sectional study was carried out using a questionnaire between October 2005 and
February 2006. A total of 240 clients presenting within a period of 72 hours after the
incident of rape were interviewed. Data regarding their sociodemographic characteristics,
genital injuries and infections, baseline HIV and pregnancy status, contraceptive use and
treatment modalities offered was collected and analyzed using Epi- info and SPSS for
statistical significance.
Results
Out of the 240 victims of sexual assault interviewed the mean age was 20.5 years (range
2-65 years). The majority of the victims were in the age group 16-24 years (35.4%), lived
in Eastland's part of Nairobi 76 (31.7%), were single 105 (43.8%), Christians 220
(91.7%), unemployed 98 (40.8%) and had completed basic or primary school 125
(52.1 %). A fifth (21.3%) reported physical abuse. During the rape 3.3% of the assailants
were reported to have used condoms. Victims younger than the age of sexual consent
(l6years) were more likely to be assaulted in the assailant's residence (p<0.05). Just over
half of the cases reported to law enforcement 137 (57.1%).
Extragenital injuries were observed in 25.3% of the victims. For severe injuries, one
victim presented in coma and another had fractured humerus.
366
Most genital injuries were bruises 52.9% of the vulva, vagina, cervix and anus followed
by tears 46.7% of the perineum, hymen and vagina. Among the severe injuries were those
that resulted in vesicovaginal fistula (2, 0.8 %), rectovaginal fistula (2, 0.8%) and an
abdominal haematoma (1,0.4%). Two of the victims (0.8%) had foreign objects in their
genitalia. Those who were 16 years and younger were twice as likely to suffer genital
tears (OR=2.3). Spermatozoa were identified in collected secretions in 14% of the
victims.
Conclusions
Most sexual assault cases come from under privileged settings and are not reported to law enforcement almost half the time, beir.g most prevalent among women aged 16-24.
Minors are most often assaulted within their homes. Most assailants do not use condoms
in this high HIV prevalence setting putting victims at risk for infection. Within this non
conflict setting, we observed severe injuries classified as traumatic fistula.
e
Recommendations
Sexual assault is a real health problem for young women and clear policy and structures
to reduce its occurrence are urgently needed. This would include increased parental
awareness and strategies to create awareness and take preventive measures among young
women living in identified higher risk zones. It is important that clear guidelines for care
and encouraging reporting of such assaults be instituted in health units where women
may seek such care.
Citation
Master of Medicine in Obstetrics and GynaecologyPublisher
University of Nairobi, Department of Obstetrics & Gynaecology