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.