The below was written by Heidi Fantasia PhD, RN, WHNP-BC. Dr. Fantasia is an Associate Professor at the Solomont School of Nursing, University of Massachusetts – Lowell, and a member of the NPWH Board of Directors
April is Sexual Assault Awareness Month. While this is the 18th year we have recognized this public health issue, there is still work to be done to overcome the shame and stigma that plagues victims of sexual assault. This annual recognition serves two purposes, to raise public awareness about sexual assault, sexual harassment, and abuse, and to provide education, resources, and potential solutions for prevention.
A Common Experience
It is estimated that between 25% and 50% of women will experience an attempted or completed sexual assault during their lifetime. Those rates could even be higher when you consider that many sexual assaults are never disclosed or reported, often times because it was perpetrated by someone who is known to the victim. Sexual assault can be defined in many different ways, but broadly it refers to sexual activity in which consent wasn’t obtained or wasn’t freely given. This includes sexual activity or contact that was unwanted, coerced or occurred after intimidation or threats of harm. Although both women and men can be victims of sexual assault, women have the highest rates.
The Role of a Provider
It is always an individual’s decision whether to disclose an assault. But health care providers play an important role in creating a safe space where people feel supported when talking about uncomfortable topics that they may have never discussed anyone else.
Ask the Questions
Asking simple questions such as “Have you ever been forced to have sex when you didn’t want to”, “Have you ever experienced physical or sexual violence from a partner” and “Are you currently afraid of someone” helps start a conversation. These questions can be modified for any practice setting and asked in person or incorporated as part of the patient history. Letting individuals know that these are routine questions asked of everyone will help reduce stigma and reduce the chance that women feel singled out due to factors such as age, race, ethnicity, sexual behaviors, sexual orientation, and gender identification.
Believe Women and Assure Nonjudgement
Individuals who have experienced assault, whether it was attempted or completed, can experience a range of emotions, including fear of not being believed, shame, embarrassment, and self-blame. They may be worried that others will judge their behavior or relationships. Discussing sexual assault allows for open and honest conversations about consent, coercion, and healthy relationships. The most important way health care providers can help those who have experienced sexual assault is believing their account and listening to their most immediate concern.
Offer Timely Resources
If the assault occurred recently (typically within the past 5-7 days), individuals can be directed to a hospital or center with a sexual assault program that provides forensic evidence collection. This evidence will be used if they decide to move forward with legal proceedings. It is important to make sure those who have experienced sexual assault understand the decision to press charges is completely theirs, and having evidence collected does not mean they have to go down this road now.
If the assault occurred outside of this time frame or if the individual doesn’t want to have this done, the office visit should focus on what they identify as most important. This may include concerns about pregnancy, sexually transmitted infections, or emotional issues such as fear, anxiety, and depression. Providers can offer outside resources for additional support such as individual and group counseling, liaisons with law enforcement, and legal assistance.
Providers Create Change
Increasing awareness of sexual assault as a prevalent public health issue will help decrease victim blaming and normalize conversations about best strategies for prevention. Whether a woman is coming in for an annual checkup or seeking help after a sexual assault, our work as clinicians can help lift the veil of secrecy so that more women can get the care they need.