Adolescent Sexual Assault

Epidemiology

Exact figures on the incidence of rape are unavailable because many rapes are not reported. It is estimated that 1 in 5 women and 1 in 71 men will be raped in their lifetime. Females exceed males as reported rape victims, but male rape may be more underreported than female rape. In 2010 the DOJ National Crime Victimization Survey reported that the annual rates of sexual victimization per 1,000 persons were 4.1 for ages 12-17 yr and 3.7 for 18-34 yr. Between 1995 and 2013 the rate of rape and sexual assault was highest for adolescent females between ages 18 and 24 yr. The National Survey of Children's Exposure to Violence (NatSCEV 2014), revealed that 12.9% of 14-17 yr olds experienced any sexual victimization in the past year, 21.7% had experienced any sexual victimization in their lifetime; and 4.2% experienced sexual assault in the past year and 10.2% in their lifetime. This survey also demonstrated how other experiences with violence compound the risk for sexual victimization. Youth with a history of maltreatment by a caregiver were 4 times more likely to experience sexual victimization and >4 times more likely to experience sexual victimization if they had any witness to violence. Among older adolescents age 18-24 yr, the rate of rape and sexual assault was 1.2 times higher for those not enrolled in college than those in college. Further, several studies of youth in the juvenile justice system demonstrate a particularly high prevalence of prior sexual victimization of girls in the juvenile justice system.

Rape occurs worldwide and is especially prevalent in war and armed conflicts. The World Health Organization estimates that rape and domestic violence are responsible for 5–16% of healthy years of life lost by females of reproductive age.

Female adolescents and young adults have the highest rates of rape compared to any other age-group. The normal developmental growth tasks of adolescence may contribute to this vulnerability in the following ways: (1) the emergence of independence from parents and the establishment of relationships outside the family may expose adolescents to environments with which they are unfamiliar and situations that they are unprepared to handle; (2) dating and becoming comfortable with one's sexuality may result in activities that are unwanted, but the adolescent is too inexperienced to avoid the unwanted actions; and (3) young adolescents may be naïve and more trusting than they should be (see Chapter 132 ). Many teens are technologically competent, which gives sexual perpetrators access to unsuspecting vulnerable populations who were previously beyond their reach. Social media, chat rooms, and online dating sites represent a major risk for adolescents, resulting in correspondence with individuals unknown to them or protective family members, while simultaneously providing a false sense of security because of remote electronic communications. A determined perpetrator can obtain specific information to identify the adolescent and arrange for a meeting that is primed for sexual victimization.

Some adolescents are at higher risk of being victims of rape than others ( Table 145.1 ).

Types of Rape

Rape and sexual assault can occur in a variety of circumstances ( Tables 145.2 and 145.3 ). A victim can be sexually assaulted or raped by someone they know or a by stranger, though more often the assailant is someone known to the victim. Understanding those circumstances allows for a more trauma-sensitive approach and may impact the medical management and response to the patient. The circumstances and relationship of the assailant to the victim may impact if, when, and how a patient discloses. The gender of the victim may also affect disclosure; transgendered people and males are uniformly less likely to disclose rape/sexual assault than females. The gender of the assailant may be the same or different than the victim's, and there may be one or more than one perpetrator. In any scenario the sexual assault/rape can be facilitated by threats or coercion, physical force, or drugs.