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Unwanted pregnancy see Pregnancy from rape  Emotional and psychological Frequently, victims may not recognize what happened to them was rape. Some may remain in denial for years afterwards. Victims may react in ways they did not anticipate. These are common survival responses of all mammals. An assumption is that someone being raped would call for help or struggle. A struggle would result in torn clothes or injuries. They may consolidate with time and sleep. A woman or girl may orgasm during a sexual assault. This may become a source of shame and confusion for those assaulted along with those who were around them. Immediately following a rape, the survivor may react outwardly in a wide range of ways, from expressive to closed down; common emotions include distress, anxiety, shame, revulsion, helplessness, and guilt. This is called vicarious traumatization. This significantly reduces the likelihood of pregnancy and disease transmission , both to the victim and to the rapist. Rationales for condom use include: Concern for the victim is generally not considered a factor. Those who have been raped have relatively more reproductive tract infections than those not been raped. Acquiring AIDS through rape puts people risk of suffering psychological problems. Acquiring HIV through rape may lead to the in behaviors that create risk of injecting drugs. This leads to the rape of girls and women. Victim blaming and Post-assault treatment of sexual assault victims Society's treatment of victims has the potential to exacerbate their trauma. Women who have been raped are sometimes deemed to have behaved improperly. Usually, these are cultures where there is a significant social divide between the freedoms and status afforded to men and women. Finally, rape victims are blamed more when they are raped by an acquaintance or a date rather than by a stranger e. The underlying message of this research seems to be that when certain stereotypical elements of rape are in place, rape victims are prone to being blamed. These include the idea that power is reserved to men whereas women are meant for sex and objectified, that women want forced sex and to be pushed around,  and that male sexual impulses and behaviors are uncontrollable and must be satisfied. Many rape victims blame themselves. Female jurors might look at the woman on the witness stand and believe she had done something to entice the defendant. This can be perpetrated by the rapist, friends, or relatives of the rapist. The intent can be to prevent the victim from reporting the rape. Other reasons for threats against the those assaulted is to punish them for reporting it, or of forcing them to withdraw the complaint. The relatives of the person who has been raped may wish to prevent "bringing shame" to the family and may also threaten them. This is especially the case in cultures where female virginity is highly valued and considered mandatory before marriage; in extreme cases, rape victims are killed in honor killings. Victims are to be informed of this immediately by law enforcement or medical service providers. They are able to conduct a focused medical-legal exam. If such a trained clinician is not available, the emergency department has a sexual assault protocol that has been established for treatment and the collection of evidence. Emphasis is placed on performing the examinations at a pace that is appropriate for the person, their family, their age, and their level of understanding. This general assessment will prioritize the treatment of injuries by the emergency room staff. Medical personnel involved are trained to assess and treat those assaulted or follow protocols established to ensure privacy and best treatment practices. Informed consent is always required prior to treatment unless the person who was assaulted is unconscious, intoxicated or does not have the mental capacity to give consent. In more violent cases, the victim may need to have gunshot wounds or stab wounds treated. The presence of infection is determined by sampling of body fluids from the mouth, throat, vagina, perineum , and anus. Rape investigation Victims have the right to refuse any evidence collection. Victims advocates ensure the victims' wishes are respected by hospital staff. After the physical injuries are addressed and treatment has begun, then forensic examination proceeds along with the gathering of evidence that can be used to identify and document the injuries. Photographs of the injuries may be requested by staff. The patient is discouraged from bathing or showering for the purpose of obtaining samples from his or her hair. Once the injuries of the patient have been treated and she or he is stabilized, the sample gathering will begin. Dried semen that is on clothing and skin can be detected with a fluorescent lamp. These specimens are marked, placed in a paper bag,  and be marked for later analysis for the presence of seminal vesicle-specific antigen. The procedures have been standardized. Evidence is collected, signed, and locked in a secure place to guarantee that legal evidence procedures are maintained. This is known as the chain of evidence and is a legal term that describes a carefully monitored procedure of evidence collection and preservation. Maintaining the Chain of evidence from the medical examination, testing and tissue sampling from its origin of collection to court allows the results of the sampling to be admitted as evidence. Follow up examinations also assess the patient for tension headaches , fatigue , sleep pattern disturbances, gastrointestinal irritability, chronic pelvic pain, menstrual pain or irregularity, pelvic inflammatory disease, multiple yeast infections, sexual dysfunction, premenstrual distress, fibromyalgia, vaginal discharge, vaginal itching, burning during urination, and generalized vaginal pain. An internal exam may be recommended if significant bloody discharge is observed, though. An oral exam is done if there have been injuries to the mouth, teeth, gums or pharynx. Though the patient may have no complaints about genital pain signs of trauma can still be assessed. Prior to the complete bodily and genital exam, the patient is asked to undress, standing on a white sheet that collects any debris that may be in the clothing. The clothing and sheet are properly bagged and labeled along with other samples that can be removed from the body or clothing of the patient. Samples of fibers , mud, hair, leaves are gathered if present. Samples of fluids are collected to determine the presence of the perpetrator's saliva and semen that may be present in the patients mouth, vagina or rectum. Sometimes the victim has scratched the perpetrator in defense and fingernail scrapings can be collected. If a foreign object was used during the assault, x-ray visualization will identify retained fragments. Internal injuries to the cervix and vagina can be visualized using colposcopy. Using colposcopy has increased the detection of internal trauma from six percent to fifty-three percent. Genital injuries to children who have been raped or sexually assaulted differ in that the abuse may be on-going or it happened in the past after the injuries heal. Scarring is one sign of the sexual abuse of children. Many studies found a difference in rape-related injury based on race, with more injuries being reported for white females and males than for black females and males. This may be because the dark skin color of some victims obscures bruising. Examiners paying attention to victims with darker skin, especially the thighs, labia majora, posterior fourchette, and fossa navicularis, can help remedy this. Chlamydial and gonococcal infections in women are of particular concern due to the possibility of ascending infection. Immunization against hepatitis B is often considered. Serum hepatitis B surface antigen assay Microscopic evaluation of vaginal discharge saline wash and staining Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis from each penetrated location.
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