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Sexual violence on college campuses may be more prevalent than you think. Are you asking patients the right questions about their sexual health?
Once again, rape on college campuses has risen to public consciousness. On March 31, 2014, in an anonymous open letter, a female Harvard student described her sexual assault by a fellow student whom she had considered her friend. She goes on to expose the university hierarchy as unwilling to initiate a proper investigation of her claims and as being unable to deal with what had happened to her in a supportive and sensitive way. Instead, the university is cited as choosing to brush the incident aside, essentially rewarding the perpetrator for his actions.1
Rape on college campuses has long been known to be a problem, but it is not one we like to admit to. These young people represent the intellectual elite of our society; how painful for us to admit that this has become an issue of epidemic proportions.
The Rape, Abuse & Incest National Network (RAINN) reports that the U.S. Department of Justice estimates that 20% to 25% of all women in college or graduate school will experience a sexual assault.2 According to the results of the 2008 National Crime Victimization Survey, more than 75% of women who reported a rape were younger than 25 years old at the time of their assault. Of those, more than 25% of the victims of reported rapes were between 18 and 24 years of age. Less than 5% of these incidents are ever reported, which is far below the 40% reporting incidence for the general public. Furthermore, as with most sexual assault, the victim and assailant know each other.3
Unfortunately, high school students are not immune to assault either. In 2011, almost one in eight female high school students reported ever having been raped. Sexual assault and rape are crimes that disproportionately affect girls and women between the ages of 12 and 24 years. Regardless of race, they are two to three times more likely than adults older than 25 years to be raped or sexually assaulted.4
Jimmy Carter opines in his newest book, A Call to Action: Women, Religion, Violence, and Power,5 “The tragedy is that most on campus rapes are perpetrated by serial rapists who can safely assume that their crimes will not be revealed.” He goes on to ask how this can be and notes that the “Hopkins Undergraduate Research Journal of March 2012, which reported that one in three college assaults that get reported are committed by student athletes, who are often popular and influential.”
In response to these devastating statistics, the White House has released new and stricter guidelines regarding the treatment of sexual assault victims and reporting of such crimes in annual campus crime statistics.6
In addition, Sen Kirsten Gillibrand (D, NY) and Sen Claire McCaskill (D, MO) have now turned significant attention to such problems on the nation’s campuses. “After a year of working hard to reform how the military handles sexual assault cases,” Senator Gillibrand said in an email, “the stories I have heard from students are eerily similar. Once again the problem is systemic, survivors feel twice betrayed, and reform is required.”
In light of all of this, what is our role as ob/gyns? Our first obligation is to simply ask the question. In checking in with our patients about any past history of sexual assault, we give them permission to speak about what is generally a taboo subject. In the same way that we are obligated to ask about and act upon issues of domestic violence, we should be talking about sexual violence as well.
When a patient reveals that she has been assaulted, I ask her when the event occurred. If it was recent, we discuss STD testing, referral for counseling, police reporting, referral to a crime victims’ service, an assessment of her safety, and any other medical concerns. If it was a more distant event, I inquire about her need for counseling, whether she has flashbacks, what impact the assault has had on her ability to date and maintain healthy relationships, and whether or not she feels safe.
Neither the justice system nor the medical system serves victims of sexual violence well. As the primary medical contact for young women, ob/gyns are the front line for the medical and psychological well-being of survivors of sexual violence.
1. Waldman K. Harvard student writes about being sexually assaulted, then ignored by administrators. April 1, 2014. Available at: http://www.slate.com/blogs/xx_factor/2014/04/01/harvard_student_writes_in_the_crimson_about_her_sexual_assault_and_the_school.html. Accessed May 12, 2014.
2. Rape, Abuse & Incest National Network (RAINN) website. Campus safety. Available at: https://www.rainn.org/public-policy/campus-safety. Accessed May 14, 2014.
4. Child Trends Data Bank. Adolescents Who Have Ever Been Raped. July 2012. Available at: http://www.childtrends.org/wp-content/uploads/2012/07/31_Rape.pdf. Accessed May 14, 2014.
3. Chamberlain L, Levenson R. Addressing Intimate Partner Violence Reproductive and Sexual Coercion: A Guide for Obstetric, Gynecologic, Reproductive Health Care Settings. Third Edition. Available at: http://www.futureswithoutviolence.org/userfiles/file/HealthCare/Reproductive%20Health%20Guidelines.pdf. Accessed May 14, 2014.
5. Carter J. A Call to Action: Women, Religion, Violence, and Power. New York, NY: Simon & Schuster; 2014.
6. Steinhauer J. White House to press colleges to do more to combat rape. New York Times. April 28, 2014. Available at: http://nytimes.com/2014/04/29/us/tougher-battle-on-sex-assault-on-campus-urged.html?_r=0. Accessed May 14, 2014.