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Your health
Being raped or sexually assaulted can affect your physical and emotional health, so it is important to get medical help as soon as you can. You can get help and treatment without reporting the assault to the police. If the assault took place some time ago, it is still worth getting checked out. It is never too late to get help.
Many people who have been raped or sexually assaulted get help from health services without saying what happened to them. It is fine for you to do that. Even if you tell, you should not have to go over what happened in detail. The reason health staff ask you questions is so that they can work out the best way to help you. But you do not have to tell them anything you do not want to. Whatever you say will be treated in confidence. This means that information about you will not be passed onto anyone else without your consent, unless you are thought to be at serious risk of further harm. There are a very few exceptions. For example, if you are a young person under social work 'supervision', the health authority has a duty to tell the police.
It is important that you take care of yourself and get yourself checked out for your own peace of mind. Worrying about infection, pregnancy or other health matters can affect how well you recover from a sexual assault. It can also affect your relationships with the people around you. Also, early treatment can prevent long-term health problems or make them less likely. For some health matters (for example infection or unwanted pregnancy), the sooner you take action, the more choice and control you will have. Taking control is one way of helping yourself to recovery.
The trauma of what happened to you may mean that the thought of having to go through an intimate medical examination may be very distressing. It may put you off going for help. But it may be possible for you to get medical treatment without having to say what happened and without being touched by anyone. You can take a friend with you for support and you can ask to see a male or female doctor. Some clinics offer treatment without testing. Some offer testing and treatment, for example for chlamydia (see below) by post. It is possible to test for some infections on a urine sample so you will not necessarily need to be examined.
The following section gives some ideas about where to go for medical help and treatment. Where you go will depend on what you prefer, where you live and where you feel most comfortable going. There are Genito-Urinary Medicine ( GUM) clinics in most areas of Scotland. These cater for women and men and provide free, confidential services including testing for sexually transmitted infections and emergency contraception ( see here). Other suggestions are family planning clinics, young people's clinics, local health centres and GPs ( see also Sexual Assault Referral Centre). If you are not sure where to go, you can phone the Sexual Health Helpline free on 0800 567 123 for advice or see online at www.nhs24.com/info/sexhealthclinic
You have the right to:
- Decide what to say and who to tell
- Have someone with you for support
- Ask to see a male or female worker, depending on your preference
- Confidentiality
- Ask for information and explanations
- An interpreter if your first language is not English
- Decide whether or not to take any tests offered
- Time to consider your options
- Complain, if you are not happy about how you are treated
Shock, injury and pain
In the immediate aftermath of an attack or in the hours and days that follow, you may feel a whole range of things including shock, pain, anger, numbness and denial. You may feel none of these. Everyone is different and there is no correct way to respond.
Shock
Injury or trauma can result in shock. This affects people in different ways but common reactions are:
- Uncontrollable shivering or shaking
- Unable to sit down or relax
- Crying without warning or unable to stop crying
- Laughing hysterically
- Being sick
- Feeling numb, distant or calm
- Unable to talk to anyone
If you are in shock it may be difficult for you to take in what is happening, or to remember the details of the assault. This is perfectly normal. It helps to:
- Keep warm
- Drink lots of fluids (non-alcoholic) but only if you are not reporting to the police
- Stay somewhere you feel safe
- Have people you trust with you
- Give yourself time
The effects of shock will pass but this may take less or more time depending on who you are, your circumstances and the nature of the assault. People all react differently. If you are in any way anxious about how you are feeling you may find it helpful to speak to your GP or a support agency (see section 4).
Bleeding and injury
If you are bleeding or injured you may need urgent medical treatment. Even if your injuries do not seem serious, it may be useful to get a check up in case of any internal damage.
If you need emergency help, go to the Accident and Emergency (A&E) department of your nearest hospital. If it's not an emergency, contact your GP for an appointment. Outwith surgery hours, you can phone NHS 24 on 08454 24 24 24 if you think you need to be seen by a doctor or want to ask for advice (see also www.nhs24.com) . You will get medical attention and support whether or not you want to report the assault to the police.
If you go to A&E and want to report the assault to the police, healthcare staff will contact the police for you. They will not examine you in case they spoil any evidence but they will treat injuries which need urgent attention.
If you go to the police and need urgent medical help, they will make sure you get this.
Pain
You may be in pain from an assault, sometimes in places where you do not remember being hurt. Sometimes the shock of what is happening means you block it out. Or you may have been unconscious or asleep at the time. Bruises may not appear until sometime later.
Even if the assault is not invasive, you may feel sore and stiff because you were scared and stressed while under attack.
Pregnancy
The risk of becoming pregnant after a one-off assault is small. It depends on various factors such as your age; whether you usually use certain methods of contraception; whether the attacker used a condom.
Preventing unwanted pregnancy
If there is any risk of pregnancy, you can take emergency contraception as soon as possible and up to 72 hours after the attack. You take one pill as soon as possible after the assault. The sooner you take this, the more effective it is. You can get emergency contraception over the counter from a pharmacy, from your GP, a police doctor, hospital A&E, GUM clinics or family planning clinics. It is free from hospitals, GUM and family planning clinics. For other places you may have to pay a prescription charge.
If it's over 72 hours, a doctor can fit an emergency coil (inter uterine device IUD) up to five days after the assault. This stops an egg from being fertilised or implanted in the womb. It can be removed after a normal period or left in as a contraceptive.
If you were pregnant at the time of the assault
If you know that you were already pregnant at the time of the assault, it is important to get checked in case you have picked up an infection (see below). You can get advice from a doctor in a sexual health clinic or the doctor looking after you in pregnancy. Early treatment can get rid of or reduce the chance of any damage to the baby.
If you are concerned about the baby being harmed during the assault, it will be helpful to see your doctor or midwife who may be able to check that the baby is well, depending on how far on in the pregnancy you are.
It is important to let anyone who is caring for you know that you are pregnant so you are only given medication or have procedures done which do not harm the baby.
If there is a possibility that you might be pregnant, a pregnancy test can be done.
If you were already pregnant before the assault but didn't realise, the emergency contraception pill will probably have little effect on the foetus, but an IUD may cause problems. An IUD would only be fitted if there was no risk of pregnancy before the assault. Medical staff will be able to discuss this and answer any questions you have.
Pregnancy testing
If you think you might be pregnant as a result of the assault, it is best to get this confirmed as soon as possible. The sooner you know for sure, the more time you will have to decide what to do next. You can be tested by your GP, family planning clinic, GUM clinic and at some pharmacies. Pregnancy testing is free. You can also buy home pregnancy testing kits from any pharmacy. A pregnancy test can be done on the day your next period is due. It involves testing your urine. You should take a urine sample first thing in the morning in a clean dry jar and take it to the testing centre.
A positive result almost always means you are pregnant. A negative result may mean you are not pregnant but false negatives are fairly common early on. So, if it's negative but you still think you are pregnant, repeat the test a week later.
If you are pregnant, you may want to end the pregnancy or continue with it. You may have a clear idea about what you want to do but it may be helpful for you to talk over your options with a health adviser, for example at a GUM or family planning clinic or your GP. You should be given all the information you need to make your own decision about what you think is best for you.
If the result is positive and you want the pregnancy ended, you need to act as soon as possible. Although abortion is legal up to 24 weeks, this is very rare. It is also safer and easier within the first 12 weeks from the start of your last period. Abortions are available free of charge through the NHS but are generally only carried out up to 18 weeks. Private clinics may have a later upper limit but you will have to pay for the procedure. Surgical termination involves surgically removing the contents of the womb; medical termination involves taking tablets.
If you want to continue the pregnancy, you can choose to keep the baby or have it adopted after birth. These are difficult decisions with long-term implications for you and the child. You may want to discuss the various options with an adviser and trusted friends or family. Your local social work department can give you information and advice about adoption. The social work department is part of your local council. You will find the contact details of your local council in the phone book.
Evidence of paternity
If you become pregnant as a result of rape or sexual assault and undergo a surgical termination of the pregnancy, it may be possible to obtain DNA from foetal tissue. This can then be used to confirm or refute paternity and may help with forensic evidence.
Sexually transmitted infections
Sexually transmitted infections ( STIs) can be spread through intimate sexual contact - through the vagina, anus and mouth. So, if you have been raped/sexually assaulted and your attacker did not use a condom, or if you don't know if they used one, it is important to get tested to make sure you have no infection. Also, STIs may have no symptoms so tests will show whether you need treatment.
Chances of infection
The chances of picking up an infection vary depending on the circumstances. It is not very common to pick up an infection from a one-off contact. If you do, it is likely to be one of the most common types, which are easy to treat. However, more serious infections are always manageable. It is best that any infections are treated early. The sooner you start treatment, the less damage they can cause.
Chlamydia (see below) is very common while HIV, although many people are anxious about it, is not easy to pass on. The chance of being infected from a one-off exposure to HIV is very small. However, if you do get HIV, there is a huge amount that can be done to minimise its impact and help you stay well.
Testing for infection
Some infections can be tested for early on (after two weeks) while others may take some time to show up in tests (up to six months). Just because you have no symptoms does not mean there is no infection so it is important to be tested to make sure.
You may not feel able to cope with tests which may need samples to be taken from your mouth, anus or vagina (although it may be possible for you to take the samples yourself if you prefer). If you do not want to be tested, it is possible for many common infections to be treated with antibiotics.
STIs can be tested and treated by your GP, Genito Urinary Medicine ( GUM) clinics and Family Planning clinics. You do not have to go through your GP to go to a GUM or Family Planning clinic. You can refer yourself. Treatment at GUM and Family Planning clinics is free and there are no prescription charges.
When you go to a clinic, you will be seen by a doctor/health professional who will take a case history. The doctor will find it helpful to know how you were raped/assaulted - vaginally, anally or orally - in order to discuss risks of infection with you, but you do not have to discuss the assault itself in detail. You can ask to see a male or female doctor.
Infections can be checked for by a combination of urine, blood and swab tests. Swab tests may be taken from the genital area (for women this requires an internal examination), the anus and the throat. This involves using something like a cotton bud to take samples from the affected area. This is not painful.
Some results can be given within a fortnight. Some infections are not detectable for several months, so you may be asked to return for further tests. The clinic may ask to take some blood for storage at your first appointment as a reference point for future tests.
Main sexually transmitted infections to be aware of
The list in section 1 describes the main STIs to be aware of. The commonest infection is chlamydia. Gonorrhoea and trichomoniasis are far less common. They can all be tested for two weeks after the assault by taking a sample from the affected area(s). They are all treated easily with antibiotics. Some infections take a while before they show up in tests.
Syphilis and HIV can take three months and Hepatitis B and Hepatitis C can take up to six months before they show up in tests. These require blood tests.
Immediate treatment for Hepatitis B and HIV
If there is a risk that the attacker has Hepatitis B, you will be offered immediate vaccination rather than waiting for the result of the blood test. Some clinics offer this routinely for sexual assault. There is an increased risk of contracting Hepatitis B if the attacker is an intravenous drug user as it can be spread by sharing needles and equipment. Vaccination cannot prevent Hepatitis C.
If there is a risk of HIV, it is possible to start a course of preventative treatment immediately. This is called post exposure prophylaxis ( PEP). It should be started as soon as possible after exposure and within 72 hours. There are side effects from this treatment so you will not be offered it unless there is a high risk of HIV infection. There is an increased risk of contracting HIV if you were raped/
sexually assaulted on holiday in an area where there is a lot of HIV; raped anally (because of tearing) or experienced tearing during a vaginal rape; for men who are sexually assaulted by men; or if the attacker is in a high risk group. A doctor or health adviser can give you advice about this.
Increased risk
Risk varies according to who the attacker is, the circumstances and the nature of the assault. If there is a lot of trauma or bleeding then risk is increased. If the attacker used a condom, the risk is lower. So it is important to speak to a doctor or health adviser who can assess the likely risks and explain the best action to take.
If you are male and you have been sexually assaulted by another man, there is a slightly higher risk of some infections. Infections that are more commonly found amongst men who have sex with men are gonorrhoea, syphilis, Hepatitis B and C, a more severe form of chlamydia and HIV.
Many men who are sexually assaulted feel embarrassed about reporting. Even if you do not wish to report to the police, it is important for your own health and the health of your partner(s) to get a check up at your local GUM clinic, where you can be advised about the risks of the different infections, checked and given treatment if needed.
Sexual contact
You may not want to have or think about sexual contact after the assault. If you do, you may want to use condoms until you have had the all clear from any tests.
You do not have to do everything at once.
You have a choice. You can take all the tests, some tests or none at all.
You can go to a clinic of your choice.
You can be treated without testing.
You do not have to give your name and address or any personal details to get treatment.
The infection(s) you are most likely to get are the ones which are easiest to cure.
You do not have to inform your own GP if you choose not to.
More about STIs
Chlamydia: very common but most people do not have symptoms. In women it can cause vaginal discharge and irregular bleeding. In men it can cause a discharge from the penis and pain when urinating. If left untreated it can produce pelvic pain, testicular discomfort and in some cases reduced fertility in women. It can be cured with antibiotics.
Gonorrhoea: much less common than chlamydia. In men it causes pain/burning feeling when urinating and a discharge from the penis. In women it may cause a vaginal discharge. It can be cured with antibiotics.
Hepatitis B: a very uncommon virus which attacks the liver. It can be passed through unprotected sex but it is preventable with a course of three vaccinations.
Hepatitis C: a virus which attacks the liver. It is only rarely spread by unprotected sex. About half the people who are infected clear the virus themselves and there is treatment to help those who don't.
HIV: a virus which weakens the immune system. People infected with HIV may not show symptoms at first, and if undetected it may lead to AIDS (Auto Immune Deficiency Syndrome). A person is said to have AIDS when their HIV infection has caused severe suppression of their immune system resulting in one of a very specific group of severe infections or cancers. The HIV virus can be suppressed and the immune system successfully preserved by drug treatment, preventing people from becoming ill. However, there is no cure for HIV.
Syphilis: still very uncommon in heterosexual men and women, but increasingly common in men who have sex with men. It is an infection which usually begins with a small painless sore or ulcer in the penis or vagina. Often it can go unrecognised, and needs a blood test to detect it. It can be cured with antibiotics.
Trichomoniasis: an uncommon infection which may have no symptoms but which often causes a profuse yellow or green discharge from the vagina with soreness. Men usually act as carriers and do not show symptoms. It can be cured with antibiotics.
More information
Sexual Health Helpline: 0800 567 123
NHS 24: 08454 242424
Brook Helpline: 0800 0185 023 (for under 25s)
British Association for Sexual Health and HIV: www.bashh.org
Directory of clinics by postcode: www.nhs24.com/info/sexhealthclinic
NHS 24: www.nhs24.com
Family Planning Association: www.fpa.org.uk
Brook: www.brook.org.uk (includes secure online enquiry service for under 25s)
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