This page has been printed from the Yarrow Place website http://www.yarrowplace.sa.gov.au

This is your choice. Often it is a good idea to see a doctor as soon as possible to make sure you are OK and to talk about any concerns you have about your health.

Do I need to tell the doctor I have been raped or sexually assaulted?

That depends on the service you want. The doctor can assist you best if she/he knows why you are there.

What will happen if I see a doctor?

That depends on what your concerns are and what you want to have happen. A doctor can provide you with:

Information about your medical care and answers to your questions;

A health check to:

• Check for possible injuries and their treatment
• Talk about pregnancy testing
• Talk about sexually transmitted infections including information, testing and treatment
• Talk about the effects of the rape and sexual assault on you and your body, such as feeling depressed or suicidal, eating and sleeping patterns, or level of anxiety
• A medical certificate if you need some time off work, school or uni.

If you are thinking about reporting to the police, the doctor can collect evidence for the police with your consent (you can find more information under 'forensic medical examination'). It is important that this done soon as possible.

The following information is about seeing a doctor at Yarrow Place

Health Check

The doctor will talk with you about your health concerns. The doctor will ask you if you want to be examined and talk with you about the examination. The doctor will ask your consent and you may need to sign a consent form that says you agree to the examination. Even after giving consent you can change your mind at any time and say "yes" to some parts of the examination and "no" to other parts. In South Australia, you can give consent and sign the consent form yourself when you are 16 years and older.

The sorts of things the doctor can talk with you about are:

Injuries

A lot of people who have been raped or sexually assaulted will have no injuries as a result of the assault. Some people will have injuries such as bruises, scratches and grazes. A small number of people will have serious injuries that need to be treated in hospital.

Bruising, aches, pain and stiffness may be more noticeable in the first few days after the assault.

Genital and anal injuries

Injuries to this area can cause soreness, pain, bleeding or stinging when going to the toilet. Some people may experience pain or tenderness when having sex after the assault. These injuries generally heal quickly but new or heavier bleeding, abdominal pain or any other worrying symptoms need to be checked by a doctor.

Pregnancy

For women, if you were not using contraception at the time of the rape, you may want to take the Emergency Contraceptive Pill, Postinor-2 to reduce the chance that you will get pregnant. You can get this medication from most chemists without needing a prescription from the doctor. It is also available from Yarrow Place. Take the 2 tablets together as a single dose

Postinor-2 can be taken up to 5 days after unprotected sex but the sooner it is taken the more effective it is at preventing pregnancy.

Postinor-2 can sometimes cause nausea or vomiting. If vomiting occurs within 2 hours of taking the tablets, the medication will need to be taken again. Less common side effects are vaginal bleeding, headache, breast tenderness and dizziness.

Even though Postinor-2 is effective at preventing pregnancy, it is important to have a follow up pregnancy test to be sure. Talk to your doctor if you have abdominal pain or cramps or your next period is lighter than normal or is late.

If you are pregnant at the time of the assault you may be worried about your baby. It is unlikely that your baby will have been harmed but you can ask the doctor to check that your baby is OK. If you have any bleeding or abdominal pains it is very important to see your doctor.

If you are pregnant as a result of a rape, please see your doctor to discuss the options you have in relation to the pregnancy.

Sexually Transmitted Infections (STIs)

Many people who have been sexually assaulted are concerned about sexually transmitted infections (STIs). In South Australia getting an infection after a sexual assault is uncommon. However it is still important to check. Testing for sexually transmitted infections can be done in the first few days after an assault (called baseline testing). Testing at this time only shows whether or not you had an infection before the sexual assault. It is not necessary to have testing at this time but some people want baseline tests taken. Infections that the doctor might test for are chlamydia, gonorrhoea, hepatitis B, hepatitis C, HIV/AIDS, syphilis and vaginal infections such as thrush. For more information about the above STIs please click here to visit the Clinic 275 web site.

The best time to test for infections after the assault are:

2-3 weeks for chlamydia, gonorrhoea and vaginal infections; and

3 months for a blood test for HIV, hepatitis B and C, and syphilis

Medication to prevent sexually transmitted infections

There are medications available that may reduce your risk of developing a sexually transmitted infection. The doctor will talk with you about the risks of infection and the type of medication that you can take to help reduce the risk.

Psychological Impacts

The psychological impacts of rape and sexual assault are often very significant. Trouble sleeping, anxiety, depression and thoughts of suicide are common reactions. Changes in sexual desire may occur. Remember, people do recover from the impact of rape. It is good to think about what you need to do to help you recover and how to keep safe in this process.

Some people have problems with drugs and alcohol, eating disorders and hurting themselves after being sexually assaulted. Although these coping strategies may help you they may harm your health. Please think about safe ways to deal with the effects of the assault such as talking to a friend, writing in a journal, and seeing a counsellor or your doctor.

Suicidal thoughts in particular can be very distressing. Talk to a trusted person about these thoughts and seek help from a health practitioner so that you can be safe until the thoughts are no longer a problem.

Drugs, alcohol & sexual assault

Sometimes people are concerned that they have been drugged and sexually assaulted. There are many ways that drugs and/or alcohol may be involved in sexual assaults. You may have been sexually assaulted when

• you were under the influence of a drug that you were using for recreational purposes
• you were using prescription drugs and drinking alcohol and were unaware of the combined effects
• your drink was spiked for the purpose of sexual assault
• your drinks were a higher alcohol content than you were led to believe

Typically, a person has been out to a club or party and feels intoxicated out of proportion to the amount of alcohol they have had. You may have gaps in your memory and wake up in a strange place and in circumstances that make you believe that you have been sexually assaulted.

If you are worried that this has happened to you, see your doctor or contact Yarrow Place to talk about what you can do in this situation

Forensic medical examination

If you are thinking about reporting to the police you can choose to have a forensic medical examination. The examination is done to provide evidence that can:

• support the type of sexual assault that occurred
• support your explanation of what took place
• help identify the person who sexually assaulted you.

This examination is most useful within 72 hours of the rape or sexual assault. However, it can be done up to 1 week after the assault. The doctor or nurse (in some rural areas) will collect evidence. Before collecting evidence, the doctor or nurse will talk with you about the examination and give you time to ask questions about it. You have the right to say yes or no to the collection of any samples. Evidence can include swabs taken for semen and saliva, clothing and hair samples. Evidence also includes detailed documentation of your injuries.

Making a decision about contacting police can be difficult. We can offer a 'just in case' forensic medical examination. Evidence is collected and stored safely until you make a decision within a 6 month period.

What happens to the forensic evidence collected during the examination?

(This information only refers to services provided by Yarrow Place)

If you decide to:

1. Ask the police to investigate your complaint:

The police will take the evidence to the Forensic Science Centre. The scientists will examine the evidence that was collected and provide the results and a report to the police. It can take some time for this to be done.

2. Have evidence collected and stored securely while you decide whether or not to ask the police to investigate your complaint - "just in case forensic examination":

If you have chosen this option, the evidence will be stored securely by Yarrow Place for 3 months from the date of collection. After 3 months the evidence will be transferred to the Forensic Science Centre for a further 3 months. After the 3 months at the Forensic Science Centre it will be destroyed. This means that you have 6 months in which the evidence will be available if you decide to ask the police to investigate your complaint.

You can contact the police at any stage after an assault, even many years later, but the evidence will only be available for 6 months from the time of collection.

Preserving forensic evidence

Sometimes people choose to delay the forensic medical examination because they have more pressing needs such as arranging childcare or needing to have a sleep.

The following information is provided to let you know what you can do to maximise the successful collection of forensic evidence when the examination is done, if there is to be a delay.

Washing/Showering

Some evidence may be lost if you shower or wash before the examination. If you can, it is better not to wash before the examination. It is very normal to want to have a shower or wash, so if you need to, try not washing the areas that have been involved in the assault. For example, don't wash your breast if you have been 'kissed' there during the assault or if you were anally or vaginally raped please do not wash these areas.

Toilet

If you need to urinate ("do a wee"), press your underpants to your external genitalia (vagina or penis) before removing them and going to the toilet. If you can, try not to defaecate ("do a poo") if you have been anally raped. If you do have to go, press your underpants to the anus before removing them and going to the toilet.

Clothing

Please keep the clothing worn at the time of the assault and do not wash it.

Follow up medical care

Another appointment with the doctor is made to offer you:

• pregnancy testing
• testing for sexually transmitted infections
• a check to see how your injuries are healing
• an opportunity to talk about other problems that have been caused by the assault such as sleep disturbance and depression.
• time to talk about ways of coping with the effects of the assault

Pap Smears

Some survivors of sexual assault find it difficult to undergo regular preventative health care such as pap smears. Yarrow Place offers a sensitive preventative health service for all clients. This includes pap smears, breast checks, STI testing and contraceptive advice.

Case Notes

Yarrow Place keeps medical and counselling case notes separate. Your case notes record information from each time you speak with the doctor and/or counsellor (face to face or telephone).

Your medical notes contain:

• information about the medical examination that was done as a health check
• information about evidence from the assault (the forensic medical examination)
• information about medical problems you have had since the assault
• medical tests, baseline tests and treatment that you have been given. (Only if you have had follow-up medical care at Yarrow Place)

The counselling notes contain:

• agreements that you have made with your counsellor
• a brief summary of issues you have discussed with your counsellor
• any advice, information or encouragement your counsellor gives you to do particular things
• any items (letters, poems, drawings) that you've given to your counsellor - you can keep these yourself if you prefer
• any correspondence between Yarrow Place and any other service that you've agreed we can talk to.

Confidentiality

Case notes are confidential and are kept in a locked room at Yarrow Place. Information about you is confidential. No information about you can be given to anyone else without your permission, subject to certain legal constraints. The situations when we cannot guarantee confidentiality are:

• if your worker believes that you are a danger to yourself or others
• if you are under 18 years of age or have told your worker about a child (under 18) being abused or at risk of abuse. We are required by law to notify Child Youth and Family Service. (For more information please read Mandatory Notification)
• we are legally required to notify the Department of Health about particular sexually transmitted infections
• if you take legal action against Yarrow Place
• if you are involved in legal action against the alleged offender

You may want information to be given to your family doctor, health worker or other people. If you would like this to happen, you will be asked to give Yarrow Place permission in writing for the information to be passed on.

Mandatory Notification

In South Australia, some workers are required by law to inform Child Youth & Family Services (CYFS) if they suspect that a child has been or is being abused or neglected. The legal definition of a child for these purposes is a person under the age of 18. The worker only requires a suspicion of child abuse or neglect. The worker must have formed the suspicion during the course of their work. This law applies to volunteers and paid workers. The law is known as the Children's Protection Act (1993). Workers who are required by law to notify CYFS are called mandated notifiers.

This means that CYFS must be notified if a person under the age of 18 years is suspected of having been raped or sexually assaulted.

Mandated Notifiers include:

• medical practitioners
• pharmacists
• registered or enrolled nurses
• dentists
• psychologists
• members of the police force
• community corrections officers (a person whose duties include the supervision of young or adult offenders in the community)
• (an officer or employee of an administrative unit of the Public Service whose duties include the supervision of young or adult offenders in the community)
• social workers
• teachers in any educational institution (including a kindergarten)
• family day care providers
• any employee or volunteer in an agency (government and non government) engaged in or responsible for the delivery of health, education, child care or residential services wholly or partly for children.

The law does not require proof of harm. However, a notification must be given with a statement of their observations, information and opinions upon which the suspicion is based. The report can be given verbally to a social worker from CYFS (Child, Youth & Family Services).

Mandated notifiers are assured of confidentiality. They are immune from civil liability and allegations of any breach of professional ethics when reporting their suspicions in good faith.

Reporting a rape or sexual assault to CYFS usually results in CYFS informing the police of what happened. The police may conact you to discuss what you want to happen.