Aetiology

The causes of sexual assault and abuse are complex and are outside the scope of this topic.

Pathophysiology

Sexual abuse and assault can result in a wide range of physiological and psychological effects, both immediate and long-term.[14]

In the period immediately following sexual assault, individuals may present with acute injuries such as bruises, lacerations, and genital trauma. In cases involving force, weapons, or substance use, the severity of physical injuries increases. Sexually transmitted infections can occur, and rape-related pregnancy rates are approximately 5% per incident in girls and women aged 12-45 years.[14]​ Long-term health issues may include increases in physical symptoms reported by patients, reduced social function, altered health perceptions, and a decreased quality of life. Women may also experience chronic pelvic pain, dysmenorrhoea, and sexual dysfunction more frequently than those without a history of sexual assault.[14]

After a sexual assault, individuals may experience a rape-trauma syndrome, which unfolds in two phases.[14]​ The acute phase, lasting days to weeks, involves physical symptoms; for example, widespread pain, and emotional reactions such as anger, anxiety, guilt, and mood swings. The delayed phase, occurring in the weeks or months following the assault, may include flashbacks, nightmares, phobias, and physical symptoms such as somatic and gynaecological symptoms.

Long-term psychological outcomes of sexual abuse or assault include post-traumatic stress disorder, depression, anxiety, eating disorders, sleep disorders, and thoughts or acts of self-harm or attempted suicide.[7][15][16]​​[17][18]​​ Substance use disorders, including alcohol and illicit drugs, are also associated with a history of sexual assault.[7][14]​​ In children, mental health disturbances may manifest as behavioural changes. Behavioural changes include internal or depressive symptoms, and external acting-out behaviours.

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