Revictimization refers to repeated sexual assualts by the same perpetrator.
Almost half of rape victims are under the age of 18.
Girls 16-19 are twice as likely as the general population to be victims of rape, attempted rape, or other forms of sexual assualt.
Almost half of juvenile sexual assault victims know their attacker.
Families and pts cope better when they are given limited information about the rape kit process.
Doctors are legally mandated to perform a full "rape kit" on all pediatric patients who present to the ED for alleged CMS-S.
Sexual assault kits must be collected within 24 hours of the alleged assault to be admissible in court.
Mandatory pregnancy tests are given starting at age 13.
Almost half of pediatric pts admitted for sexual assault show signs of an STD.
Sexual assault is a comprehensive term that includes any forced or inappropriate sexual activity.
Typical CMS-S Protocols
Get report from SW before you do anything!
Meet with the Attending, Resident and SW prior to teaching/preparation.
Meet with the pt to build rapport and do teaching
Find out what they call all their body parts prior to giving them a label like "vagina"
Attend procedures with pt if desired to provide distraction and support
Possibly remain with pt if suspected perpetrator is at the hospital.
Medical Staff Meeting: At the Meeting with other Medical Staff you will Discuss:
Which cultures will be done (if any at all)
-includes: penile, vaginal, rectal, and/or anal.
Where the exam will happen (in room in the pelvic room)
If the doctor will be using a sepculum (age 12 and up)
If the doctor will be using a colposcope or any other external photos by SW
Possible positions the child will be asked to move inot
Medical Teaching and Preparation
Initially meet with the patient to introduce self and offer to provie some activities while you collect your materials.
Return with needed items
Explain procedure in developmentally appropriate terms
Explan the importance of softening inner-thigh muscles during exam
Ask the pt who they would like in the room and offer to provide distraction/support during that time
Then alert doctor that you have finished teaching
CMS-R (Rape Kit)
The nurse MUST remain in the room with the kit until it is sealed
-Pubic hair combing
-Sailva test (swabs)
-Vaginal or penile swabs
-May collect underwear or other clothing
-Blood draws are necessary
Alert parents to its location so thy do not bump into the cultures or cross contaminate evidence
Keep constant distraction with the pt. to avoid additional anxiety during waiting times
Finding Some Ways to Offer Respect
Refer to the patient by name and show an interest in them
Advocate for less invasive procedures first (such as oral swabs)
Advocate for the patient to get dressed prior to the blood draw.
Turn away or hold up a sheet to shield the pt during clothing changes.
Advocate taking time to allow the patient to comply with medical procedures rather than having other medical staff hold them down for procedures
Be empathetic and do no assume you know everything
Validate concersn for pt and family
Anticipate questions they may have and try to find answers from the appropriate professionals
Interpret questions the doctor asks and the patient is confused about
Don't focus on the trauma and instead offer some opporutnities to escape the situation (humor or playing games)
Things to Remember
If the child lives with the alleged perp, they may go into foster care
-Don't tell them that they will be going home soon.
Parents may feel uncomfortable and want to retell their side of the story to seek validation fo their feelings of guilt, etc.
-Try to redirect the conversation in the presence of the children as it can be very traumatic.
Guardinans may not make choices that align with your personal values.
-Remember your role as a professional and try to remain within your ehtical limits in challenging situations.
Revictimization and Discrimination Against Victims of Sexual Crimes
Sometimes medical staff have a bias that the pt "deserved it" because of dress, behavior, etc.
Beliefs may be that they are seeking attention and did not "really get raped"
Some believe that rape kits should not always be collected because the parents "won't really do anything about it anyways"
Callous attitudes towards victims and their families
Laying blame on the victim for compliance issues
--Potential fears and misconceptions that are not disclosed: "I didn't want to have it (referring to the exam) because last time there was video."
Following the Exam; Doctor Returns to the Room to Discuss:
Postexposure Prophylaxis Medications
Plan B or other "emergency contraceptive choices"
Prescriptions for antibiotics
Follow up recommendations
Possible follow up at a children's safety center around the state (or consult with expert)
Answers any additional questions.
Research reports that increased parental and child distress being significantly associate with the child being 12 years and older
Parents report less stress being related to staff attitudes and doctoer explanations.
Most parents and children report miconceptions about the exam being more invasive, painful, and scary.
Sexuality in Infancy and Childhood
Ultrasound images indicate that sexuality beings in the womb
During infancy the foundations for sensuality, intimacy, and relationship to others is established.
Early Infancy: Ages 0-1
"Failure to Thrive" Syndrome
Explore their bodies
Early Childhood: Ages 2-6
Develops an awareness of being a boy or girl
Curious about their own bodies and the bodies of others
May include sex play
Reaction to Child
Avoid a negative reaction
Socialize to privacy
Help the child to become comfortable with their own sexuality
Begin positive communication early
Respect the child's needs regarding privacy
Initial School Age Years: 7-11
Generally have learned societal norms
Spurt of knowledge and understanding occur around age 11
Questioning continues often with misconceptions
Around the ages of 11-12, there is a distinct increase of levels of interest toward the other gender.
Puberty: Ages 7-15
Begins earlier and last longer than previously believed
Puberty: Two Part Process
Adrenal glands start to mature and secrete the androgen hormone DHEA, which is then converted to testosterone and estrogen.
The testicles and ovaries mature, usually several years afer adrenarch. The pituitary gland begins to secrete FSH in high doses.
Puberty: Changes in Girls
Underarm and pubic hair
Glands develop-body odor and acne
Feminization of body-fatty deposits in hips
Puberty: Changes in Boys
Development of sex organs (testes, scotum, penis, prostate, and seminal vesicles)
Muscle and tissue
Masculine body features
Growth of body hair
Deepening of vocie
Adolescence: Ages 13-18
Focus on changing body; social stresses
Abstract thinking skills
Strengthen gender identity and clarify sexual orientation
Experience confusion, fear, and misunderstandings.
Varying research to support frequency of teenage intercourse
Initiation of sexual intercourse
Adolescence: Social Development
Learn ground rules of relating to other people
Teenage romances and relationships
-Opening up to another; becoming more vulnerable
Adolescent Same Gender Sexual Activity
Explore same-gender relationships
Some clearly identify themselves as having same-gender orientation
Decide if they are homosexual or heterosexual by age 17
Adolescent Heterosexual Activity
Frequently believe that their friends are more knowledgeable and experienced.
May have guilt feelings about new sexual feelings and desires.
Eventually try experimentation
Stages of intimacy
Relationships with family and peers
Stages of Intimacy
Touching above clothes
Touching under clothes
Much higher in the U.S. than other developed countries
Over 1 million teen pregnancies in U.S. annually; 80-90% unplanned; 1/3 end in abortion
Increased risk for some
Some encouraging signs- a decrease probably due to more effective use of birth control.
Adolescent Sexual Health
Must educate from birht
Focus on how to maintain long-term relationships
Better training for professionals
Identify at-risk youth and offer sex education, support services, counseling intervention
Sexually Healthy Adolescent
Appreciates own body
Takes responsbility for own behaviors
Knowledgeable about sexuality issues
Communicates with family
Seeks information about family values/contributes to self values
Respectful to both genders
Expresses love in appropriate ways
Evaluates readiness for mature sexual relationships
Adult Sexuality and Relationships
Our culture attempts to prolong the youthful period of the lifespan.
In loco parentis role faded in the 70s-80s college years often a transitional phase
89% of men and 70% of women in college engage in sexual intercourse
Over 60% of college freshmen are sexually active
Adult Sexuality: Intimacy
One of the major taskes is to achieve intimacy with others
Sexuality and Aging
Trend is to stay single longer
Sharing of sex is usually viewed as something for youth
Older people retain sexual desire.
Myths about Sexuality and Aging
Loving and sexual feelings are experienced only during youth
Sex is primarily for reproduction
Older men retain sexually interesting to younger partners than do older women.
Special Problems and Patterns of Aging
Sexual dysfunctions due to physiological changes and illness.
-Surgeries effect sexual behaviors
-Hormonal and physiological changes of older age
Life Factors that Influnce Sexual Potentials in Old Age
The individuals or couples sexual history
Sexual values and attitudes
Knowledge about sexuality
Maintenance of self-esteem and sense of identity
Maximizing Sexual Expression During Later Years
Elderly people can be freed from many concerns:
-Need to "prove" oneself
-Obessions with performance
-Balancing work and personal time
-Interruptions of children
1 Corinthians 13:4-7
Love is patient and kind; love is not jealous or boastful; it is not arrogant or rude. Love does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrong, but rejoices in right. Love bears all things, believes all things, hopes all things, endures all things.
3 Components of Love (Rubin, 1970)
Types of Love in Intimate Relationships
Intense psychological feelings
Generalized physiological arousal, strong sexual desire
Sternberg's Triangular Theory of Love
Lee's Styles of Loving
The Chemistry of Love (Walsh and Liebowitz)
Passionate love is a result of surging levels of 3 key brain chemicals:
Produce amphetamine-like effects: euphoria, giddiness, and elation
Also contribute to sexual arousal
Does not last because the body develops a tolerance
In long-lasting relationships, the body gradually steps up production of endorphins which cause us to feel good when we are with a loved partner.
Who do we fall in love with and why?
Proximity-people we see frequently
Similarity-similar in beliefs, interests, and values
Reciprocity- when people like us, we like them back
-"whats beautiful is good" belief
-status by association
-most important in early stages
-may be an indicator of physical health
Jealousy in Relationships: Jealousy Prone Person
High value on wealth and popularity
Maintaining Relationship Satisfaction: Ingredients in Lasting love relationship
Good Communication, realistic expectations and shared interests
Ability to face and deal with conflict
Maintaining Relationship Satisfaction: Characteristics of High Quality Relationships
Seeing partner as best friend
Maintaining frequent positive interaction
Maintaining Relationship Satisfaction: Other Characteristics
Parents had sucessful marriages
Have similar interests, attitudes, personalities
Satisfied with sexual relationship
Adequate, steady home
Not pregnant when married
Maintaining Relationship Satisfaction: Sexual Relationship
Planning for intimacy
Focus on what is normal for your relationship
Frequency of Sexual Activity
National average is once a week
Higher frequency correlations
Quality is probably a better indicator of sexual fulfillment than frequency.
5.5 million; a 72% increase in the last 10 years.
A "trial marriage"
Convenience and companionship
What does love have to do with it?
A change in cultural definition of love
Love and Cohabitation
In cohabitation intimacy and passion rather than commitment are the strongest elements
Cohabitation and Better Marital Adjustment
Does not create a better marriage
Rank thair marriage lower
Think Twice About Cohabiting-4 Principles by Popenoe and Whitehead
Increased chance of divorce
Strong predictor of failure of future relationships
Limit cohabitation to the shortest period of time
Don't cohabit when children are involved.
What is the biggest problem with cohabitation?
When are 2 people married before God?
Two basic conditions according to Olthius (1975) study of scripture:
-That the relationship be based upon a mutually shared convenantal commitment
-Consummated through sexual intercourse
-Does the couple need consent from parents or family?
-Does a couple need to make their commitment before a community of believers?
-Is consent of civil authorities needed?
Family, Community, and Civil Structures Support Marriage
Strength of commitment multiplied when made before a witness of believers.
Government structures protect spouses and children's financial and property rights.
The church can provide support for marriage as an institution.
How should the church respond to cohabitation?
Uphold biblical standard
Lovingly help couples understand how the biblical concept can bring depth and stability to the relationship
Offer compassionate and a church home
Offer public ceremony within community of faith
Continue to show love and grace
Sex reassignment surgery
Gender Roles and Stereotypes
-one of the effects of stereotyping is sexism
-Leads us to interpret same bahavior in prejudicial ways-also "man's work and woman's work"
Psychological unhealthful effects
Focus on the roles of genetics and prenatal influences including the role of hormones in predisposing gender-linked patterns
Prenatal Brain Organization
Children acquire gender role stereotypes by the ages of 2.5 to 3.5
How do children adopt such stereotypical behavior patterns?
Social Learning Theory
Gender Schema Theory
A person's desire for the physical presence and emotional support of the other person.
An individual's concern for the other's well-being.
The desire for close, confidential communication with the other.
The motivational component that fuels romantic feelings, physical attraction, and desire for sexual interaction
The emotional componenet of love that encompasses the sense of being bonded with another person; sharing private thoughts and feelings.
Is the thinking or cognitive aspect that refers to the conscious decision to love another and maintain a relationship over time despite difficulties
Emphasis on physical beauty as they search for the ideal mate.
Playing the field; like the act of seduction; little/no commitment
Roller coaster of affection and jealousy
Slow to develop, but endures; usually begins with a friendship
Selfless, caring, compasionate desire to give without expectation of reciprocity.
seek partners with social, educational, religious, and interest patterns compatible with their own.
Jealousy in Relationships: Negative Consequences
Precipitates partner violence
Stifles relationship development
Raises anxiety, depression, anger
Jealousy in relationships is related to?
injured pride or fear of losing what one wants to control, rather than love
Not engaging in sexual behavior; can be two degress: complete or partial
Self-restraint or self-denial, not engaging in sexual activity.
-commonly due to religious beliefs
-celibacy may be a life-long decision
-concerns about pregnancy and STD's
-More priority given to developing the relationship