First Male Sexual Assault Victim - Experience and Learning

Hello everybody 

Hope you're doing well.

This is slightly unconventional topic. I'm talking about but as an emergency physician, I think we'd be having more cases like this in future thanks to the awareness and I'm glad we'd be there to help people there. Idea is to learn and spread awareness about dealing with these cases in a civilized way rather than panicking.

Men facing sexual assault is also a thing. I happened to read this article on ACEPs website. Thought of sharing my experience as well.Will drop the link in the end.

Experience is not unique . Untapped , untouched and forgotten area of my specialty. I honestly did nothing there. But I guess it was God's way of telling me , this can happen , you better be prepared mentally, academically.

I don't think I had read about this after I closed my Forensic Medicine textbook in my medical school , later in my MRCEM Intermediate exam.

 The Event

Last year, I was on night call ,my nurse told me that there is a gentleman who has a prescription for tetanus but is not comfortable showing him the prescription. The patient was also apprehensive about paying charges.

A typical ER physician who kind of handles the administration aspect as well as the billing sometimes... I intervened .

I see a young man visibly distressed with tears in his eyes ,his voice hardly coming out. He asked for a private space because he had something confidential to discuss.

It was weird because I had a male nurse standing right next to me. Probably it was a moment where a patient confiding in a doctor over a nurse .

He said , Mam, I have been sexually assaulted. I'm in a state of mental distress. Can you please make it easier for me by just administering this injection? I asked him for a prescription, he did show me a valid prescription. he had seemed help already. He said that he didn't want to move around go to places and do uncomfortable things.Please don't complicate it for me.

As an doctor, the thing you are concerned the most about is how the patient is doing and if he's stable. He let me read the prescription in detail, the medications he has been prescribed and the plan of care from then on. I realised he's been rightly guided about the post exposure prophylaxis . I thought I'd read about Indian detail and left it in my never-ending list of tasks.

I requested the nurse to administer the tetanus injection and let the gentleman leave.

On this article from ACEP was a long lost lear .

If it helps anybody back here in India . I'd be very glad.

 

Learning 

Males can be victims of sexual assault and abuse.

Male sexual assault victims have the same rights as female victims.

Male sexual assault victims report to law enforcement and seek health care services much less frequently than females.

Certain unique aspects of male sexual assault and rape myths can lead to shame, stigma, and mental health crisis in male victims.

Your emergency department has the same duties to the male victims of sexual assault as to female victims.

Emergency departments need to provide male SA victims the same trauma-informed, victim-centered care as female victims.All protocols and procedures should be the same. Rapid triage assessment, including evaluation for potential injuries, should occur. The patient should be placed in a quiet area to await evaluation. All the options should be explained to the patient. In the US ,Patients also have the right to request no law enforcement response and to have anonymous reporting and evidence collection. 

Detailed forensic history should be reserved for forensic medical officers , and the clinician needs to rule out potentially serious injuries and instability. Laboratory and radiographic testing should be performed as indicated. Although rare, some serious injuries seen in male victims include: head injury, fractures, genital injury/mutilation, and anorectal tears and perforation (the patient may present with peritoneal signs).  

Swabs of the male genitalia should be obtained, paying attention to the penile glans/prepuce, shaft, base, and anterior scrotum. Two moistened swabs are used, but more can be used on each specific outlined area. Male victims may experience anal penetration at a higher rate than female victims, so an anorectal examination should be performed. Swabs should be obtained from the perineum, perianal area, and anal canal. Significant anal or rectal trauma may require evaluation by general, trauma, or colorectal surgery. 

Sexually transmitted infection screening and prophylaxis, including HIV, should be provided as per protocol. For those starting HIV post-exposure prophylaxis, medications/prescriptions should be provided.

Link to the article.

https://www.acepnow.com/article/when-the-patient-is-a-male-breaking-down-the-stigma-of-male-rape/?elq_mid=63414&elq_cid=30850514&utm_campaign=39563&utm_source=eloquaEmail&utm_medium=email&utm_content=Email-Research-IssueAlert-ACEPeNOW_2022-7-24.html

Any feedback with respect to Indian Setting is welcome.

So far so much.