Rape is a violent crime defined as forced sexual intercourse without consent. Sexual assault includes threatened, attempted, and completed rape and other types of unwanted sexual contact. Many cases of sexual assault are never reported to police, and victims often do not receive medical or psychiatric care. Those who present acutely for medical care may appear in an emergency room or rape crisis center. Others, such as the young women in the cases described in this article, present to their primary care provider a few days or weeks after the assault with concerns about pregnancy, sexually transmitted disease, or disabling psychologic symptoms. Still others struggle alone for years with the psychologic sequelae of sexual assault before seeking help.

Comprehensive care of a person who has been sexually assaulted is a complex task requiring coordination among medical providers, legal professionals, and providers of psychiatric care. This article presents the basic information required to provide medical care for adolescent women surviving sexual assault. Some of the principles discussed also apply to older patients and to male victims. (For a more thorough discussion of the care of male survivors of sexual assault, please refer to the book by Scarce<sup>61Men are most commonly sexually assaulted in all-male social settings, such as boarding schools, institutions housing young men, fraternities, military installations, and prisons. Clinicians should be alert to the possibility of prior sexual assault among young men whose social histories include time spent in all-male environments, especially if this residence was not voluntary.

Cliquez ici pour aller à la section Références</sup> and to the resources listed there.)^{*Men are most commonly sexually assaulted in all-male social settings, such as boarding schools, institutions housing young men, fraternities, military installations, and prisons. Clinicians should be alert to the possibility of prior sexual assault among young men whose social histories include time spent in all-male environments, especially if this residence was not voluntary.} The authors focus on medical care, discussing to some degree the medical provider's role in collecting legal evidence, and in screening for and managing the psychologic sequelae of sexual assault. A detailed review of the medical-legal sexual assault examination (rape kit) is beyond the scope of this article but is presented thoroughly in a textbook on the topic.<sup>13Men are most commonly sexually assaulted in all-male social settings, such as boarding schools, institutions housing young men, fraternities, military installations, and prisons. Clinicians should be alert to the possibility of prior sexual assault among young men whose social histories include time spent in all-male environments, especially if this residence was not voluntary.

Cliquez ici pour aller à la section Références</sup>

Patient autonomy, participation, and control are crucial components of the recovery process and of ethical practice with patients who present for care after a sexual assault. Some young women wish to pursue evidence collection; others do not. The examination process itself may simply be too traumatic for many adolescents, especially those who are very young or who have not had previous gynecologic care. Patients who decline a full medical-legal examination should not be pressured to consent to one, but should be offered pregnancy prevention, prophylaxis against sexually transmissible infections, counseling, and support. Decisions regarding which aspects of treatment to pursue and which to decline should lie entirely with the patient, even if her physician or her parents disagree. It is the responsibility of the treating clinician to offer (or make immediate arrangements for) comprehensive care, to support the patient in her choices, and to provide long-term medical and mental health follow-up care.