11 ABUSE ANDVIOLENCE 221
yelling result in more severe physical injuries or even
death. Degree of submission is higher when the at-
tacker has a weapon such as a gun or knife. In addition
to forcible penetration, the more violent rapist may uri-
nate or defecate on the woman or insert foreign objects
into her vagina and rectum.
The physical and psychological trauma that rape
victims suffer is severe. Related medical problems can
include acute injury, sexually transmitted diseases,
pregnancy, and lingering medical complaints. A cross-
sectional study of medical patients found that women
who had been raped rated themselves as significantly
less healthy, visited a physician twice as often, and
incurred medical costs more than twice as high as
women who had not experienced any criminal victim-
ization (American Medical Association, 1999). The
level of violence experienced during the assault was
found to be a powerful predictor of future use of med-
ical services. Many victims of rape experience fear,
helplessness, shock and disbelief, guilt, humiliation,
and embarrassment. They also may avoid the place or
circumstances of the rape; give up previously pleasur-
able activities; and experience depression, sexual dys-
function, insomnia, and impaired memory (American
Medical Association, 1999).
Until recently, the rights of rape victims often
were ignored. For example, when rape victims re-
ported a rape to authorities, they often faced doubt
and embarrassing questions from male officers. The
courts did not protect the rights of victims—for ex-
ample, a woman’s past sexual behavior was admissi-
ble in court, although the past criminal record of her
accused attacker was not. Laws to correct these prob-
lems have been enacted on a state-by-state basis since
the mid-1980s.
Although the treatment of rape victims and the
prosecution of rapists have improved in the past
2 decades, many people still believe that somehow
a woman provokes rape by her behavior and that
the woman is partially responsible for this crime.
Box 11-5 summarizes common myths and misunder-
standings about rape.Assessment
To preserve possible evidence, the physical examina-
tion should occur before the woman has showered,
brushed her teeth, douched, changed her clothes, or
had anything to drink. This may not be possible,Cynthia is a 22-year-old college student who spent Sat-
urday afternoon with a group of friends at the football
game. Afterward, they were going to attend a few par-
ties to celebrate the victory. Alcohol was served freely at
these parties. At one party, Cynthia become separated
from her friends but started talking to Ron, whom she
recognized from her English Lit course. They spent the
rest of the evening together, talking, dancing, and drink-
ing. She had had more drinks then she was used to, as
Ron kept bringing her more every time her glass was
empty. At the end of the night, Ron asked if she wanted
him to drive her home. Her friends were staying longer
at the party.
When Ron and Cynthia arrived at her apartment,
none of her roommates had returned yet, so she asked
Ron to come in. She was feeling a little tipsy and theyCLINICALVIGNETTE: RAPE
began kissing. She could feel Ron really getting excited.
He began to try to remove her skirt, but she said, “No”
and tried to move away from him. She remembered him
saying, “What’s the matter with you? Are you a prude or
what?” She told him she had had a good time but didn’t
want to go further. He responded, “Come on, you’ve
been trying to turn me on all night. You want this as much
as I do.” He forced himself on top of her and held his arm
over her neck and raped her.
When her roommates return in about 1 hour, Cyn-
thia is huddled in the corner of her room, seems stunned,
and is crying uncontrollably. She feels sick and confused.
Did she do something to cause this whole thing? She
keeps asking herself whether she might not have gotten
into that situation had she not been a little tipsy. She is so
confused.Box 11-5
➤ COMMONMYTHSABOUTRAPE
- When a woman submits to rape, she really
wants it to happen. - Women who dress provocatively are asking for
trouble. - Some women like rough sex but later call it rape.
- Once a man is aroused by a woman, he cannot
stop his actions. - Walking alone at night is an invitation for rape.
- Rape cannot happen between persons who are
married. - Rape is exciting for some women.
Adapted from University of Buffalo Counseling Center
(1999). http://ub-counseling.buffalo.edu /Relationships/
Violence/ warnings.html