Adolescent Medicine 

         Sexual Assault Vignettes       

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Case No. 1

AA is a 16 year old female who presented to the ED accompanied by her 17 year old girlfriend who told the triage nurse that AA was raped earlier. AA had some difficulty with her speech and the nurse detected alcohol in her breath. She asked AA for her parents name, address and telephone number and instructed them to wait until they could be contacted and came to the hospital. Two hours later the triage nurse in the next shift called AA but didnít get any answer. She realized AA and her girlfriend had left the ED. She called the on-duty administrator who instructed her to call the police.


Case No. 2

BB is a 17 year old female who presented to the adolescent clinic with her mother to ask for a prescription for birth control pills. BB admitted to the examiner that she was involved in a romantic consensual sexual relationship with a 25 year old man who was not a member of her immediate family. She denied any abuse or mistreatment on his part. BBís mother was aware of this relationship, knew the man and never noticed any abuse or mistreatment towards her daughter. The medical evaluation revealed no contraindications for oral contraceptives. After informed medical consent was obtained from BB, a prescription for birth control pills was issued.


Case No. 3

CC is a 17 year old female who presented to the adolescent clinic complaining of abdominal pain. She had been in the ED three days prior to this visit with the same complaint. The ED encounter sheet indicated that the physical examination was normal, that a urine pregnancy test was negative, that no specific treatment was provided and that no prescription was issued. After the assessment of the abdominal pain failed to reveal any significant findings, the examiner strongly suspected that there might have been another reason for CCís visit. She was questioned whether she had ever been emotionally, physically or sexually abused and if she wanted to talk about it. She offered a dramatic history. Two months prior to the visit to the adolescent clinic she arrived from Africa to live with her paternal grandmother. Her father had stayed back in Africa. Within one month of her arrival, her grandmother introduced her to a 48 year old male who was her friend. She told CC that she should become this manís woman. She turned down the offer. The grandmother punished her by severely restricting her of food and the ability to leave the apartment. Two weeks prior to the visit to the adolescent clinic the grandmother took her to the manís apartment with the pretense that they were visiting an old friend. After a few minutes there, the grandmother left. CC stated that the man insisted on having sex with her. She tried to resist his attempts but he forced her to bed, tied her up and sexually abused her, having repeated vaginal intercourse throughout the night. The next morning he put her in a taxi cab, paid the driver and instructed him to take her back to the grandmotherís address. Significant findings in the physical examination included hyper-pigmented concentric marks around the wrists and the ankles suggestive of healing friction burns. There were no signs of trauma in the external genitalia. The clitoris was absent. There were no disfiguring scars. This could have been an indication that the clitoridectomy was the result of a controlled surgical procedure. CC was informed that her history revealed that a crime might have been committed. She was asked if she wanted to report the incident to the police and was offered help to do that. She declined this suggestion and emphatically told the examiner that she would not do anything that would get her grandmother in trouble. She was offered the help of the rape coordinator which she accepted. The rape coordinator was notified.


 
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