Sexual Assault

Authored by Dr Mary Lowth, 02 Dec 2016

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Hayley Willacy, 02 Dec 2016

This leaflet discusses sexual violence. If you are reading this leaflet it may be that you have experienced sexual violence, or that you are trying to offer support to someone who has experienced sexual violence. This leaflet describes feelings and difficulties survivors of sexual violence may experience. It offers some guidance on how they might help their recovery. It cannot hope to describe the way every survivor will feel. It discusses the things that survivors say have helped them and it tries to answer questions you might have about the physical and psychological effects of rape and sexual violence. It offers suggestions on where to find support.

Sexual violence violates your basic right to 'own' your own body and it takes away your power. This has psychological, emotional and physical effects, which can last for a long time. These effects can be very difficult to deal with; however, with the right help and support they can be managed and you will recover. Learning more can help you find the best form of care to begin the healing process. Understanding your options can help you decide what to do.

You should not be forced to do anything you don't want to do. It is very important to be back in control of what happens to you. However, there are certain things to consider that will help your recovery, and you may need urgent medical attention.

The things that help many survivors include:

  • Specialised support and counselling.
  • Feeling a sense of control during the recovery process.
  • The passage of time.
  • Recognising guilt and shame as negative feelings that need to be tackled.

Involving the police

Most rape and sexual assault survivors never report their assault to police. However, the police are able to offer a supportive, helpful and practical service, even if you feel you do not want to press charges against your attacker.

The police are available 24 hours a day. Call them on 999/112/911 and explain that you have been raped or sexually assaulted. They will come to collect you from wherever you are. If you go to the police you will be offered medical advice, access to counselling and support and the option to prosecute your attacker. If you do this immediately there may be evidence on your body which will help that prosecution. Difficult and awful though this is, in order to try to preserve that evidence for the police you should stay in the same clothes and not bathe or wash before you speak to them. Going to the police offers you:

  • Help and support.
  • Medical examination and advice.
  • The opportunity to keep your options open if you think you might want justice.
  • Sexual health screening.
  • Emergency contraception.

Going to a sexual assault referral centre (SARC)

If you go to the police you will be seen by specially trained police officers and then by trained professionals at a SARC. If you prefer not to see the police, you can go directly to your nearest SARC.

The services and support of the staff at a SARC are available to you whether or not you have reported the assault to police. Being seen at a SARC will allow collection of evidence so that you keep your options open regarding prosecution. You can choose to be dealt with anonymously. The Survivors Trust (see support groups, below) lists details of your nearest SARC in England or Wales. You can also find it by calling the NHS 111 non-emergency service, speaking to your GP or the Accident and Emergency (A&E) department of your local hospital.

Getting urgent medical help

If you have been raped or sexually assaulted and you need urgent medical care, call 999/112/911 and ask for an ambulance to take you to the nearest A&E department. Once they have dealt with any urgent medical problems they will offer to refer you to the police and/or a SARC if you wish them to do so. They can also offer many sexual health services, including emergency contraception and medication for prevention of HIV (see below).

Seeing your own GP

If you can't face going to the police and are unable to get to (or don't want to visit) a SARC, go to see your GP. Go to reception. Tell them it is an emergency. If possible take a friend who can tell them that you have experienced a serious assault. Unhappily, many surgery receptionists will ask you to justify an emergency appointment by explaining yourself. However, you do not have to tell them you have been raped or sexually assaulted. Repeat that it is an emergency. Be willing to see the nurse - the nurse will involve the doctor if needed.

Help from supportive friends

A survivor may choose to seek support only from people among their personal support system. Friends are enormously important. To have a close friend who doesn't mind being called at any time of the day or night is enormously valuable.

Friends often don't know how to provide this support alone. They may worry about saying the wrong thing, or they may have conflicting feelings because they know the attacker. If you are relying on a partner or parent, they may be unwilling to accept reality, be too distressed to support you and may even seem to blame you as you do yourself. In that situation, it is very important to find additional support outside your friends and relatives.

Contact a support centre

Sometimes it is easier to talk to a stranger about terrible, intimate experiences than to a friend, however supportive your friends want to be.

There are a number of organisations offering experienced confidential telephone and online support for people who have been raped or sexually assaulted. They will understand your experience and can help you make the decisions you may be finding difficult - about what to do, and whom to tell. They can provide invaluable support to help you recover. Their contact details and hours of opening vary but they are listed under 'support groups' below.

In the UK, Rape Crisis specialised in the care of women and girls for many years; however, some Rape Crisis centres now also offer specific support for men. All centres will be able to give you details of the right support group for your gender.

Being a survivor

We try to talk about people who have experienced rape and sexual assault as survivors, rather than as victims. This is important because using the word 'survivor' defines you by what you experienced, rather than by who you are. 'Survivor' is a forward-looking, positive word. 'Victim' implies you are vulnerable. Using positive language about yourself can affect the way you think about yourself.

The most important thing to do when someone tells you they have been raped or sexually assaulted is to listen to them. Believe them. Most allegations of rape and sexual assault are true.

Sexual assault takes away power and ownership of your own body and it is crucial to help people start to recover by giving them back control over what is happening to them. They should not, therefore, be forced to go to the police, but strongly encouraged.

Rape and sexual assault are common: the 2012/13 Crime Survey for England and Wales estimated that 1 in 50 women and 1 in 200 men in the UK had experienced some form of sexual assault in the previous year. Most people know their attacker, and rape is often associated with domestic violence.

There are many countries in the world where rape and sexual violence are very much more common than this. There are also some communities and groups of people who are much more vulnerable to sexual violence and more likely to experience it, even in the UK.

Rape is the penetration of your mouth, vagina or anus by a penis, without your agreement (consent). The legal definition of rape always involves penetration by a penis. Assault by penetration means the penetration of the vagina or anus with an object or body part other than the penis, without your consent.

Sexual assault includes any unwanted sexual contact, including touching you sexually and forcing you to touch yourself or another sexually. Both men and women can be guilty of sexual assault and assault by penetration; however, only a man can be convicted of rape. It is possible for a woman or man to force a man to penetrate them, through intimidation or through physical force. This is not currently defined as rape, but as sexual assault.

Examples of rape include penetration by the penis of:

  • A person aged under 16 years.
  • A person who says no.
  • A person who feels unable to refuse through intimidation or threat.
  • A person who says they do not consent.
  • A person who is unable to consent through being drunk or high - for example, with alcohol or drugs.
  • A person who is unable to consent because their drink has been spiked.
  • A person who is unable to consent through learning disability.
  • A person who is unable to consent because they are unconscious.
  • A person who is unable to consent because of mental illness.
  • A person who is penetrated without giving consent, through threat or violence.
  • A person who is physically forced into penetration.
  • A person who initially consents to penetration but then makes it clear that they want it to stop. If the attacker does not stop, this is rape.
  • A person who becomes unconscious during penetration.

Sexual assault and rape can happen to people of any gender, although women are at greater risk than men. Adolescents, young adults and people who are already in a position of lesser power are those at greatest risk. This includes people with disabilities, people with substance misuse problems, homeless people, sex workers and prisoners (including those in detention centres). People who live in institutions are also more at risk, including those in the military. Survivors of childhood or adolescent sexual or physical abuse are more likely to experience rape and sexual assault as adults. People who identify themselves as transgender, gay or bisexual are more likely to experience rape and sexual assault than those who are heterosexual.

Across the world, civil and military conflict is associated with rape. Rape and sexual violence are widely used as weapons of war and are also associated with ethnic cleansing. In a number of countries, prisoners of any gender being detained by security authorities are regularly raped and sexually assaulted.

Consent to sexual contact of any sort is your agreement that sexual contact should begin or continue. To consent to penetration, a person needs to be conscious, awake, capable of judgment, capable of understanding the situation and free from being forced or made to cooperate (coercion).

Consent needs to be three things in order to be valid:

  • Voluntary: you need to be willing and not coerced.
  • Informed: you need to understand what sort of sexual contact you are consenting to. A child cannot consent to sex. Consent to one thing does not mean you have consented to things you were not expecting.
  • Capacity: you must be capable of making a decision. This means being conscious and capable of understanding and processing information about what you are doing.

Consent can be withdrawn at any time.

Tea-sex-consent

This useful illustration of consent to sex explains clearly how the responsibility is on the person who wants to have sexual contact with you to make sure that you consent. Reading this may help you to realise that you did not 'invite' the assault.

It compares initiating sexual contact with someone to offering them a cup of tea.

It begins 'Ask them if they would like tea':

  • If they say yes, then you know they want a cup of tea.
  • If they don't seem sure, then you can make them a cup of tea - or not - but be aware that they may not want to drink it. If they don't want to drink it, don't make them drink it. Just because you made it doesn't mean that you are entitled to watch them drink it.
  • If they say no, then you don't make the tea. Don't make them drink tea. Don't get annoyed at them for not wanting tea. They just don't want tea.
  • They might say yes please, that's good of you - but when the tea arrives they actually don't want it at all. This may be kind of annoying, as you've gone to the trouble to make the tea - but they remain under no obligation to drink the tea. Some people change their minds whilst you're preparing the tea. And that's OK. And you are still not entitled to watch them drink it.
  • If they're unconscious don't make them tea. Unconscious people don't want tea and they can't answer the question, 'Do you want tea?'.
  • If they said yes to the tea but, in the time it took you to prepare it they became unconscious, put the tea aside and make them safe. Don't make them drink the tea.
  • If someone said yes to tea then passed out whilst still drinking it, don't keep pouring it down their throat. Make sure they're safe. Unconscious people don't want tea.
  • If someone said yes to tea at your house last Saturday that doesn't mean they want you to make them tea all the time. They don't want you to turn up, make them tea and force them to drink it on the basis that they wanted it last week. Nor do they want to wake up to find you pouring tea into their mouth because you wanted tea last night.
  • If they say yes to tea, this does not mean you should also expect them to drink coffee, or take several cups of tea at once. Nor does it mean your friends can also join in and give them tea.
  • If you can understand how ludicrous it is to force people to have tea when they don't want tea, and you can understand if people don't want tea, then you understand the requirement for consent for sex.

Your reaction to rape and sexual assault will be affected by your age, life experience, culture and support system. The nature of the rape will affect the way you feel. The level of threat and violence will also affect the way you feel, particularly your sense of personal safety. Your ability to trust your friends may be affected, particularly if the rapist is a friend.

Your response may not be immediate and it may change over time. Reaction may occur within a week, a year, ten years or never.

Physical effects

The immediate physical effects a person can experience after a sexual assault or rape depend on what happened, how forcefully, it was done, what physical resistance they used and whether objects other than the penis were used.

Oral effects: in the case of oral rape, bruising and cuts and splits (lacerations) to the mouth and lips may occur; a sore throat and nausea are common.

Vaginal effects: vaginal rape usually leads to vaginal pain. There may be vaginal bleeding, swelling and bruising. Grazing of the labia and vaginal wall are common after forced or violent intercourse. This makes passing urine very painful and walking very uncomfortable. Cuts and splits to the vagina on the inside can also occur (this is more likely if an object other than the penis was used). If you have heavy bleeding it is important to seek medical help. Vaginal rape is often associated with injury to the upper thighs through legs being forced apart.

In women of menstrual age, the vaginal tissues are strong, stretchy and have a rich blood supply. Healing, even of cuts and splits, is usually very fast. However, in women who are postmenopausal, and in prepubertal children, the vaginal wall is thinner and much more delicate. Injury occurs more easily and may not heal well without medical help.

Anal effects: non-consensual anal penetration is highly traumatic. Even consensual anal penetration is often painful; people who choose it need to adapt and stretch gradually, using care and lubrication. Without this care and lubrication, injury is highly likely, both to the survivor and, in fact, to the attacker. Anal rape is usually very painful and the pain remains for some time. Splits and bruising to the margin of the back passage (anus) are common and can lead to constipation and to pain on opening the bowels. This soreness may last for many days, although a doctor can prescribe something to help healing and relieve pain. Internal injury to the back passage (rectum) can occasionally occur, particularly if objects other than the penis were inserted. If this happens there may be persistent bleeding and intense lower tummy (abdominal) and rectal pain, even when not trying to pass a motion. It is very important to seek medical help, as tears to the bowel wall may need urgent repair.

Bruising and injury: assault may include violence to other parts of the body. In the stress and panic of the event, you may not notice or remember injuries which are very painful later. The body thinks first about survival and recognises its injuries only afterwards. You may be very stiff and aching the next day, when swelling of injured tissues has occurred. Bruising is common, particularly injuries to the wrists, thighs, neck, head and face. Biting is sometimes seen in rape. It usually leaves bruising rather than cuts and is often on the breast. The marks it leaves can sometimes be used to prove the identity of a rapist.

Confusion: the stress of rape can prevent you from remembering things properly and clearly, leaving you confused and with a muddled or incomplete memory. This is more likely to be the case if you had used drugs or alcohol, and much more likely if you were subjected to any blows to the head, particularly if you were knocked out.

Sexually transmitted infections (STIs): one reason why it is so important to seek medical help after rape is that it allows doctors to assess the risk of STI and give you preventative treatment. This includes preventative treatment for HIV (see below).

Pregnancy: you may also need emergency contraception (see below).

Effects of severe stress: severe stress can itself cause physical illness. In the immediate aftermath this may include symptoms of severe anxiety such as:

  • Panic attacks.
  • Tremor.
  • Nervousness.
  • Impaired memory.
  • Loss of appetite with a feeling of sickness (nausea) and being sick (vomiting).
  • Diarrhoea.
  • Chest pains.
  • Over-breathing (hyperventilation).

Psychological effects

After any trauma our first thought as human beings is about finding safety, being safe and dealing with physical injury. After this many other thoughts can crowd in.

Self-blame is common. Most rape survivors blame themselves for 'allowing' the crime to happen - for putting themselves 'in that situation'. This is a normal reaction but one that needs to be dealt with in order to recover. It is discussed further below.

Shock can lead to a feeling of numbness and unreality, as if you are playing a part in a film. You may feel confused, vulnerable and unsafe and you may feel scared that it will happen again. Phobias about your environment are common, such as fear of being alone, or fear of your usual neighbourhood or your own home.

Physical effects

Healing: most bruising and cuts and splits (lacerations) in the vaginal skin heal quickly in women of menstrual age, less so in older women and children. Splits and grazes to the edge of the anus can be more problematic, as they are stretched and irritated when the bowels are opened and may not settle down for some time. Treatment may be needed to ease them.

Periods and urination: rape and sexual assault include more problematic periods and pain on passing urine in women.

Sex: pain on penetrative intercourse is common in both sexes after rape and sexual assault. Vaginal pain, itching and frequent urination may be caused by bruising from the rape but can equally be caused by anxiety. Consensual anal intercourse may be painful or impossible after anal rape, because of spasm of the muscles that protect the back passage. This can be caused both by splits and grazes, and by anxiety and fear of pain. Many people who have been raped are afraid to resume normal sexual activity at all because of fears about pain and because of flashbacks to the rape itself. Many others do not want sex, as they feel no sexual desire. Fear of pain will prevent physical arousal and a vicious circle can be set up where you are dry and it is therefore painful.

Bowels: where anal rape has occurred, constipation and pain on opening the bowels can persist for a very long time. This may lead to chronic constipation as you try to avoid the pain, both consciously and unconsciously. If you seek medical help this can be remedied.

Sexually transmitted diseases: these may include chlamydia, herpes and hepatitis. A sexual health screen as soon as possible after the assault can prevent most cases. HIV can be acquired through rape. This is discussed in detail under 'What are the chances of acquiring HIV through rape and sexual assault?', below.

Generalised symptoms: anxiety and distress can cause many physical and psychological symptoms - stomach aches, headaches, a feeling of sickness (nausea) and depression are common.

Other physical effects survivors often describe include experiencing long-term (chronic) fatigue, shortness of breath, muscle tension, tremor, changes in eating and and changes in sleeping patterns. Problems with menstruation and fertility are also common.

Psychological effects

About half of survivors have recovered from psychological effects at 12 weeks but for many, the symptoms persist for many years. The long-term mental effects of rape and sexual assault include self-harm, eating disorders, substance misuse and suicidal thoughts. These represent the mind trying to relieve stress and to escape the thoughts and feelings it has left behind.

Self-blame and feelings of guilt and shame: these are common and can persist for many years. These are discussed in more detail below.

Dissociation: this is a mechanism the brain can use to cope with trauma. People 'go outside themselves' and become detached from reality. Sometimes they go back and relive the assault. This can be very distressing. If friends witness it they need to gently ground you in the present, speaking softly and encouraging you to concentrate on some small thing in the environment.

Self image: some survivors see their bodies as ruined or dirty. You have had a forced intimate contact with another person. They may have insulted, abused or humiliated you at the same time, compounding the feelings of degradation. You may remember what was said and may even start to believe these comments are true. It can be very hard to describe to others what was said, particularly if you secretly believe it. If this sounds familiar then consider talking to someone about this. Poisonous thoughts about yourself created by rape and sexual violence can be addressed if you can get them out into the open and are able to see them for what they are. If you don't do this you may start to assume that others feel the same way about you.

Relationships: rape and sexual assault can affect how you feel about your friends and family. It can make you avoid people. You may not feel able to do things that you did formerly, particularly if they involve acting independently or alone.

Sleep disorders: these are common after rape and sexual assault. They can include trouble falling asleep or staying asleep, sleeping at unusual times of day, or sleeping for longer or shorter than usual.

Feeling afraid: this is normal. If you were raped or sexually assaulted by a stranger you may be afraid of being alone or in any situation like the one where it happened. If you were raped or sexually assaulted by a person you knew, it may be very damaging to your personal life. It can make you wary of other friends. You may fear that your other friends may choose to believe the rapist rather than you. You may worry that you cannot trust other friends.

Anger: this is a positive feeling. Sometimes it does not come until later, if at all. However, feeling angry at your rapist at last begins to shift the way you see the responsibility for what happened, from you to them.

Mental illnesses: depression and suicidal thoughts are increased in survivors of rape.

Post traumatic stress disorder (PTSD): this is more likely following rape than following any other crime. It manifests itself as nightmares and flashbacks, edginess and fear, being easily startled and, often, losing interest in the future. it typically begins three months or more after the event. PTSD is particularly likely if:

  • You felt there was a threat to your life.
  • Violent force was used.
  • You have been abused or assaulted before.
  • You have previously been abused or assaulted but you were not believed.

Survivors from ethnic minorities are more likely to experience PTSD.

Very long-term effects of rape

Talking about previous sexual abuse may take decades. Some survivors never discuss it.

The way a person feels about rape and sexual assault may change as their perspectives on life change. Feelings such as anger and hurt which you thought you had resolved and learned to live with may return, sometimes suddenly and needing further discussion. For example, your feelings about something experienced when you were an adolescent may suddenly make you angry afresh when you have adolescent children of your own.

Previous sexual abuse which has never been addressed may lead to physical symptoms of pelvic pain, other long-term (chronic) pain syndromes, fibromyalgia and chronic headaches. It may lead to relationship difficulties, problems with fertility and low sex drive (libido). It can lead to problems with self-image and to insecurities around your body and sexuality. Self-harm and suicide are more common, as are anxiety, depression and PTSD.

Survivors of long-term abuse are more likely to be abused again.

Counselling helps recovery. It will help you to explore the issues that trouble you. Many of the long-term effects of rape and sexual assault come from the internalised feelings of self-blame, discussed below. Such self-blame may occur particularly from feelings that what happened to you was deserved, or that what was said to you was true.

Self-blame, shame and guilt are common. They are important, as they get in the way of recovery. Shame stops you seeking help. It makes you withdraw from friends and support. You may become angry and aggressive. If you feel shame then it's important to see this as a negative feeling caused by the attacker. Shame leads to self-blame and is linked to eating disorders, substance misuse, anxiety, depression and other mental disorders.

There are two main types of self-blame:

  • Behavioural self-blame (when you think that you should have done something differently).
  • Character self-blame (when you think that there is some in-built fault with you which meant that you deserved to be assaulted).

Rape and sexual assault are never the fault of the person who is raped or sexually assaulted. Penetration is an active act; the attacker has to keep doing something to continue. Sexual assault involves forcing - and continuing to force - your will on to another person. It is never your fault that someone did this to you. It is never your fault that they did not stop when you asked them to. They, not you, are responsible for their actions. If they were drunk or high, mentally impaired, or incapable of judgement, that might make them less capable of judgement. However, this does not make you more responsible. It would be very difficult to live a normal life if you had to assume that all those around you were drunk, high, mentally impaired or incapable of judgement.

Read the section, above, called 'Tea-sex-consent' if you think this is incorrect. Focusing on this may help you overcome the negative feelings survivors experience. In most cases, both time and therapy are needed to allow you to feel normal again.

It is possible to become pregnant if you are a woman of fertile age and the rapist ejaculated inside or near your vagina. In around 5% of cases, rape results in pregnancy. Emergency contraception, if taken in time (usually within five days of the episode) will prevent most pregnancies.

Pregnancy is more likely if you are menstruating regularly and are in the first half of your menstrual cycle. However, cases have been described of pregnancy occurring at the 'wrong' time of the cycle following rape. Emergency contraception may be purchased over the counter at many pharmacies. It is also available from A&E, walk-in centres, SARCs, the police and your own GP.

This depends on the type of assault you experienced and on whether or not the attacker had an active STI. Transfer of most infections is more likely if penetration is traumatic and causes injury to tissues.

Both oral and genital infections, including HIV, can be acquired through rape and sexual assault - most often through penetrative acts. They include:

  • Genital herpes
  • Chlamydia
  • Gonorrhoea
  • Syphilis
  • Trichomonas
  • Hepatitis B
  • HIV

Screening for these conditions can be offered by a SARC, by a regular genitourinary medicine (GUM) clinic, or by your GP. Preventative treatment to stop you from developing these diseases is available in many cases. See separate leaflet called Sexually Transmitted Infections for more details.

HIV can be acquired by rape. In most cases the risk is very low.

If the attacker is not HIV-positive then you will not acquire HIV. HIV remains an uncommon condition in the UK. However, in some countries, particularly in the developing world, it is very common, so that an attacker is more likely to be HIV-positive.

If the attacker is HIV-positive then your chances of being infected depend on their health as well as on what happened to you. (People on treatment for HIV are much less infectious than those on no treatment.)

HIV infection is a rare condition in the UK and the attacker is not likely, statistically, to be HIV-positive. The chance of acquiring HIV through vaginal penetration is therefore very low - about 1 in 250,000. The chance is greater if your attacker originates from a country or community in which the HIV rates are high, such as Southern Africa.

The chance of acquiring HIV from an HIV-positive man after one act of vaginal penetration is around 1 in 1,000. From anal rape by an HIV-positive man, it is about 1 in 100. The risk from oral sex with an HIV-positive man is extremely low.

The chance of acquiring HIV through sexual contact which does not involve penetration by the penis is extremely low.

Concern about HIV is a strong reason to seek medical help early. This is particularly important if you have experienced anal rape, as the risk is higher. Casualty departments are able to issue preventative medicines to stop you from getting HIV if your risk is high. You need to begin these tablets (called PEPSE) within 72 hours of the attack, in order for them to be effective. PEPSE is antiviral therapy and it is taken for four weeks. It is normally given if your risk of HIV is higher than 1 in 1,000.

Everyone is different. Recovery from the shock and trauma of rape and sexual assault can take anything from a few weeks to many years. Some of this depends on factors about you - your age, your life experience, your cultural beliefs. Much will depend on the support that you receive.

There are three broad 'phases' of adjusting that survivors describe:

1. Shock: you may experience acute anxiety, fear and guilt. You can't believe what happened. It feels unreal and you think perhaps it was a terrible dream. You blame yourself.

2. Denial: you may feel you need to 'forget the whole thing'. You will try to get back to normal. You may not want to talk or think about it, although you may sleep poorly and feel low. The future looks uninteresting and you don't enjoy anything.

3. Integration: disturbed sleep with recurring nightmares is common. Flashbacks to what happened can be frequent and may be triggered by everyday sights and sounds. Feelings of fear and edginess are common, as is a tendency to be sharp and snappy with others. You may feel that you need counselling. These symptoms have been called rape trauma syndrome in the past, although in fact this is now felt to be a type of post-traumatic stress disorder (PTSD).

Everyone is different; however, there are some things which have been found to be helpful.

Understanding your own feelings: one of the most important steps is for you to acknowledge your feelings of hurt and your anger toward the attacker. Some people make excuses for the attacker, saying they are sick, or drugged. However, doing this reduces your ability to feel anger.

If you recognise that you feel some guilt about the attack then you can start to think about why you feel this. Many of these feelings come from the myths about rape which you may have already accepted, such as the idea that if you dress in a certain way or visit a certain place you might have 'invited' rape. Once you can address this you will doubt yourself less.

Taking back control: taking steps to feel more in control can be helpful. Seeking medical treatment can ease fears about health. Self-defence courses may make you feel more physically secure. Carrying a rape alarm and putting better locks on your door may help you feel secure. Pressing charges against the attacker can move you towards accountability and justice.

Counselling: this is generally extremely helpful to guide you through this process of recovery. Support may help you talk through your feelings with others who have similar experiences. Seeing a specialist rape counsellor can be hugely valuable. Most regions in the UK offer specialist rape support services through sexual health clinics. Translators are available, particularly in metropolitan areas, although if you speak a rare language then letting them know in advance may help them find someone.

Why me? Could I have avoided this? These are very natural questions to ask if something terrible has happened to you. We ask it as a part of trying to learn how to make ourselves safer. We want to go back in time and do things differently. It is important to remember, however, that rape and sexual assault happen because of the choices made by the attacker. The only choices you yourself make that could have put you 'in harm's way' are the small ones we all make all the time - which way to walk, what to say, who to accept as a friend or partner. We would not choose to put ourselves in harm's way but nowhere in life is absolutely risk-free. We do our best to negotiate the risks of life as sensibly as we can. You did not choose to be assaulted.

The causes of rape are poorly understood. Rape is an act of violence and power which often bears little relationship to 'normal' sexual behaviour. Reasons for rape include power and domination, and cruelty and intimidation. Drugs and alcohol may contribute to this by removing normal inhibitions and giving a sense of power. Sexual arousal is needed by a man in order to rape, but is often not the driving factor. The widespread availability of pornography featuring bondage and coerced or sadistic sex may be a contributing factor in some cases. Some rapists have themselves been sexually abused in the past, although the vast majority of people who are sexually abused do not become rapists.

Some men who commit sexual offenses claim that they misunderstood that the other person had not consented, often because they or the other party were drunk. This isn't good enough as a response. The responsibility is on the person who penetrates or sexually uses another, on the person who is actively having sex, to be sure that the other person is agreeing to this. A part of this includes being certain that the other party is capable of deciding to have sex. These are not difficult assessments to make, if those who want to initiate sexual contact remember that without a clear yes, it's a no. See, again, the 'Tea-sex-consent' example, above.

Rape and sexual assault involve a choice or choices made by the attacker and you cannot always prevent this. There are some steps you can take to reduce your chance of experiencing rape and sexual assault.

If you did not do these things, that does not make the assault your fault.

Most prevention suggestions look at personal safety - for example:

  • Advice that you should try to avoid finding yourself alone with a stranger in a space isolated by walls, by a car or by absence of other people. This includes avoiding unlicensed minicabs hailed 'on the street' (only licensed taxi drivers can legally stop when hailed). It also includes staying with friends when out late, particularly if you have been drinking, and agreeing to look after one another. It includes more obvious things like not picking up hitchhikers and not leaving doors unlocked.
  • Advice about remaining aware of your environment and the people around you, and being aware of your own sense of unease. If someone or something is making you uneasy that's an important signal and you may have a chance to act on it before a more dangerous situation develops. Acting to change things may include running, seeking the help of others, or calling 999/112/911. If you use your mobile phone the emergency services can usually locate you even if you're not speaking.
  • Advice about alarms, locks and personal safety equipment, about care avoiding 'spiked' drinks in bars, and about meeting new dates in public places.
  • Advice about being prepared to leave a situation before it develops.
  • Advice about getting help - knocking on doors, stopping strangers, driving your car to a public place. 'Ask for Angela' is a recent social media innovation which is spreading rapidly. It encourages people who are uncomfortable or uneasy with a date to escape without fuss. You discreetly ask for help by going to the bar where you say you want to 'Ask for Angela' - a phrase aimed at alerting staff so that they can help you - perhaps by discreetly calling you a taxi and letting you know when it arrives.
  • Advice about seeking help if you experience domestic violence or the threat of domestic violence.

Most people who experience sexual assault will have a profound emotional reaction. This may last for weeks, months or years.

Physical after effects are usual, and medical help with improve their recovery. Prevention of pregnancy and of any STI is very important. It is particularly important that the risk of HIV be assessed early, so that preventative treatment (which has to start within 72 hours) can be taken.

Specialised counselling is always desirable but it needs to be your choice. It will help you recover and come to terms with what has happened.

Further reading and references

  • Ullman SE, Filipas HH; Predictors of PTSD symptom severity and social reactions in sexual assault victims. J Trauma Stress. 2001 Apr14(2):369-89.

So for the past 3 days I felt careless not like sad and I don't care about anyone but like nothing bothers me . for example everything that disgusts me or makes me scared or is a bad thing like a...

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