Monday, August 1, 2016

Guest Post: preventing sexual assualt

- Yalda Jabbarpour, MD

“You don’t know me, but you’ve been inside me, and that’s why we’re here today.” So began the statement of Brock Turner’s victim at his sentencing this spring. Turner, a former Stanford University student, was found guilty of three counts of sexual assault, but his 6 month sentence sparked outrage. Although this case brought renewed interest to the problem of sexual assault, the sad truth is that it is not unique. A recent poll conducted by the Washington Post and Kaiser Family Foundation found that 20 percent of young women reported being sexually assaulted on their college campuses in the past four years. 1 in 5 women. As a mother and family physician who cares for adolescents, these statistics are frightening, especially considering the life-long physical and psychological consequences for the victims.

According to a 2010 article in AFP, sexual assault is associated with sexually transmitted infections (STIs), posttraumatic stress disorder, anxiety, depression, chronic pain syndromes, drug and alcohol abuse, irritable bowel syndrome, headaches, fibromyalgia and sexual dysfunction. Sexual assault is a true public health crisis. What can family physicians do to curb this epidemic?

Much of the literature on the physician’s role in sexual assaults deals with the aftermath: collection of the rape kit, post-exposure STI prophylaxis, identifying and treating long term physical and psychological sequelae. But I would argue that, as is the case in much of what we do, prevention is the key. I propose we start by defining the problem for our patients. In the Post/Kaiser poll, 46 percent of college-aged respondents said it’s unclear whether sexual activity that occurs when both people have not given clear agreement constitutes sexual assault. This means that we need to have open and honest conversations with adolescents and young adults about the need for both parties to give consent before having sex. Establishing rapport is key to broaching sensitive topics with adolescents, and to do this, it is important to ask adolescents specific questions about their practices rather than stating general facts.

Once we have defined the problem, we need to counsel patients on the risk factors associated with it and how to mitigate those. Race, ethnicity, social class, study habits or religious practices were not related to sexual assault in the Kaiser poll. However, women who said they sometimes or often drink more than they should are twice as likely to be victims of completed, attempted or suspected sexual assault compared with those who rarely or never do. Therefore, counseling men and women on responsible drinking strategies—such as using a buddy system, pouring their own drinks, and knowing their limits—is key.

Certainly, physicians alone cannot solve the issue of sexual assault, but we should consider addressing it in every preventive health discussion we have with college-aged students. When sharing her solidarity with other victims of sexual assault, the Stanford victim appropriately quoted Anne Lamott: “Lighthouses don’t go running all over an island looking for boats to save; they just stand there shining.” It may not be within our power, or our job description, to stamp out sexual assault, but physicians can serve as lighthouses, helping to illuminate for our patients a safe path through their college careers.

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Dr. Jabbarpour is the Robert L. Phillips, Jr. Health Policy Fellow at Georgetown University School of Medicine.

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