Medical care use among women before and after sexual assualt: a population survey

We set out to compare medical care utilisation patterns between women who were sexually assaulted and women who were not sexually assaulted in the year before and the year after the assault. Cases studied were 690 females aged 15 and over who had undergone a forensic evidence examination for sexual assault between April 1996 and March 1997 and the same number of female age-matched controls. This was a population-based, matched case-control study using administrative databases of medical encounters (only physician services). Outcomes included physician visits by physician speciality; clinic and hospital diagnoses and hospital discharges. Of the cases, 38·4% were aged 15-19; 21·4% aged 20-24; and 40·2% aged 25 or older. Before and after the sexual assault, cases were more frequent users of medical services than controls. Cases were seen more often, received more medical services and were more likely to be hospitalised than controls in both time periods. Cases were also more likely to be diagnosed with a vast range of physical and psychological problems during the period of study. The persistence of mental and physical health problems before and after a forensic examination for sexual assault presents a challenge. Of paramount concern are issues concerning informed consent to undergo the examination. Collection and documentation of evidence may be important for victims with severe mental illness who may have more difficulty testifying in court. Our study suggests the need for future research examining the reasons why women do not undergo the examination both in terms of whether it is offered and declined or not offered to them.