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Revictimization refers to repeated sexual assualts by the same perpetrator.
Almost half of rape victims are under the age of 18.
Girls 16-19 are twice as likely as the general population to be victims of rape, attempted rape, or other forms of sexual assualt.
Almost half of juvenile sexual assault victims know their attacker.
Families and pts cope better when they are given limited information about the rape kit process.
Doctors are legally mandated to perform a full "rape kit" on all pediatric patients who present to the ED for alleged CMS-S.
Sexual assault kits must be collected within 24 hours of the alleged assault to be admissible in court.
Mandatory pregnancy tests are given starting at age 13.
Almost half of pediatric pts admitted for sexual assault show signs of an STD.
Sexual assault is a comprehensive term that includes any forced or inappropriate sexual activity.
Typical CMS-S Protocols
- Get report from SW before you do anything!
- Meet with the Attending, Resident and SW prior to teaching/preparation.
- Meet with the pt to build rapport and do teaching
- Find out what they call all their body parts prior to giving them a label like "vagina"
- Attend procedures with pt if desired to provide distraction and support
- Possibly remain with pt if suspected perpetrator is at the hospital.
Medical Staff Meeting: At the Meeting with other Medical Staff you will Discuss:
- Which cultures will be done (if any at all)
- -includes: penile, vaginal, rectal, and/or anal.
- Where the exam will happen (in room in the pelvic room)
- If the doctor will be using a sepculum (age 12 and up)
- If the doctor will be using a colposcope or any other external photos by SW
- Possible positions the child will be asked to move inot
Medical Teaching and Preparation
- Initially meet with the patient to introduce self and offer to provie some activities while you collect your materials.
- Return with needed items
- Explain procedure in developmentally appropriate terms
- Explan the importance of softening inner-thigh muscles during exam
- Ask the pt who they would like in the room and offer to provide distraction/support during that time
- Then alert doctor that you have finished teaching
CMS-R (Rape Kit)
- The nurse MUST remain in the room with the kit until it is sealed
- -Pubic hair combing
- -Sailva test (swabs)
- -Vaginal or penile swabs
- -Rectal swabs
- -May collect underwear or other clothing
- -Blood draws are necessary
- Alert parents to its location so thy do not bump into the cultures or cross contaminate evidence
- Keep constant distraction with the pt. to avoid additional anxiety during waiting times
Finding Some Ways to Offer Respect
- Refer to the patient by name and show an interest in them
- Advocate for less invasive procedures first (such as oral swabs)
- Advocate for the patient to get dressed prior to the blood draw.
- Turn away or hold up a sheet to shield the pt during clothing changes.
- Advocate taking time to allow the patient to comply with medical procedures rather than having other medical staff hold them down for procedures
- Be empathetic and do no assume you know everything
- Validate concersn for pt and family
- Anticipate questions they may have and try to find answers from the appropriate professionals
- Interpret questions the doctor asks and the patient is confused about
- Don't focus on the trauma and instead offer some opporutnities to escape the situation (humor or playing games)
Things to Remember
- If the child lives with the alleged perp, they may go into foster care
- -Don't tell them that they will be going home soon.
- Parents may feel uncomfortable and want to retell their side of the story to seek validation fo their feelings of guilt, etc.
- -Try to redirect the conversation in the presence of the children as it can be very traumatic.
- Guardinans may not make choices that align with your personal values.
- -Remember your role as a professional and try to remain within your ehtical limits in challenging situations.
Revictimization and Discrimination Against Victims of Sexual Crimes
- Sometimes medical staff have a bias that the pt "deserved it" because of dress, behavior, etc.
- Beliefs may be that they are seeking attention and did not "really get raped"
- Some believe that rape kits should not always be collected because the parents "won't really do anything about it anyways"
- Callous attitudes towards victims and their families
- Laying blame on the victim for compliance issues
- --Potential fears and misconceptions that are not disclosed: "I didn't want to have it (referring to the exam) because last time there was video."
Following the Exam; Doctor Returns to the Room to Discuss:
- Postexposure Prophylaxis Medications
- Plan B or other "emergency contraceptive choices"
- Prescriptions for antibiotics
- Follow up recommendations
- Possible follow up at a children's safety center around the state (or consult with expert)
- Answers any additional questions.
- Research reports that increased parental and child distress being significantly associate with the child being 12 years and older
- Parents report less stress being related to staff attitudes and doctoer explanations.
- Most parents and children report miconceptions about the exam being more invasive, painful, and scary.
Sexuality in Infancy and Childhood
- Ultrasound images indicate that sexuality beings in the womb
- During infancy the foundations for sensuality, intimacy, and relationship to others is established.
Early Infancy: Ages 0-1
- "Failure to Thrive" Syndrome
- Explore their bodies
- Begin socialization
Early Childhood: Ages 2-6
- Develops an awareness of being a boy or girl
- Curious about their own bodies and the bodies of others
- May include sex play
Reaction to Child
- Avoid a negative reaction
- Socialize to privacy
- Help the child to become comfortable with their own sexuality
- Begin positive communication early
- Respect the child's needs regarding privacy
Initial School Age Years: 7-11
- Generally have learned societal norms
- Spurt of knowledge and understanding occur around age 11
- Questioning continues often with misconceptions
- Around the ages of 11-12, there is a distinct increase of levels of interest toward the other gender.
Puberty: Ages 7-15
- Begins earlier and last longer than previously believed
- Precocious puberty
- Delayed puberty
Puberty: Two Part Process
Adrenal glands start to mature and secrete the androgen hormone DHEA, which is then converted to testosterone and estrogen.
The testicles and ovaries mature, usually several years afer adrenarch. The pituitary gland begins to secrete FSH in high doses.
Puberty: Changes in Girls
- Underarm and pubic hair
- Glands develop-body odor and acne
- Breast development
- Growth spurt
- Feminization of body-fatty deposits in hips
- Sex desire
Puberty: Changes in Boys
- Development of sex organs (testes, scotum, penis, prostate, and seminal vesicles)
- Muscle and tissue
- Masculine body features
- Growth of body hair
- Deepening of vocie
- Sex desire
Adolescence: Ages 13-18
- Focus on changing body; social stresses
- Abstract thinking skills
- Body image
- Strengthen gender identity and clarify sexual orientation
- Experience confusion, fear, and misunderstandings.
- Varying research to support frequency of teenage intercourse
- Initiation of sexual intercourse
- Society messages
Adolescence: Social Development
- Learn ground rules of relating to other people
- Teenage romances and relationships
- -Dyadic withdrawal
- -Privacy available
- -Opening up to another; becoming more vulnerable
Adolescent Same Gender Sexual Activity
- Explore same-gender relationships
- Some clearly identify themselves as having same-gender orientation
- Decide if they are homosexual or heterosexual by age 17
Adolescent Heterosexual Activity
- Frequently believe that their friends are more knowledgeable and experienced.
- May have guilt feelings about new sexual feelings and desires.
- Eventually try experimentation
- Stages of intimacy
- Oral sex
- Peer pressure
- Relationships with family and peers
Stages of Intimacy
- Touching above clothes
- Touching under clothes
- Much higher in the U.S. than other developed countries
- Over 1 million teen pregnancies in U.S. annually; 80-90% unplanned; 1/3 end in abortion
- Increased risk for some
- Economic hardship
- Some encouraging signs- a decrease probably due to more effective use of birth control.
Adolescent Sexual Health
- Must educate from birht
- Focus on how to maintain long-term relationships
- Better training for professionals
- Identify at-risk youth and offer sex education, support services, counseling intervention
Sexually Healthy Adolescent
- Appreciates own body
- Takes responsbility for own behaviors
- Knowledgeable about sexuality issues
- Communicates with family
- Seeks information about family values/contributes to self values
- Respectful to both genders
- Expresses love in appropriate ways
- Evaluates readiness for mature sexual relationships
Adult Sexuality and Relationships
- Our culture attempts to prolong the youthful period of the lifespan.
- In loco parentis role faded in the 70s-80s college years often a transitional phase
- 89% of men and 70% of women in college engage in sexual intercourse
- Over 60% of college freshmen are sexually active
Adult Sexuality: Intimacy
- One of the major taskes is to achieve intimacy with others
- Sexual satisfaction
- Casual sex
- Serial monogamy
Sexuality and Aging
- Trend is to stay single longer
- Unmarried women
- Sharing of sex is usually viewed as something for youth
- Older people retain sexual desire.
Myths about Sexuality and Aging
- Loving and sexual feelings are experienced only during youth
- Sex is primarily for reproduction
- Older men retain sexually interesting to younger partners than do older women.
Special Problems and Patterns of Aging
- Sexual dysfunctions due to physiological changes and illness.
- -Surgeries effect sexual behaviors
- -Hormonal and physiological changes of older age
Life Factors that Influnce Sexual Potentials in Old Age
- The individuals or couples sexual history
- Partner availability
- Sexual values and attitudes
- Knowledge about sexuality
- Maintenance of self-esteem and sense of identity
Maximizing Sexual Expression During Later Years
- Elderly people can be freed from many concerns:
- -Pregnancy risk
- -Need to "prove" oneself
- -Obessions with performance
- -Balancing work and personal time
- -Interruptions of children
1 Corinthians 13:4-7
Love is patient and kind; love is not jealous or boastful; it is not arrogant or rude. Love does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrong, but rejoices in right. Love bears all things, believes all things, hopes all things, endures all things.
3 Components of Love (Rubin, 1970)
Types of Love in Intimate Relationships
- Passionate Love
- Companionate Love
- Intense psychological feelings
- Generalized physiological arousal, strong sexual desire
- Avoid conflict
- Tolerate shortcomings
- More enduring
Sternberg's Triangular Theory of Love
Lee's Styles of Loving
The Chemistry of Love (Walsh and Liebowitz)
- Passionate love is a result of surging levels of 3 key brain chemicals:
- Produce amphetamine-like effects: euphoria, giddiness, and elation
- Also contribute to sexual arousal
- Does not last because the body develops a tolerance
- In long-lasting relationships, the body gradually steps up production of endorphins which cause us to feel good when we are with a loved partner.
Who do we fall in love with and why?
- Proximity-people we see frequently
- Similarity-similar in beliefs, interests, and values
- Reciprocity- when people like us, we like them back
- Physical attractiveness
- -"whats beautiful is good" belief
- -status by association
- -most important in early stages
- -may be an indicator of physical health
Jealousy in Relationships: Jealousy Prone Person
- Low self-esteem
- High value on wealth and popularity
Maintaining Relationship Satisfaction: Ingredients in Lasting love relationship
- Good Communication, realistic expectations and shared interests
- Ability to face and deal with conflict
Maintaining Relationship Satisfaction: Characteristics of High Quality Relationships
- Supportive Communication
- Sexual expression
- Seeing partner as best friend
- Maintaining frequent positive interaction
Maintaining Relationship Satisfaction: Other Characteristics
- Parents had sucessful marriages
- Have similar interests, attitudes, personalities
- Satisfied with sexual relationship
- Adequate, steady home
- Not pregnant when married
Maintaining Relationship Satisfaction: Sexual Relationship
- Planning for intimacy
- Focus on what is normal for your relationship
Frequency of Sexual Activity
- National average is once a week
- Higher frequency correlations
- Quality is probably a better indicator of sexual fulfillment than frequency.
5.5 million; a 72% increase in the last 10 years.
- A "trial marriage"
- Convenience and companionship
What does love have to do with it?
- A change in cultural definition of love
- Complete love
Love and Cohabitation
- In cohabitation intimacy and passion rather than commitment are the strongest elements
Cohabitation and Better Marital Adjustment
- Does not create a better marriage
- More disagreements
- Rank thair marriage lower
- Usually unhappy
Think Twice About Cohabiting-4 Principles by Popenoe and Whitehead
- Increased chance of divorce
- Strong predictor of failure of future relationships
- Limit cohabitation to the shortest period of time
- Don't cohabit when children are involved.
What is the biggest problem with cohabitation?
When are 2 people married before God?
- Two basic conditions according to Olthius (1975) study of scripture:
- -That the relationship be based upon a mutually shared convenantal commitment
- -Consummated through sexual intercourse
- -Does the couple need consent from parents or family?
- -Does a couple need to make their commitment before a community of believers?
- -Is consent of civil authorities needed?
Family, Community, and Civil Structures Support Marriage
- Strength of commitment multiplied when made before a witness of believers.
- Government structures protect spouses and children's financial and property rights.
- The church can provide support for marriage as an institution.
How should the church respond to cohabitation?
- Uphold biblical standard
- Lovingly help couples understand how the biblical concept can bring depth and stability to the relationship
- Offer compassionate and a church home
- Offer public ceremony within community of faith
- Continue to show love and grace
- Gender dsyphoria
- Homosexual transsexuals
- Sex reassignment surgery
Gender Roles and Stereotypes
- -one of the effects of stereotyping is sexism
- Gender Roles
- -Leads us to interpret same bahavior in prejudicial ways-also "man's work and woman's work"
- Psychological unhealthful effects
- Focus on the roles of genetics and prenatal influences including the role of hormones in predisposing gender-linked patterns
- Evolutionary Perspective
- Prenatal Brain Organization
- Children acquire gender role stereotypes by the ages of 2.5 to 3.5
- How do children adopt such stereotypical behavior patterns?
- Psychodynamic Theory
- Social Learning Theory
- Cognitive-Development Theory
- Gender Schema Theory
A person's desire for the physical presence and emotional support of the other person.
An individual's concern for the other's well-being.
The desire for close, confidential communication with the other.
The motivational component that fuels romantic feelings, physical attraction, and desire for sexual interaction
The emotional componenet of love that encompasses the sense of being bonded with another person; sharing private thoughts and feelings.
Is the thinking or cognitive aspect that refers to the conscious decision to love another and maintain a relationship over time despite difficulties
Emphasis on physical beauty as they search for the ideal mate.
Playing the field; like the act of seduction; little/no commitment
Roller coaster of affection and jealousy
Slow to develop, but endures; usually begins with a friendship
Selfless, caring, compasionate desire to give without expectation of reciprocity.
seek partners with social, educational, religious, and interest patterns compatible with their own.
Jealousy in Relationships: Negative Consequences
- Precipitates partner violence
- Stifles relationship development
- Raises anxiety, depression, anger
Jealousy in relationships is related to?
injured pride or fear of losing what one wants to control, rather than love
Not engaging in sexual behavior; can be two degress: complete or partial
- Self-restraint or self-denial, not engaging in sexual activity.
- -commonly due to religious beliefs
- -celibacy may be a life-long decision
- -concerns about pregnancy and STD's
- -More priority given to developing the relationship
Sexual Behaviors: Fantasy