Allegations of sexual abuse in an intensive care unit

Objectives: To describe misperceptions of sexual abuse by critically ill, s edated patients undergoing routine perineal care in an intensive care unit and to offer suggestions for addressing patient allegations of sexual mistr eatment in this setting. Design: Case reports and discussion. Setting: intermediate care unit extension of a medical intensive care unit at a university teaching hospital. Patients: A 57-yr-old man who misperceiv ed rectal intubation as sexual assault while receiving intravenous lorazepa m for sedation; a 31-yr-old woman who misinterpreted a perineal bed bath as sexual abuse while receiving lorazepam and fentanyl, Interventions: None, Conclusions: Under the influence of commonly used psychotropic drugs, some acutely ill, hospitalized patients misperceive routine perineal care as sex ual abuse. Because the care that gives rise to mistaken allegations of sexu al misconduct is often given in private, and because sexual abuse of patien ts sometimes actually occurs in hospitals, institutional investigation of t hese complaints is both sensitive and difficult, Some inpatient allegations of sexual abuse may not be resolvable by any means. Awareness of the poten tial for misinterpretation of perineal care may help prevent this disturbin g phenomenon and promote fair, reasoned investigation when patient complain ts of sexual abuse do arise in acute care hosptials.