Emergency department characteristics of male sexual assault

Objective: To characterize the nature, frequency, and treatment of male sex ual assault encountered by physicians in an ED. A minor objective compared the lengths of time the victim knew the assailant between males and females to determine whether there were differences between male and female victim s. Methods: Retrospective review over four years of all male patients with a diagnosis of sexual assault presenting to an urban academic ED in New Yor k City. Demographics, types of injury, assailant/victim information, and tr eatment of the assault were obtained. Results: Twenty-seven male sexual ass aults (approximately 12% of all sexual assaults) were documented during thi s time period. Forcible rectal, oral, or both rectal and oral intercourse o ccurred 14, 4, and 9 times, respectively. Documented physical trauma occurr ed in nine of 27 visits, with two admissions for head trauma. Five addition al patients complained of rectal pain with no independent objective evidenc e of trauma. Prophylactic treatment with antibiotics for the prevention of Neisseria gonorrhoeae and Chlamydia trachomatis was offered in 26 of 27 epi sodes and prophylactic HIV protection was given to only two of 21 eligible patients. Documentation of HIV status and HIV counseling occurred only in t en and five visits, respectively. The male-to-female odds ratios for whethe r the assailant was unknown, known less than 24 hours, or known more than 2 4 hours were 0.43 (95% CI = 0.15 to 1.26), 2.48 (95% CI = 0.94 to 6.53), an d 0.92 (95% CI = 0.31 to 2.71), respectively. Conclusions: The percentage o f total sexual assaults occurring in males who present to an ED is now more than 10% of all sexual assaults seen in this urban ED. These assaults are associated with a high proportion of patients with documented trauma. Altho ugh the treatment of traditional sexually transmitted diseases appears to b e covered well, the need for HIV documentation, counseling, and possible HN prophylaxis should be addressed more aggressively. In comparing the length s of the relationships between the victim and the assailant, it appears twi ce as likely that the female victim will not know her assailant compared wi th the male, and twice as likely that the male victim will know his assaila nt less than 24 hours compared with the female.