Sex & Violencethe Health Implications

Dr Olwen WilliamsConsultant Sexual Health

Clinical Director Amethyst SARC North WalesMember EHRC Wales

WHO Definition Sexual Violence

• any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work

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• Rape by strangers; rape within marriage or dating relationships • systematic “war rape" during armed conflict; • unwanted sexual advances or sexual harassment, including

demanding sex in return for favours;

• sexual abuse of mentally or physically disabled people; • sexual abuse of children; • Forced marriage or cohabitation, including the marriage of children

• denial of the right to use contraception or to adopt other measures to protect against sexually transmitted diseases;

• Forced abortion• violent acts against sexual integrity, including genital mutilation and

obligatory inspections for virginity; • forced prostitution & trafficking of people for the purpose of sexual

exploitation

Interlinked domestic abuse /sexual violence

1:4 Worldwide lifetime risk of sexual assault 1:20 of UK women have experienced rape (estimated)

• 45% Sexual Assault committed by current partner• 74% Sexual Assault occurs in the persons own home• Attacks by partners double risk of physical injury British Crime Survey 2000

• North Wales Police report increase of 3.8% in Sexual Assault in 2011

Potential Health Consequences Medical

Injuries sustained during the assault

Sexually transmitted infections

HIV & other Blood Born Viruses

Pregnancy and gynaecological complications

Psychosocial Higher prevalence of mental health issues

Socially ostracised

Impact on family, partner and friends

Effects on children of witnessing sexual violence

Risk Assessment at disclosure

• Establish recent or historic sexual assault• Assess need for medical intervention• Assess individuals physical safety

• Are there any Child protection issues?

• Explain options available

• Respect individuals wishes

• Be supportive…………………………

Amethyst SARC

A one-stop facility to provide a

comprehensive and coordinated response to

all victims of rape and sexual assault

regardless of whether or not a report is

made to the police

Police Referral

Refer individual to Police where assault took place

In North Wales, specialist police teams for dealing with sexual offence allegations based at SARC/Amethyst Centre

The police refer to the local sexual assault referral centre (SARC) for forensic medical examination (FME) Evidence managed by the police Follow-up at the SARC

Non-police referral to a SARC

Patient, Sexual Health, A+E , Maternity Services contact the SARC

- to refer

- for advice

SARC discusses options with client

- Appointment made for FME or F/U only depending on patient consent and timing

- Not a walk-in service, by appointment only

10 Key Elements of a SARC

24 hour access

Crisis Workers

Gender Choice of FME

AppropriatelyTrained

FME

Dedicated Forensically Approved Premises

Risk Assessment

PEPSEEmergency Contraception

Referral for FU

ISVACo-ordinated Interagency

arrangements

Core TeamNHS Standards of

Clinical Governance

DataCollection

Contact Details

Sarah.Staveley@nthwales.pnn.police.uk Tel: 01492 805072Mobile: 07799342695Amethyst Centre1 Bryn Eirias CloseColwyn BayLL29 8AB

olwen.williams@

wales.nhs.uk

01978725924

07799342725