Effects and aftermath of rape

Effects and aftermath of rape can include both physical trauma and psychological trauma. However, physical force is not necessarily used in rape, and physical injuries are not always a consequence. Deaths associated with rape are known to occur, though the prevalence of fatalities varies considerably across the world. For rape victims the more common consequences of sexual violence are those related to reproductive health, mental health, and social wellbeing.

Gynecological
Common physical injuries received by rape victims include:


 * vaginal bleeding or infection
 * fibroids
 * decreased sexual desire
 * genital irritation
 * pain during intercourse
 * chronic pelvic pain
 * urinary tract infections

Pregnancy
Pregnancy may result from rape. The rate varies between settings and depends particularly on the extent to which non-barrier contraceptives are being used. A study of adolescents in Ethiopia found that among those who reported being raped, 17% became pregnant after the rape, a figure which is similar to the 15–18% reported by rape crisis centres in Mexico.

A longitudinal study in the United States of over 4000 women followed for 3 years found that the national rape related pregnancy rate was 5.0% per rape among victims aged 12–45 years, producing over 32 000 pregnancies nationally among women from rape each year.

Experience of coerced sex at an early age reduces a woman’s ability to see her sexuality as something over which she has control. As a result, it is less likely that an adolescent girl who has been forced into sex will use condoms or other forms of contraception, increasing the likelihood of her becoming pregnant.

A study of factors associated with teenage pregnancy in Cape Town, South Africa, found that forced sexual initiation was the third most strongly related factor, after frequency of intercourse and use of modern contraceptives. Forced sex can also result in unintended pregnancy among adult women. In India, a study of married men revealed that men who admitted forcing sex on their wives were 2.6 times more likely to have caused an unintended pregnancy than those who did not admit to such behavior. Should pregnancy result from a first-time encounter it would carry a higher risk of pre-eclampsia, the condition in which the mother's body reacts adversely to the proteins of the fetus.

Sexually Transmitted Diseases
Violent or forced sex can increase the risk of transmitting HIV. In forced vaginal penetration, abrasions and cuts commonly occur, thus facilitating the entry of the virus through the vaginal mucosa. Adolescent girls are particularly susceptible to HIV infection through forced sex, and even through unforced sex, because their vaginal mucous membranes have not yet acquired cellular density sufficient to provide an effective barrier that develops in the later teenage years.

Being a victim of sexual violence and being susceptible to HIV share a number of risk behaviors. Forced sex in childhood or adolescence, for instance, increases the likelihood of engaging in unprotected sex, having multiple partners, participating in sex work, and substance abuse. People who experience forced sex in intimate relationships often find it difficult to negotiate condom use either because using a condom could be interpreted as mistrust of their partners or as an admission of promiscuity, or else because they fear experiencing violence from their partners. Sexual coercion among adolescents and adults is also associated with low self-esteem and depression factors that are associated with many of the risk behaviors for HIV infection.

Research on women in shelters has shown that women who experience both sexual and physical abuse from intimate partners are significantly more likely to have had sexually transmitted diseases.

Self blame
Self-blame is among the most common of both short- and long-term effects and functions as an avoidance coping skill that inhibits the healing process and can often be remedied by a cognitive therapy technique known as cognitive restructuring.

There are two main types of self blame: behavioral self blame (undeserved blame based on actions) and characterological self blame (undeserved blame based on character). Victims who experience behavioral self blame feel that they should have done something differently, and therefore feel at fault. Victims who experience characterological self blame feel there is something inherently wrong with them which has caused them to deserve to be assaulted.

A leading researcher on the psychological causes and effects of shame, June Tangney, lists five ways shame can be destructive: Tangney says shame has a special link to anger. "In day-to-day life, when people are shamed and angry they tend to be motivated to get back at a person and get revenge."
 * lack of motivation to seek care;
 * lack of empathy;
 * cutting themselves off from other people;
 * anger;
 * aggression.

In addition, shame is connected to psychological problems - such as eating disorders, substance abuse, anxiety, depression, and other mental disorders as well as problematic moral behavior. In one study over several years shame-prone kids were prone to substance abuse, earlier sexual activity, less safe sexual activity, and involvement with the criminal justice system.

Behavioral self blame is associated with feelings of guilt within the victim. While the belief that one had control during the assault (past control) is associated with greater psychological distress, the belief that one has more control during the recovery process (present control) is associated with less distress, less withdrawal, and more cognitive reprocessing.

Counseling responses found helpful in reducing self blame are supportive responses, psychoeducational responses (learning about rape trauma syndrome) and those responses addressing the issue of blame. A helpful type of therapy for self blame is cognitive restructuring or cognitive-behavioral therapy. Cognitive reprocessing is the process of taking the facts and forming a logical conclusion from them that is less influenced by shame or guilt.

Suicide
Childhood and adulthood victims of rape are more likely to attempt or commit suicide. The association remains, even after controlling for sex, age, education, symptoms of post-traumatic stress disorder and the presence of psychiatric disorders. The experience of being raped can lead to suicidal behavior as early as adolescence. In Ethiopia, 6% of raped schoolgirls reported having attempted suicide. They also feel embarrassed to talk about what had happened to them. A study of adolescents in Brazil found prior sexual abuse to be a leading factor predicting several health risk behaviours, including suicidal thoughts and attempts.

Effects of sexual assault on children
Rape and other forms of sexual assault on a child can result in both short-term and long-term harm, including psychopathology in later life. Psychological, emotional, physical, and social effects include depression, post-traumatic stress disorder,  anxiety, eating disorders, poor self-esteem, dissociative and anxiety disorders; general psychological distress and disorders such as somatization, neurosis, chronic pain, sexualized behavior, school/learning problems; and behavior problems including substance abuse,  destructive behavior, criminality in adulthood and suicide.

The risk of lasting psychological harm is greater if the perpetrator of the sexual assault on the child is a relative (i.e., incest), or if threats or force are used. Incestual rape has been shown to be one of the most extreme forms of childhood trauma, a trauma that often does serious and long-term psychological damage, especially in the case of parental incest.

Secondary victimization
Rape is especially stigmatizing in cultures with strong customs and taboos regarding sex and sexuality. For example, a rape victim (especially one who was previously a virgin) may be viewed by society as being "damaged." Victims in these cultures may suffer isolation, be disowned by friends and family, be prohibited from marrying, be divorced if already married, or even killed. This phenomenon is known as secondary victimization.

Secondary victimization is the re-traumatization of the sexual assault, abuse, or rape victim through the responses of individuals and institutions. Types of secondary victimization include victim blaming and inappropriate post-assault behavior or language by medical personnel or other organizations with which the victim has contact.(Campbell et al., 1999) Secondary victimization is especially common in cases of drug-facilitated, acquaintance, and statutory rape.

Victim blaming
The term Victim blaming refers to holding the victim of a crime to be responsible for that crime, either in whole or in part. In the context of rape, it refers to the attitude that certain victim behaviors (such as flirting or wearing sexually provocative clothing) may have encouraged the assault. In extreme cases, victims are said to have "asked for it" simply by not behaving demurely.

It has been proposed that one cause of victim blaming is the just world hypothesis. People who believe that the world is intrinsically fair may find it difficult or impossible to accept a situation in which a person is badly hurt for no reason. This leads to a sense that victims must have done something to deserve their fate. Another theory entails the psychological need to protect one's own sense of invulnerability, which can inspire people to believe that rape only happens to those who provoke the assault. Believers use this as a way to feel safer: If one avoids the behaviours of the past victims, one will be less vulnerable. A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. Many of the countries in which victim blaming is more common are those in which there is a significant social divide between the freedoms and status afforded to men and women.