Sexual violence

Sexual violence occurs throughout the world, although in most countries there has been little research conducted on the problem. Due to the private nature of sexual violence, estimating the extent of the problem is difficult. Research in South Africa and Tanzania suggests that nearly one in four women may experience sexual violence by an intimate partner, and up to one-third of adolescent girls report their first sexual experience as being forced.

Sexual violence has a profound impact on physical and mental health. As well as causing physical injury, it is associated with an increased risk of a range of sexual and reproductive health problems, with both immediate and long-term consequences. Its impact on mental health can be as serious as its physical impact, and may be equally long lasting. Deaths following sexual violence may be as a result of suicide, HIV infection or murder – the latter occurring either during a sexual assault or subsequently, as a murder of ‘‘honour’’. Sexual violence can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families and others as a consequence.

Coerced sex may result in sexual gratification on the part of the perpetrator, though its underlying purpose is frequently the expression of power and dominance over the person assaulted. Often, people who coerce their spouses into sexual acts believe their actions are legitimate because they are married. Rape of women and of men is often used as a weapon of war, as a form of attack on the enemy, typifying the conquest and degradation of its women or men or captured male or female fighters. It may also be used to punish people for transgressing social or moral codes, for instance, those prohibiting adultery or drunkenness in public. Women and men may also be raped when in police custody or in prison.

Definition of sexual violence
Sexual violence is defined as:
 * 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.

Coercion can cover a whole spectrum of degrees of force. Apart from physical force, it may involve psychological intimidation, blackmail or other threats – for instance, the threat of physical harm, of being dismissed from a job or of not obtaining a job that is sought. It may also occur when the person aggressed is unable to give consent – for instance, while drunk, drugged, asleep or mentally incapable of understanding the situation.

Sexual violence includes rape, defined by some as physically forced or otherwise coerced penetration of the vulva or anus, using a penis, other body parts or an object. The attempt to do so is known as attempted rape. Rape of a person by two or more perpetrators is known as gang rape. Sexual violence can include other forms of assault involving a sexual organ, including coerced contact between the mouth and penis, vulva or anus.

Forms and contexts of sexual violence
A wide range of sexually violent acts can take place in different circumstances and settings. These include, for example:
 * 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 favors;
 * 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 and trafficking of people for the purpose of sexual exploitation.

The extent of the problem
Data on sexual violence typically come from police, clinical settings, nongovernmental organizations and survey research. The relationship between these sources and the global magnitude of the problem of sexual violence maybe viewed as corresponding to an iceberg floating in water (see diagram). The small visible tip represents cases reported to police. A larger section may be elucidated through survey research and the work of nongovernmental organizations. But beneath the surface remains a substantial although unquantified component of the problem.

In general, sexual violence has been a neglected area of research. The available data are scanty and fragmented. Police data, for instance, are often incomplete and limited. Many people do not report sexual violence to police because they are ashamed, or fear being blamed, not believed or otherwise mistreated. Data from medico-legal clinics, on the other hand, may be biased towards the more violent incidents of sexual abuse.

The proportion of people who seek medical services for immediate problems related to sexual violence is also relatively small. Although there have been considerable advances over the past decade in measuring the phenomenon through survey research, the definitions used have varied considerably across studies. There are also significant differences across cultures in the willingness to disclose sexual violence to researchers. Caution is therefore needed when making global comparisons of the prevalence of sexual violence.

Factors associated with being a victim of sexual violence
Explaining sexual violence is complicated by the multiple forms it takes and contexts in which it occurs. There is considerable overlap between forms of sexual violence and intimate partner violence. There are factors increasing the risk of someone being coerced into sex, factors increasing the risk of an individual person forcing sex on another person, and factors within the social environment including peers and family influencing the likelihood of rape and the reaction to it.

Research suggests that the various factors have an additive effect, so that the more factors present, the greater the likelihood of sexual violence. In addition, a particular factor may vary in importance according to the life stage.

Factors increasing men's risk of committing rape
Data on sexually violent men are somewhat limited and heavily biased towards apprehended rapists, except in the United States, where research has also been conducted on male college students. Despite the limited amount of information on sexually violent men, it appears that sexual violence is found in almost all countries (though with differences in prevalence), in all socioeconomic classes and in all age groups from childhood onwards. Data on sexually violent men also show that most direct their acts at women whom they already know. Among the factors increasing the risk of a man committing rape are those related to attitudes and beliefs, as well as behaviour arising from situations and social conditions that provide opportunities and support for abuse

The consequences of sexual violence
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. Among the more common consequences of sexual violence are those related to reproductive, mental health and social wellbeing.

What is being done to prevent sexual violence
The number of initiatives addressing sexual violence is limited and few have been evaluated. Most interventions have been developed and implemented in industrialized countries. How relevant they may be in other settings is not well known. The interventions that have been developed can be categorized as follows.