Advertisement
Full length article| Volume 266, P77-82, November 2021

Download started.

Ok

Care of women and girls after sexual assault in Geneva: A descriptive study between 2005 and 2014

Open AccessPublished:September 21, 2021DOI:https://doi.org/10.1016/j.ejogrb.2021.09.020
Care of women and girls after sexual assault in Geneva: A descriptive study between 2005 and 2014
Previous ArticlePrevalence, social impact and help-seeking behaviour among women with urinary incontinence in the Gulf countries: A systematic review
Next ArticleIncreased incidence with improved survival of gynecologic carcinosarcoma: A population-based study

      Abstract

      Background and purpose

      We aimed to examine epidemiological data and identify risk factors for sexual assault. This study included women seeking care at the Geneva University Hospitals emergency obstetrics and gynaecological unit.

      Method

      Retrospective, sociodemographic, and clinical data were collected from the medical reports.

      Results

      We reviewed 836 medical charts and registered 92.8 women and girls per year who consulted the emergency department after sexual assault. The average age was 26 (±12) years, with a median of 23 years. Body lesions were reported in 525 patients (63%) and genital traumatic lesions were reported in 230 (28%) patients. Sexual assault by a stranger was reported in 436 cases (52%). Thirty percent of patients knew their aggressor. Aggressions were predominantly committed on the weekend, accounting for 367 cases (46%), with nearly two-thirds (65%, n = 474) occurring between 10 pm and 6 am. In total, 399 (48%) patients who were sexually assaulted reported having consumed alcohol and 102 (12%) reported having taken drugs prior to the aggression; 80 (10%) patients had consumed both and 286 (34%) had amnesia. Half of the sample sought and received medical care within 24 h from the time the aggression took place.

      Conclusion

      Sexual assault risk factors in our study population in Geneva included use of drugs and alcohol, with amnesia. Future prevention and education interventions should target these areas.

      Abbreviations:

      WHO (World Health Organization), SAC (Sexual Assault Consultation), OR (Odds Ratios)

      Keywords

      Introduction

      According to the World Health Organization (WHO), sexual violence is defined as any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or that are 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 [

      Sexual Abuse [Internet]. http://www.apa.org. [cité 14 nov 2015]. Disponible sur: http://www.apa.org/topics/sexual-abuse/index.aspx.

      ]. The prevalence of sexual assault varies from one country to another; it is difficult to determine exact numbers because it is suspected that not all sexual assaults and abuse are reported. In some countries, more than 1 in 4 women have been victims of sexual violence, with 37% of women living in developing countries having experienced physical or sexual violence committed by an intimate partner [

      WHO | Sexual violence [Internet]. WHO. [cité 1 janv 2019]. Disponible sur: http://www.who.int/entity/reproductivehealth/topics/violence/sexual_violence/en/index.html.

      ,

      WHO. https://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globally-experience-violence. 09032021.

      ]. In 2019 in Switzerland, Amnesty International published a survey of 4495 women showing that 22% of Swiss women had experienced a sexual assault at least once in their lives [

      Jede 5. Frau betroffen [Internet]. Amnesty International Schweiz. [cité 25 juin 2020]. Disponible sur: https://www.amnesty.ch/de/themen/frauenrechte/sexuelle-gewalt/dok/2019/sexuelle-gewalt-in-der-schweiz.

      ].
      The population at highest risk of sexual abuse are women who are either married or living with their partner [

      Krug EG, Weltgesundheitsorganisation, éditeurs. Rapport mondial sur la violence et la santé. Genève; 2002. 376 p.

      ,

      World health organization. Violence against women. Intimate partner and sexual violence against women. Hrp. 2019

      ]. Other known risk factors include use of drugs and/or alcohol, polygamy, prostitution, poverty, and young age [

      Krug EG, Weltgesundheitsorganisation, éditeurs. Rapport mondial sur la violence et la santé. Genève; 2002. 376 p.

      ,
      • Du Mont J.
      • Forte T.
      Intimate partner violence among women with mental health-related activity limitations: a Canadian population based study.
      BMC Public Health. 2014; 14: 51
      ,
      • Messman-Moore T.
      • Ward R.M.
      • Zerubavel N.
      • Chandley R.B.
      • Barton S.N.
      Emotion dysregulation and drinking to cope as predictors and consequences of alcohol-involved sexual assault: examination of short-term and long-term risk.
      J Interpers Violence. 2015; 30: 601-621
      ]. It is important to properly care for victims of sexual abuse as the aggression often results in immediate and long-term physical and psychological consequences such as memory loss, chronic pain, and social difficulties. In addition, psychological impacts include depression with suicide attempts, post-traumatic stress disorder, anxiety, and sleep and eating disorders [

      Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011. Morb Mortal Wkly Rep Surveill Summ Wash DC 2002. 5 sept 2014;63(8):1‑18.

      ,

      Kremer I, Orbach I, Rosenbloom T. Mental pain and suicidal tendencies in sexual and physical abuse victims. Arch Suicide Res 2017;21(2):307‑21.

      ,
      • Satyanarayana V.A.
      • Chandra P.S.
      • Vaddiparti K.
      Mental health consequences of violence against women and girls.
      Curr Opin Psychiatry. 2015; 28: 350-356
      ]. Mental health disorder is both a consequence and a risk factor for sexual abuse. Women with a history of mental health disorders have been found to have greater risk of a sexual assault owing to their vulnerability depending on their psychological state and have been proposed to be targeted by health and social services for the prevention of sexual violence [
      • Du Mont J.
      • Forte T.
      Intimate partner violence among women with mental health-related activity limitations: a Canadian population based study.
      BMC Public Health. 2014; 14: 51
      ,
      • Brown R.
      • Du Mont J.
      • Macdonald S.
      • Bainbridge D.
      A comparative analysis of victims of sexual assault with and without mental health histories: acute and follow-up care characteristics.
      J Forensic Nurs. 2013; 9: 76-83
      ,
      • Frías Á.
      • Palma C.
      • Farriols N.
      • González L.
      Sexuality-related issues in borderline personality disorder: A comprehensive review.
      Personal Ment Health. 2016; 10: 216-231
      ,
      • Brooker C.
      • Tocque K.
      Mental health risk factors in sexual assault: What should Sexual Assault Referral Centre staff be aware of?.
      J Forensic Leg Med. 2016; 40: 28-33
      ].
      Women and girls who have been sexually assaulted are more likely to develop gynaecological problems such unwanted pregnancy, abortion, dysmenorrhea, and sexually transmitted diseases [
      • Du Mont J.
      • Forte T.
      Intimate partner violence among women with mental health-related activity limitations: a Canadian population based study.
      BMC Public Health. 2014; 14: 51
      ,
      • Brown R.
      • Du Mont J.
      • Macdonald S.
      • Bainbridge D.
      A comparative analysis of victims of sexual assault with and without mental health histories: acute and follow-up care characteristics.
      J Forensic Nurs. 2013; 9: 76-83
      ,
      • Frías Á.
      • Palma C.
      • Farriols N.
      • González L.
      Sexuality-related issues in borderline personality disorder: A comprehensive review.
      Personal Ment Health. 2016; 10: 216-231
      ,
      • Brooker C.
      • Tocque K.
      Mental health risk factors in sexual assault: What should Sexual Assault Referral Centre staff be aware of?.
      J Forensic Leg Med. 2016; 40: 28-33
      ].
      It has been shown that women who seek justice against the aggressor usually recover a better quality of life as they receive emotional support during the process, which helps to improve their mental health [
      • Calton J.
      • Cattaneo L.B.
      The effects of procedural and distributive justice on intimate partner violence victims’ mental health and likelihood of future help-seeking.
      Am J Orthopsychiatry. 2014; 84: 329-340
      ]. Implementation of a high-quality medical care response, with a trained team and complete account of events, is mandatory for the success of legal prosecution.
      Our aim was to study the population of women and girls who experienced sexual assault and attended the emergency obstetrics and gynaecological unit of the Geneva University Hospitals. We also sought to identify risk factors that could guide future local prevention interventions.

      Methods

      We included all women and girls, regardless of age, for whom a sexual assault consultation (SAC) was conducted by a gynaecologist and a forensic doctor at the emergency obstetrics and gynaecological unit of the Geneva University Hospitals between 2006 and 2014.
      According to our local protocol implemented in 2006, any woman or girl who has been sexually assaulted is triaged by a nurse, then examined by the forensic doctor and gynaecologist on call. After an interview with both health professionals, the forensic doctor examines the victim’s body, collects medicolegal specimens (from under the nails or any other part of the body that may be relevant), and takes photos of any lesions. The gynaecologist uses a colposcope to examine the vulva, anus, vagina, and cervix and documents any genital or anal lesions, if present. Bacteriological samples are collected from the vagina and cervix to screen for Chlamydia trachomatis and Neisseria gonorrhoeae. Vaginal samples are also taken for microscopic analyses of possible sperm deposits.
      Depending on the delay between the consultation and the assault, as well as the characteristics of the aggression, the patient receives the following prophylactic treatment: one intramuscular injection of ceftriaxone 500 mg, azithromycin 1 g per os, emergency contraception with ulipristal acetate or levonorgestrel (if not using any contraception), and prophylactic treatment for HIV and/or hepatitis B [

      Krug EG, Weltgesundheitsorganisation, éditeurs. Rapport mondial sur la violence et la santé. Genève; 2002. 376 p.

      ,

      World health organization Geneva. Guidelines for medico-legal care for victims of sexual violence. WHO library. 2003.

      ,
      • Subramanian S.
      • Green J.S.
      The general approach and management of the patient who discloses a sexual assault.
      Mo Med. 2015; 112: 211-217
      ]. After the assault, a final report is written and signed by the forensic and gynaecologic health professionals. Final reports are secured and remain confidential. Reports can only be given to the patient, their lawyer, or to the judicial department handling legal proceedings. The SAC can be done under legal mandate if requested by the public prosecutor.
      Our study was approved by our local ethics committee, the Swiss Association of Research Ethics Committees (ID 20 16-01144). Epidemiological and clinical data and details of sexual assaults were collected from all available SAC reports. We examined factors including age, marital status, amnesia regarding the aggression, and alcohol or drug consumption described by the woman before the aggression. In this study, we did not test for the presence of drugs in the urine that specifically suggested a drug-facilitated sexual assault. We analysed the timing and location of the aggression, number of aggressors, their relationship to the victim, and use of a weapon during the aggression. We analysed the presence of bodily, genital, or anal injuries; condom use; and the average time before victims sought a consultation.
      Descriptive statistical analyses were performed using R Foundation software version R3.6 (The R Foundation for Statistical Computing, Vienna, Austria) and odds ratios (ORs) were calculated using Stata version 16 (StataCorp LLC, College Station, TX, USA).

      Results

      Between 2006 and 2014, 836 medical reports were available for review. The number of consultations remained relatively stable during the study period, with an average of 92.8 cases per year (Fig. 1), with the maximum number of consultations (n = 110) in 2011 and the fewest (n = 90) in 2013 (Fig. 1). The mean patient age was 26 (±12) years, with a median age of 23 years. The oldest patient was 92 years old and the youngest was 1 year old (Fig. 2). Minors represented 26% (n = 217) of the sample, with 2% (n = 19) under the age of 10 years. Thirty-five percent of the study population (n = 292) was between age 10 and 20 years and most were single (86%, n = 527). Married woman only represented 8% (n = 48) of patients. Fifteen percent (n = 127) of the patients had never had sexual vaginal penetration before the assault. Among these patients, most (n = 88, 66%) were younger than 16 years old (Fig. 2).
      Figure thumbnail gr1
      Fig. 1Number of consultations per year.
      Figure thumbnail gr2
      Fig. 2Age distribution of the victims by age group with the highest prevalence of 35% between the age of 10 and 20 years old.
      Body traumatic lesions were reported in 63% (n = 525) of cases. These included predominantly lower (n = 164, 31%) and upper limb (n = 109, 20%) injuries as well as head trauma (n = 111, 21%) (Fig. 3). Genital traumatic lesions were reported in 28% (n = 230) of cases. Among these, 58% (n = 171) were located in the lower genital tract (vulva, vagina, or cervix) and 18% (n = 53) involved the hymen. Lesions around the anal region accounted for 17% (n = 49) of cases (Fig. 4). Most body and genital lesions were bruises (n = 314, 60%) and abrasions (n = 109, 21%) (Fig. 5). In 29% (n = 239) of cases, there were no genital or body traumatic lesions. We categorized genital injuries into three groups, based on the article by Zilkens et al [
      • Zilkens R.R.
      • Smith D.A.
      • Phillips M.A.
      • Mukhtar S.A.
      • Semmens J.B.
      • Kelly M.C.
      Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.
      Forensic Sci Int. 2017; 275: 195-202
      ]. Lesions requiring no medical treatment, such as oedema, bruises, and redness, were defined as mild/moderate lesions whereas those requiring medical attention, such as open wounds and fractures, were defined as severe lesions. Severe genital injuries were found in 73.33% (n = 11) of cases after penile penetration (Table 1). However, penile penetration was also reported in cases with no (75.69%, n = 299) or mild to moderate injuries (79.69%, n = 79) (Table 1). The second most traumatic penetration was with both penile and digital penetration (13.33%, n = 2) (Table 1).
      Figure thumbnail gr3
      Fig. 3Distribution of body lesions. There is a predominance for inferior limb lesions accounting for 31% of them followed by superior limb lesions.
      Figure thumbnail gr4
      Fig. 4Percentage of genital and oral lesions. The most frequent genital lesions are localized in the lower genital tract region with 74%.
      Figure thumbnail gr5
      Fig. 5Type of lesions. The most frequent type of lesions were bruises.
      Table 1Frequency of injury type according to the type of penetration.
      No lesionMild/moderate genital injuries*Severe genital injuries**P value
      Type of penetration<0.0001
      Unknown56 (14.17%)4 (3.88%)1 (6.66%)
      Finger21 (5.3%)15 (14.56%)1 (6.66%)
      Object4 (1.01%)2 (1.94%)0 (0%)
      Penile299 (75.69%)79 (79.69%)11 (73.33%)
      Penile, finger15 (3.79%)2 (1.94%)2 (13.33%)
      Penile, object0 (0%)1 (0.97%)0 (0%)
      *Mild/moderate: edema, redness, bruise.
      **Severe injuries: open, teared wounds.
      Fifty-two percent (n = 436) of the victims were assaulted by an unknown person whereas 30% (n = 249) knew their aggressor. Among the latter, 8% (n = 66) and 6% (n = 48) were assaulted by their partner and ex-partner, respectively. Only 4% (n = 37) of victims were sexually assaulted by a family member and these were mostly minors (n = 28, 76%) (Fig. 6). Assaults were usually committed by one person (n = 612, 83%) who rarely used a weapon (n = 49, 6%).
      Figure thumbnail gr6
      Fig. 6Relationship to the aggressor. In half of the cases the aggressor was unknown and in 30% known.
      Nearly half of all sexual assaults were committed during the weekend, with two-thirds (n = 474, 65%) occurring between 10 pm and 6 am. In 43% (n = 339) of cases, the assault took place in the aggressor’s home, 23% (n = 180) were in a public area, and 18% (n = 139) were in the victim’s home. Victims reported having consumed alcohol in nearly half of cases (n = 399, 48%) or taken drugs (n = 102, 12%) prior to the aggression. No drug or alcohol consumption was reported by patients under 10 years old. Consumption of both substances was highest among 14- to 30-year-olds, with 76% (n = 303) having consumed alcohol and 67% (n = 72) reporting drug use. Thirty-four percent (n = 286) of women reported having memory loss. Among these, 17% (n = 49) had consumed both alcohol and drugs, 66% (n = 188) only alcohol, and 2% (n = 5) only drugs. Women were 13 times (OR 13.20, 95% confidence interval [CI] 9.12–19.13) more likely to present with amnesia if they had consumed alcohol and 2.7 times (2.53, 95% CI 1.67–3.85) more likely to have amnesia when they had used drugs (Table 2).
      Table 2Logistic regression showing the relation (odds ratio) between amnesia and drug or alcohol consumption.
      alcoholDrug
      Amnesia
      Yes13.2 (9.12–19.13)1.08 (1.04–1.13)
      No1 (base outcome)1 (base outcome)
      *Values given are odds ratios with 95% confidence interval.
      Forty-nine percent (n = 413) of the sample sought and received medical attention within 24 h of the aggression, 20% (n = 165) between 24 and 72 h, 9% (n = 79) between 72 h and 1 week, and 11% (n = 89) between 1 week and 1 month after the assault; 10% (n = 84) of patients sought consultation after 1 month. In only 1% (n = 6) of cases, the consultation delay was not documented in the medical report (Fig. 7). Patients older than 14 years were more likely to consult within the first 24 h compared with younger girls. Women between the ages of 31 and 50 years were 3.7 times (95% CI 1.84–7.37) more likely to consult within the first 24 h than girls under age 13 years (Table 3). In the first 24 h, more vaginal injuries were observed compared with later consultation (OR 1.61, 95% CI 1.18–2.19) (Table 3). Women assaulted by a known person were less likely to consult within the first 24 h (OR 0.49, 95% CI 0.37–0.65) in contrast to victims assaulted by an unknown person. Women assaulted by a family member other than their partner were less likely to consult within the first 24 h (OR 0.18, 95% CI 0.08–0.41) (Table 3). Compared with women who had not consumed alcohol, those who had consumed alcohol were twice as likely to consult within the first 24 h (OR 2.08, 95%, CI 1.58–2.74), and women who had used drugs were 1.8 times more likely than those who had not used drugs to seek consultation within that time frame (OR 1.79, 95% CI 1.17–2.74) (Table 3).Women presenting with amnesia were more likely to consult within the first 24 h compared with women who did not have amnesia (OR 1.37, 95% CI 1.03–1.82) (Table 3).
      Figure thumbnail gr7
      Fig. 7Consultation delay in hours, week(s) and month(s).
      Table 3Logistic regression showing the relation (odds ratio) between time of consultation and characteristic of the assault.
      <24 h24–72 h<72 h
      Perpetrator
      Unknown1 (base outcome)1 (base outcome)1 (base outcome)
      Known (Acquaintance, partner, ex-partner)0.49 (0.37–0.65)1.12 (0.79–1.59)2.30 (1.68–3.15)
      Family member0.18 (0.08–0.41)0.39 (0.12–1.29)7.09 (3.48–14.49)
      Victim alcohol intake
      No1 (base outcome)1 (base outcome)1 (base outcome)
      Yes2.08 (1.58–2.74)1.36 (0.96–1.92)0.33 (0.24–0.46)
      Victim drug intake
      No1 (base outcome)1 (base outcome)1 (base outcome)
      Yes1.79 (1.17–2.74)1.13 (0.67–1.88)0.42 (0.24–0.72)
      Genital injuries
      No1 (base outcome)1 (base outcome)1 (base outcome)
      Yes1.61 (1.18–2.19))1.05 (0.72–1.55)0.51 (0.36–0.73))
      Age of the victim
      0–13 years1 (base outcome)1 (base outcome)1 (base outcome)
      14–30 years2.75 (1.43–5.29)0.99 (0.48–2.05)0.44 (0.24–0.79)
      31–50 years3.68 (1.84–7.37)0.69 (0.31–1.54)0.38 (0.20–0.72)
      51 + years3.63 (1.47–9.02)0.75 (0.26–2.30)0.39 (0.15–0.96)
      Amnesia
      No1 (base outcome)1 (base outcome)1 (base outcome)
      Yes1.37 (1.03–1.82)1.65 (1.57–2.35)0.41 (0.29–0.58)
      *Values given are odds ratios with 95% confidence interval.

      Discussion

      Our study revealed that the number of women and girls who had experienced sexual assault and who were admitted to the obstetrics and gynaecology emergency unit of the Geneva University Hospitals remained unchanged between 2006 and 2014, with an average of 92.8 cases per year. This rate is despite the contemporary exponential diffusion and use of social media, which has greatly influenced and facilitated sexual encounters and sexual violence [
      • Henry N.
      • Powell A.
      Technology-facilitated sexual violence: a literature review of empirical research.
      Trauma Violence Abuse. 2018; 19: 195-208
      ]. In the past few years, increased access to the Internet, social media, and pornography has facilitated sexual encounters, as well as sexual violence, including sexting, sharing nude images, and other risky sexual behaviours [

      Maas MK, Bray BC, Noll JG. Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: a latent class analysis. J Youth Adolesc 2019;48(5):837‑49.

      ]. Some studies have highlighted that social media and online sexual encounters might facilitate sexual assault with perpetrators who can manipulate or blackmail victims to organize a meeting point,[
      • Henry N.
      • Powell A.
      Technology-facilitated sexual violence: a literature review of empirical research.
      Trauma Violence Abuse. 2018; 19: 195-208
      ,

      Maas MK, Bray BC, Noll JG. Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: a latent class analysis. J Youth Adolesc 2019;48(5):837‑49.

      ,

      Dir AL, Riley EN, Cyders MA, Smith GT. Problematic alcohol use and sexting as risk factors for sexual assault among college women. J Am Coll Health 2018;66(7):553‑60.

      ] and this is especially true when teenagers and children are involved [
      • Henry N.
      • Powell A.
      Technology-facilitated sexual violence: a literature review of empirical research.
      Trauma Violence Abuse. 2018; 19: 195-208
      ]. At the same time, awareness campaigns regarding sexual violence, such as those conducted by Amnesty International in Switzerland, might counteract the impact of social media via raising awareness and education [

      Droits des femmes [Internet]. Amnesty International Suisse. [cité 15 mai 2020]. Disponible sur: https://www.amnesty.ch/fr/themes/droits-des-femmes.

      ].
      Similar to previous studies from high-income countries, more women in their 20 s were represented in our total sample [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Jones J.S.
      • Rossman L.
      • Wynn B.N.
      • Dunnuck C.
      • Schwartz N.
      Comparative analysis of adult versus adolescent sexual assault: epidemiology and patterns of anogenital injury.
      Acad Emerg Med. 2003; 10: 872-877
      ,
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ]. Children, teenagers, and older people are less inclined to seek consultation after sexual assault [
      • Jones J.S.
      • Rossman L.
      • Wynn B.N.
      • Dunnuck C.
      • Schwartz N.
      Comparative analysis of adult versus adolescent sexual assault: epidemiology and patterns of anogenital injury.
      Acad Emerg Med. 2003; 10: 872-877
      ,
      • Peipert J.F.
      • Domagalski L.R.
      Epidemiology of adolescent sexual assault.
      Obstet Gynecol. 1994; 84: 867-871
      ,

      Bows H. Sexual Violence Against Older People: A Review of the Empirical Literature: Trauma Violence Abuse [Internet]. 2 janv 2017 [cité 22 nov 2020]; Disponible sur: https://journals.sagepub.com/doi/10.1177/1524838016683455?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed.

      ]. In addition, women in their 20 s in our sample were often assaulted at night and in settings where alcohol and drugs were available, such as at parties and nightlife activities with large crowds, which are all risk factors for sexual assault [
      • Sampsel K.
      • Godbout J.
      • Leach T.
      • Taljaard M.
      • Calder L.
      Characteristics associated with sexual assaults at mass gatherings.
      Emerg Med J EMJ. 2016; 33: 139-143
      ].
      We observed a higher percentage of single than married women in our sample, in contrast to WHO statistics, which indicate that married status is a risk factor for sexual assault [

      Krug EG, Weltgesundheitsorganisation, éditeurs. Rapport mondial sur la violence et la santé. Genève; 2002. 376 p.

      ]. This discrepancy may be explained by the WHO mainly collecting data from low- and middle-income countries where the mean age of marriage is lower than that in Switzerland [

      United Nation. Population Facts Department of Economic and Social Affairs. Population Division. 2011.

      ]. The mean age of marriage in Switzerland is 30 years and the mean age in our sample was <26 years. Moreover, in low- and middle-income countries, low income and education levels as well as higher rates of forced marriage under the age of 18 years have been shown to be independent risk factors of sexual violence, particularly against minors [

      World health organization. Violence against women. Intimate partner and sexual violence against women. Hrp. 2019

      ,
      • Gust D.A.
      • Pan Y.
      • Otieno F.
      • Hayes T.
      • Omoro T.
      • Phillips-Howard P.A.
      • et al.
      Factors associated with physical violence by a sexual partner among girls and women in rural Kenya.
      J Glob Health. 2017; 7020406
      ,
      • da Silva J.V.
      • Roncalli A.G.
      Prevalence of sexual violence in Brazil: associated individual and contextual factors.
      Int J Public Health. 2018; 63: 933-944
      ,

      Kidman R. Child marriage and intimate partner violence: a comparative study of 34 countries. Int J Epidemiol 2017;46(2):662‑75.

      ,

      statistique O fédéral de la. Mariages, partenariats et divorces [Internet]. [cité 3 juin 2020]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/bevoelkerung/heiraten-eingetragene-partnerschaften-scheidungen.html.

      ].
      In accordance with previous publications, nearly half of our patients were assaulted in the home of the aggressor [
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ,

      Baldé IS, Diallo A, Diallo MH, Baldé O, Sylla I, Diallo BS, et al. Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital. Med Sante Trop 2019;29(2):195‑9.

      ]. However, these data must be interpreted carefully because it has been proven that the location of the assault is mostly influenced by the victim’s relationship to the aggressor and the age of the victim. Children, adolescents, and older women are more likely to be assaulted in their own homes [
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ,

      Chopin J, Beauregard E. Sexual Abuse of Elderly Victims Investigated by the Police: From Motives to Crime Characteristics: J Interpers Violence [Internet]. 31 déc 2018 [cité 13 nov 2020]; Disponible sur: https://journals.sagepub.com/doi/10.1177/0886260518821456?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed.

      ,
      • Thomas L.
      • Scott Tilley D.
      • Esquibel K.
      Sexual assault: where are mid-life women in the research?.
      Perspect Psychiatr Care. 2015; 51: 86-97
      ,
      • Bove G.D.
      • Stermac L.
      • Bainbridge D.
      Comparisons of sexual assault among older and younger women.
      J Elder Abuse Negl. 2005; 17: 1-18
      ,
      • Sudupe Moreno A.
      Age differences among victims of sexual assault: a comparison between children, adolescents and adults.
      J Forensic Leg Med. 2013; 20: 465-470
      ]; middle-aged women are more frequently assaulted in the aggressor’s home. Our high percentage of assaults in the home of the aggressor might be explained by the victims in our sample being mostly young women (mean age 26 years).
      Alcohol consumption has been confirmed to be a risk factor for sexual assault in young women aged between 20 and 30 years old [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Jones J.S.
      • Rossman L.
      • Wynn B.N.
      • Dunnuck C.
      • Schwartz N.
      Comparative analysis of adult versus adolescent sexual assault: epidemiology and patterns of anogenital injury.
      Acad Emerg Med. 2003; 10: 872-877
      ,
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ]. Alcohol and drug use decreases victims’ awareness and increases their vulnerability and susceptibility to aggressive behaviour [
      • Peipert J.F.
      • Domagalski L.R.
      Epidemiology of adolescent sexual assault.
      Obstet Gynecol. 1994; 84: 867-871
      ,
      • Gust D.A.
      • Pan Y.
      • Otieno F.
      • Hayes T.
      • Omoro T.
      • Phillips-Howard P.A.
      • et al.
      Factors associated with physical violence by a sexual partner among girls and women in rural Kenya.
      J Glob Health. 2017; 7020406
      ,
      • da Silva J.V.
      • Roncalli A.G.
      Prevalence of sexual violence in Brazil: associated individual and contextual factors.
      Int J Public Health. 2018; 63: 933-944
      ,

      Abbey A, Wegner R, Woerner J, Pegram SE, Pierce J. Review of survey and experimental research that examines the relationship between alcohol consumption and men’s sexual aggression perpetration. Trauma Violence Abuse 2014;15(4):265‑82.

      ,

      Gatley JM, Sanches M, Benny C, Wells S, Callaghan RC. The impact of drinking age laws on perpetration of sexual assault crimes in Canada, 2009-2013. J Adolesc Health 2017;61(1):24‑31.

      ]. The combined effect of alcohol with drugs (cocaine, cannabis) or medication (anti-depressants and anxiolytics) further deteriorates individuals’ awareness, making them more vulnerable to sexual aggressors and causing more frequent amnesia [
      • Anderson L.J.
      • Flynn A.
      • Pilgrim J.L.
      A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review.
      J Forensic Leg Med. 2017; 47: 46-54
      ]. In contrast to several studies reporting that up to 34% of sexually assaulted women had consumed drugs, we found that only 12% of our sample reported having used drugs before the assault [
      • Anderson L.J.
      • Flynn A.
      • Pilgrim J.L.
      A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review.
      J Forensic Leg Med. 2017; 47: 46-54
      ,
      • Hindmarch I.
      • ElSohly M.
      • Gambles J.
      • Salamone S.
      Forensic urinalysis of drug use in cases of alleged sexual assault.
      J Clin Forensic Med. 2001; 8: 197-205
      ,
      • Scott K.M.
      • Koenen K.C.
      • King A.
      • Petukhova M.V.
      • Alonso J.
      • Bromet E.J.
      • et al.
      Post-traumatic stress disorder associated with sexual assault among women in the WHO World Mental Health Surveys.
      Psychol Med. 2018; 48: 155-167
      ]. Alcohol consumption prior to the aggression was reported by nearly half of our cohort (48%). The highest rate of consumption of both alcohol and drugs was among the group 14 to 30 years old and was consumed at parties or bars. Substance abuse and nightlife activities have been previously reported to be risk factors for sexual assault [
      • Sampsel K.
      • Godbout J.
      • Leach T.
      • Taljaard M.
      • Calder L.
      Characteristics associated with sexual assaults at mass gatherings.
      Emerg Med J EMJ. 2016; 33: 139-143
      ,

      Hannemann T-V, Kraus L, Piontek D. Consumption Patterns of Nightlife Attendees in Munich: A Latent-Class Analysis. Subst Use Misuse 2017;52(11):1511‑21.

      ,

      Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual Aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav 2019;48(2):609‑18.

      ,
      • Beselia A.
      • Kirtadze I.
      • Otiashvili D.
      Nightlife and drug use in Tbilisi, Georgia: results of an exploratory qualitative study.
      J Psychoactive Drugs. 2019; 51: 247-253
      ,
      • Kaestle C.E.
      • Droste N.
      • Peacock A.
      • Bruno R.
      • Miller P.
      Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors.
      Addict Behav. 2018; 76: 195-200
      ,

      Bellis MA, Quigg Z, Hughes K, Ashton K, Ferris J, Winstock A. Harms from other people’s drinking: an international survey of their occurrence, impacts on feeling safe and legislation relating to their control. BMJ Open 2015;5(12):e010112.

      ].
      Gathering forensic evidence requires that victims seek timely medical care after the assault. DNA samples are less likely to be present 7 days after the aggression [

      Welch J, Mason F. Rape and sexual assault. BMJ. 31 mai 2007;334(7604):1154‑8.

      ,
      • Magalhães T.
      • Dinis-Oliveira R.J.
      • Silva B.
      • Corte-Real F.
      • Nuno Vieira D.
      Biological evidence management for DNA analysis in cases of sexual assault.
      ScientificWorldJournal. 2015; 2015: 1-11
      ]. Seventy percent of our patients sought consultation within 72 h of the assault, within a time frame that allows for recording of body lesions and collection of medicolegal samples [
      • Zilkens R.R.
      • Smith D.A.
      • Phillips M.A.
      • Mukhtar S.A.
      • Semmens J.B.
      • Kelly M.C.
      Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.
      Forensic Sci Int. 2017; 275: 195-202
      ,

      Welch J, Mason F. Rape and sexual assault. BMJ. 31 mai 2007;334(7604):1154‑8.

      ,
      • Bowyer L.
      • Dalton M.E.
      Female victims of rape and their genital injuries.
      BJOG Int J Obstet Gynaecol. 1997; 104: 617-620
      ]. According to the existing literature and our study findings, children tend to consult emergency services later in comparison with adolescents and young adults. As a consequence, genital or body lesions are less frequently found in this population [
      • Rizzo A.
      • Ricard D.
      • La Harpe R.
      • Fracasso T.
      • Yaron M.
      Female Child and Adolescent sexual abuse cases reported at the Geneva university hospitals between 2006 and 2014: a retrospective study.
      J Pediatr Adolesc Gynecol. 2020; 33: 260-263
      ]. One explanation for this delay is that children are less inclined to seek consultation because the perpetrator is often a family member who can manipulate the child by inducing feelings of guilt, shame, or fear [
      • Murray L.K.
      • Nguyen A.
      • Cohen J.A.
      Child sexual abuse.
      Child Adolesc Psychiatr Clin N Am. 2014; 23: 321-337
      ]. Women who had consumed alcohol or drugs and who had amnesia were more likely to present to the emergency room within the first 24 h, according to our results. However, the latter finding is in contrast with those of other studies showing that women are less inclined to report to the police under those circumstances for fear that their consumption of alcohol or drugs or their amnesia will have a negative influence on their complaint [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ,
      • La Harpe R.
      • Burkhardt S.
      • Ricard‐Gauthier D.
      • Poncet A.
      • Yaron M.
      • Fracasso T.
      Factors influencing the filing of complaints, their investigation, and subsequent legal judgment in cases of sexual assault.
      J Forensic Sci. 2019; 64: 1119-1124
      ,
      • Wiley J.
      • Sugar N.
      • Fine D.
      • Eckert L.O.
      Legal outcomes of sexual assault.
      Am J Obstet Gynecol. 2003; 188: 1638-1641
      ]. Moreover, studies highlight that when victims declare the use of a psychoactive substance prior to an assault, the aggressor is less likely to be convicted in court [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Wiley J.
      • Sugar N.
      • Fine D.
      • Eckert L.O.
      Legal outcomes of sexual assault.
      Am J Obstet Gynecol. 2003; 188: 1638-1641
      ].
      In line with several publications, we found that approximately 50% of our victims presented with physical lesions and 28% with genital lesions, predominantly located in the lower genital tract [
      • Zilkens R.R.
      • Smith D.A.
      • Phillips M.A.
      • Mukhtar S.A.
      • Semmens J.B.
      • Kelly M.C.
      Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.
      Forensic Sci Int. 2017; 275: 195-202
      ,
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ]. Most of the reported lesions were on the body (36%–53%), probably as a result of resistance to the assault; gynaecological lesions were seen in only 24% of cases and were more frequently associated with digital penetration, in comparison with penile–vaginal penetration [
      • Song S.H.
      • Fernandes J.R.
      Comparison of injury patterns in consensual and nonconsensual sex: is it possible to determine if consent was given?.
      Acad Forensic Pathol. 2017; 7: 619-631
      ]. This highlights the importance of total body examination by a forensic doctor or trained team [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • Larsen M.-L.
      • Hilden M.
      • Lidegaard Ø.
      Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
      BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
      ,
      • Zilkens R.R.
      • Smith D.A.
      • Kelly M.C.
      • Mukhtar S.A.
      • Semmens J.B.
      • Phillips M.A.
      A detailed cross-sectional Australian study of 1163 women.
      Forensic Sci Int. 2017; 279: 112-120
      ]. Timely recording of such lesions is imperative for successful legal outcomes against the sexual aggressor. Body lesions have a considerable influence on convictions in Switzerland as well as in other countries [
      • Kolopp M.
      • Delbaere-Crespo E.
      • Lecossec C.
      • Guillet-May F.
      • Coudane H.
      • Martrille L.
      Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
      Gynecol Obstet Fertil Senol. 2017; 45: 158-163
      ,
      • La Harpe R.
      • Burkhardt S.
      • Ricard‐Gauthier D.
      • Poncet A.
      • Yaron M.
      • Fracasso T.
      Factors influencing the filing of complaints, their investigation, and subsequent legal judgment in cases of sexual assault.
      J Forensic Sci. 2019; 64: 1119-1124
      ].
      In Switzerland, the number of sexual assault cases reported to the police are documented in annual reports by the Federal Statistical Office [

      statistique O fédéral de la. Violence domestique [Internet]. [cité 18 avr 2021]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/kriminalitaet-strafrecht/polizei/haeusliche-gewalt.html.

      ]. However, there is no national collection of data on victims consulting at hospitals without a referral from the police, and there is no available information on the characteristics and circumstances of these assaults [

      statistique O fédéral de la. Violence [Internet]. [cité 1 avr 2021]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/kriminalitaet-strafrecht/polizei/gewalt.html.

      ]. Ours is the first study to report such details in Switzerland.
      Our study showed that the principal victims of sexual assault in the Geneva area between 2006 and 2014 were single women in their 20 s who had often consumed alcohol or drugs and that the aggression took place on a weekend, between 10 pm and 6 am, and especially during nightlife activities. These circumstances and characteristics of vulnerability could inform prevention, care, and education campaigns on sexual violence. Information about early consultation after an assault is also paramount to receiving timely care with prophylaxis and to the collection of forensic evidence, which highly influences the success of legal prosecution. Further multicentre and prospective studies in Switzerland could better inform preventive measures.

      Acknowledgement

      We thank Ania Wisniak for her expert guidance with statistics and Analisa Avila, MPH, ELS, of Edanz Group (https://www.edanz.com/ac) for editing a draft of this manuscript.

      Author agreement

      All authors who have participated to this manuscript and, as such, who satisfy the criteria of authorship, have agreed for this publication. The manuscript has been approved by all authors.

      Statement on funding sources and conflicts of interest

      We declare having no conflicts of interest and did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      References

      1. Sexual Abuse [Internet]. http://www.apa.org. [cité 14 nov 2015]. Disponible sur: http://www.apa.org/topics/sexual-abuse/index.aspx.

        View in Article

      2. WHO | Sexual violence [Internet]. WHO. [cité 1 janv 2019]. Disponible sur: http://www.who.int/entity/reproductivehealth/topics/violence/sexual_violence/en/index.html.

        View in Article

      3. WHO. https://www.who.int/news/item/09-03-2021-devastatingly-pervasive-1-in-3-women-globally-experience-violence. 09032021.

        View in Article

      4. Jede 5. Frau betroffen [Internet]. Amnesty International Schweiz. [cité 25 juin 2020]. Disponible sur: https://www.amnesty.ch/de/themen/frauenrechte/sexuelle-gewalt/dok/2019/sexuelle-gewalt-in-der-schweiz.

        View in Article

      5. Krug EG, Weltgesundheitsorganisation, éditeurs. Rapport mondial sur la violence et la santé. Genève; 2002. 376 p.

        View in Article

      6. World health organization. Violence against women. Intimate partner and sexual violence against women. Hrp. 2019

        View in Article
        • Du Mont J.
        • Forte T.
        Intimate partner violence among women with mental health-related activity limitations: a Canadian population based study.
        BMC Public Health. 2014; 14: 51
        View in Article
        • Messman-Moore T.
        • Ward R.M.
        • Zerubavel N.
        • Chandley R.B.
        • Barton S.N.
        Emotion dysregulation and drinking to cope as predictors and consequences of alcohol-involved sexual assault: examination of short-term and long-term risk.
        J Interpers Violence. 2015; 30: 601-621
        View in Article

      9. Breiding MJ, Smith SG, Basile KC, Walters ML, Chen J, Merrick MT. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011. Morb Mortal Wkly Rep Surveill Summ Wash DC 2002. 5 sept 2014;63(8):1‑18.

        View in Article

      10. Kremer I, Orbach I, Rosenbloom T. Mental pain and suicidal tendencies in sexual and physical abuse victims. Arch Suicide Res 2017;21(2):307‑21.

        View in Article
        • Satyanarayana V.A.
        • Chandra P.S.
        • Vaddiparti K.
        Mental health consequences of violence against women and girls.
        Curr Opin Psychiatry. 2015; 28: 350-356
        View in Article
        • Brown R.
        • Du Mont J.
        • Macdonald S.
        • Bainbridge D.
        A comparative analysis of victims of sexual assault with and without mental health histories: acute and follow-up care characteristics.
        J Forensic Nurs. 2013; 9: 76-83
        View in Article
        • Frías Á.
        • Palma C.
        • Farriols N.
        • González L.
        Sexuality-related issues in borderline personality disorder: A comprehensive review.
        Personal Ment Health. 2016; 10: 216-231
        View in Article
        • Brooker C.
        • Tocque K.
        Mental health risk factors in sexual assault: What should Sexual Assault Referral Centre staff be aware of?.
        J Forensic Leg Med. 2016; 40: 28-33
        View in Article
        • Calton J.
        • Cattaneo L.B.
        The effects of procedural and distributive justice on intimate partner violence victims’ mental health and likelihood of future help-seeking.
        Am J Orthopsychiatry. 2014; 84: 329-340
        View in Article

      16. World health organization Geneva. Guidelines for medico-legal care for victims of sexual violence. WHO library. 2003.

        View in Article
        • Subramanian S.
        • Green J.S.
        The general approach and management of the patient who discloses a sexual assault.
        Mo Med. 2015; 112: 211-217
        View in Article
        • Zilkens R.R.
        • Smith D.A.
        • Phillips M.A.
        • Mukhtar S.A.
        • Semmens J.B.
        • Kelly M.C.
        Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.
        Forensic Sci Int. 2017; 275: 195-202
        View in Article
        • Henry N.
        • Powell A.
        Technology-facilitated sexual violence: a literature review of empirical research.
        Trauma Violence Abuse. 2018; 19: 195-208
        View in Article

      20. Maas MK, Bray BC, Noll JG. Online sexual experiences predict subsequent sexual health and victimization outcomes among female adolescents: a latent class analysis. J Youth Adolesc 2019;48(5):837‑49.

        View in Article

      21. Dir AL, Riley EN, Cyders MA, Smith GT. Problematic alcohol use and sexting as risk factors for sexual assault among college women. J Am Coll Health 2018;66(7):553‑60.

        View in Article

      22. Droits des femmes [Internet]. Amnesty International Suisse. [cité 15 mai 2020]. Disponible sur: https://www.amnesty.ch/fr/themes/droits-des-femmes.

        View in Article
        • Kolopp M.
        • Delbaere-Crespo E.
        • Lecossec C.
        • Guillet-May F.
        • Coudane H.
        • Martrille L.
        Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes.
        Gynecol Obstet Fertil Senol. 2017; 45: 158-163
        View in Article
        • Jones J.S.
        • Rossman L.
        • Wynn B.N.
        • Dunnuck C.
        • Schwartz N.
        Comparative analysis of adult versus adolescent sexual assault: epidemiology and patterns of anogenital injury.
        Acad Emerg Med. 2003; 10: 872-877
        View in Article
        • Larsen M.-L.
        • Hilden M.
        • Lidegaard Ø.
        Sexual assault: a descriptive study of 2500 female victims over a 10-year period.
        BJOG Int J Obstet Gynaecol. 2015; 122: 577-584
        View in Article
        • Peipert J.F.
        • Domagalski L.R.
        Epidemiology of adolescent sexual assault.
        Obstet Gynecol. 1994; 84: 867-871
        View in Article

      27. Bows H. Sexual Violence Against Older People: A Review of the Empirical Literature: Trauma Violence Abuse [Internet]. 2 janv 2017 [cité 22 nov 2020]; Disponible sur: https://journals.sagepub.com/doi/10.1177/1524838016683455?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed.

        View in Article
        • Sampsel K.
        • Godbout J.
        • Leach T.
        • Taljaard M.
        • Calder L.
        Characteristics associated with sexual assaults at mass gatherings.
        Emerg Med J EMJ. 2016; 33: 139-143
        View in Article

      29. United Nation. Population Facts Department of Economic and Social Affairs. Population Division. 2011.

        View in Article
        • Gust D.A.
        • Pan Y.
        • Otieno F.
        • Hayes T.
        • Omoro T.
        • Phillips-Howard P.A.
        • et al.
        Factors associated with physical violence by a sexual partner among girls and women in rural Kenya.
        J Glob Health. 2017; 7020406
        View in Article
        • da Silva J.V.
        • Roncalli A.G.
        Prevalence of sexual violence in Brazil: associated individual and contextual factors.
        Int J Public Health. 2018; 63: 933-944
        View in Article

      32. Kidman R. Child marriage and intimate partner violence: a comparative study of 34 countries. Int J Epidemiol 2017;46(2):662‑75.

        View in Article

      33. statistique O fédéral de la. Mariages, partenariats et divorces [Internet]. [cité 3 juin 2020]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/bevoelkerung/heiraten-eingetragene-partnerschaften-scheidungen.html.

        View in Article

      34. Baldé IS, Diallo A, Diallo MH, Baldé O, Sylla I, Diallo BS, et al. Sexual violence: epidemiological and clinical aspects and circumstances of occurrence among women seen at the Gynecology-Obstetrics department of the Ignace Deen National Hospital of Conakry University Hospital. Med Sante Trop 2019;29(2):195‑9.

        View in Article

      35. Chopin J, Beauregard E. Sexual Abuse of Elderly Victims Investigated by the Police: From Motives to Crime Characteristics: J Interpers Violence [Internet]. 31 déc 2018 [cité 13 nov 2020]; Disponible sur: https://journals.sagepub.com/doi/10.1177/0886260518821456?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed.

        View in Article
        • Thomas L.
        • Scott Tilley D.
        • Esquibel K.
        Sexual assault: where are mid-life women in the research?.
        Perspect Psychiatr Care. 2015; 51: 86-97
        View in Article
        • Bove G.D.
        • Stermac L.
        • Bainbridge D.
        Comparisons of sexual assault among older and younger women.
        J Elder Abuse Negl. 2005; 17: 1-18
        View in Article
        • Sudupe Moreno A.
        Age differences among victims of sexual assault: a comparison between children, adolescents and adults.
        J Forensic Leg Med. 2013; 20: 465-470
        View in Article

      39. Abbey A, Wegner R, Woerner J, Pegram SE, Pierce J. Review of survey and experimental research that examines the relationship between alcohol consumption and men’s sexual aggression perpetration. Trauma Violence Abuse 2014;15(4):265‑82.

        View in Article

      40. Gatley JM, Sanches M, Benny C, Wells S, Callaghan RC. The impact of drinking age laws on perpetration of sexual assault crimes in Canada, 2009-2013. J Adolesc Health 2017;61(1):24‑31.

        View in Article
        • Anderson L.J.
        • Flynn A.
        • Pilgrim J.L.
        A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review.
        J Forensic Leg Med. 2017; 47: 46-54
        View in Article
        • Hindmarch I.
        • ElSohly M.
        • Gambles J.
        • Salamone S.
        Forensic urinalysis of drug use in cases of alleged sexual assault.
        J Clin Forensic Med. 2001; 8: 197-205
        View in Article
        • Scott K.M.
        • Koenen K.C.
        • King A.
        • Petukhova M.V.
        • Alonso J.
        • Bromet E.J.
        • et al.
        Post-traumatic stress disorder associated with sexual assault among women in the WHO World Mental Health Surveys.
        Psychol Med. 2018; 48: 155-167
        View in Article

      44. Hannemann T-V, Kraus L, Piontek D. Consumption Patterns of Nightlife Attendees in Munich: A Latent-Class Analysis. Subst Use Misuse 2017;52(11):1511‑21.

        View in Article

      45. Sanchez ZM, Santos MGR, Sanudo A, Carlini CM, Martins SS. Sexual Aggression in Brazilian nightclubs: associations with patron’s characteristics, drug use, and environmental factors. Arch Sex Behav 2019;48(2):609‑18.

        View in Article
        • Beselia A.
        • Kirtadze I.
        • Otiashvili D.
        Nightlife and drug use in Tbilisi, Georgia: results of an exploratory qualitative study.
        J Psychoactive Drugs. 2019; 51: 247-253
        View in Article
        • Kaestle C.E.
        • Droste N.
        • Peacock A.
        • Bruno R.
        • Miller P.
        Perception of intoxication in a field study of the night-time economy: Blood alcohol concentration, patron characteristics, and event-level predictors.
        Addict Behav. 2018; 76: 195-200
        View in Article

      48. Bellis MA, Quigg Z, Hughes K, Ashton K, Ferris J, Winstock A. Harms from other people’s drinking: an international survey of their occurrence, impacts on feeling safe and legislation relating to their control. BMJ Open 2015;5(12):e010112.

        View in Article

      49. Welch J, Mason F. Rape and sexual assault. BMJ. 31 mai 2007;334(7604):1154‑8.

        View in Article
        • Magalhães T.
        • Dinis-Oliveira R.J.
        • Silva B.
        • Corte-Real F.
        • Nuno Vieira D.
        Biological evidence management for DNA analysis in cases of sexual assault.
        ScientificWorldJournal. 2015; 2015: 1-11
        View in Article
        • Bowyer L.
        • Dalton M.E.
        Female victims of rape and their genital injuries.
        BJOG Int J Obstet Gynaecol. 1997; 104: 617-620
        View in Article
        • Rizzo A.
        • Ricard D.
        • La Harpe R.
        • Fracasso T.
        • Yaron M.
        Female Child and Adolescent sexual abuse cases reported at the Geneva university hospitals between 2006 and 2014: a retrospective study.
        J Pediatr Adolesc Gynecol. 2020; 33: 260-263
        View in Article
        • Murray L.K.
        • Nguyen A.
        • Cohen J.A.
        Child sexual abuse.
        Child Adolesc Psychiatr Clin N Am. 2014; 23: 321-337
        View in Article
        • La Harpe R.
        • Burkhardt S.
        • Ricard‐Gauthier D.
        • Poncet A.
        • Yaron M.
        • Fracasso T.
        Factors influencing the filing of complaints, their investigation, and subsequent legal judgment in cases of sexual assault.
        J Forensic Sci. 2019; 64: 1119-1124
        View in Article
        • Wiley J.
        • Sugar N.
        • Fine D.
        • Eckert L.O.
        Legal outcomes of sexual assault.
        Am J Obstet Gynecol. 2003; 188: 1638-1641
        View in Article
        • Song S.H.
        • Fernandes J.R.
        Comparison of injury patterns in consensual and nonconsensual sex: is it possible to determine if consent was given?.
        Acad Forensic Pathol. 2017; 7: 619-631
        View in Article
        • Zilkens R.R.
        • Smith D.A.
        • Kelly M.C.
        • Mukhtar S.A.
        • Semmens J.B.
        • Phillips M.A.
        A detailed cross-sectional Australian study of 1163 women.
        Forensic Sci Int. 2017; 279: 112-120
        View in Article

      58. statistique O fédéral de la. Violence domestique [Internet]. [cité 18 avr 2021]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/kriminalitaet-strafrecht/polizei/haeusliche-gewalt.html.

        View in Article

      59. statistique O fédéral de la. Violence [Internet]. [cité 1 avr 2021]. Disponible sur: https://www.bfs.admin.ch/bfs/fr/home/statistiken/kriminalitaet-strafrecht/polizei/gewalt.html.

        View in Article

      Biography

      Dominique Ricard-Gauthier is a fourth-year intern who works in the department of gynecology and obstetrics at the University of Geneva Hospitals, Switzerland. This article is part of a research plan for her M.D. that began in 2014 and which enabled her to study many aspects of sexual violence through different publications such as the epidemiological aspect of paediatric sexual violence and factors influencing the filing of complaints. It also helped improve the management of victims in the emergency obstetrics and gynaecological unit.

      Article info

      Publication history

      Published online: September 21, 2021
      Accepted: September 18, 2021
      Received in revised form: September 13, 2021
      Received: August 1, 2021

      Identification

      DOI: https://doi.org/10.1016/j.ejogrb.2021.09.020

      Copyright

      © 2021 The Authors. Published by Elsevier B.V.

      User license

      Creative Commons Attribution (CC BY 4.0) |
      How you can reuse Information Icon
      Creative Commons Attribution (CC BY 4.0)

      Permitted

      • Read, print & download
      • Redistribute or republish the final article
      • Text & data mine
      • Translate the article
      • Reuse portions or extracts from the article in other works
      • Sell or re-use for commercial purposes

      Elsevier's open access license policy

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX