How to counsel patients after sexual assault


Roughly a quarter of all college students are sexually victimized in some way, but many will never report their crime. Pediatricians can counsel college-bound patients about the risks and prevention strategies, and should learn to recognize the signs of unreported abuse.

Forceful, non-consensual sexual contact is on the rise at nearly 30 colleges surveyed last year by the Association of American Universities (AAU), but less than half of those students reported the crimes out of shame or fear of embarrassment.

Pediatricians are in unique position to recognize signs of sexual assault, and provide intervention for those students, says Jen Marsh, vice president for victim services at Rape, Abuse and Incest National Network (RAINN).

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“We know that the sooner people have a positive disclosure experience following an assault, the better their recovery process,” Marsh says.

Many young people believe that sexual assault won’t happen to them, Marsh says. The new report by AAU paints a different picture, revealing that only 20% of students viewed sexual assault as a threat, despite the fact that nearly a third of senior female undergraduates have experienced some type of sexual assault by graduation.

Generally speaking, AAU identified the highest rate of victimization among non-heterosexual students and female undergraduate students with disabilities. Reporting rates, however, were low across the spectrum of student victims, with victims of sexual touching related to force or incapacitation having the lowest reporting rates.

Student most at risk of sexual assault are female undergraduate students and students identifying as transgender, genderqueer, non-conforming, or questioning their gender (TGQN), according to AAU. Overall, nearly 12% of the students surveyed reported nonconsensual touching or penetration by force last year. Undergraduate TGQN students reported the highest rates of assault at 12.4%, followed by 10.8% among undergraduate females, and 8.3% of TGQN graduate students.

NEXT: What is the difference between class year?


In terms of their entire college experience, rather than annual reporting, AAU says 21.2% of seniors overall reported nonconsensual sexual conduct at some point during their time in college-33.1% of senior female students and 39.1% of TGQN senior students. About half of those cases involved nonconsensual penetration by physical force, threat of physical force, incapacitation, coercion, or absence of affirmative consent.

As far as class year goes, AAU says the 16.9% of freshman females who report sexual assault or misconduct compared to 11.1% of seniors may be due to the fact that younger students are not as familiar with “situations that may lead to an incident of sexual assault or misconduct.”

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Risk of nonconsensual sexual contact due to physical force or incapacitation declines from freshman to senior year, according to the report, but other types of nonconsensual contact remained consistent throughout the undergraduate years. Many nonconsensual sexual encounters involve alcohol or drugs, and the study found that many students decline to report the crimes against them because either they are afraid of getting in trouble for the alcohol or drug consumption; they are embarrassed or ashamed; or they thought “nothing would be done about it.”

According to the report, assaults involving alcohol and drugs were nearly equal to those that didn’t-5.4% of students report nonconsensual penetration due to incapacitation compared to 5.7% who reported nonconsensual penetration due to physical force alone. The number of students that reported forced sexual touching when incapacitated was nearly double of that in cases of force alone (12.8% vs 6.6%).

In addition to polling students on sexual contact, AAU also found that 47.7% of students reported that they had been victims of sexual harassment since enrolling in college including 75.2% and 69.4% of undergraduate and graduate TGQN students, respectively, and nearly 62% of female undergraduates. Smaller colleges had higher rates of sexual harassment, according to the report.

NEXT: Who are the offenders?


The type of college matters, too, according to the report. The AAU says overall, 13% to 30% of students in the survey reported some degree of sexual assault, but private schools had a higher rate (25.3%) than public schools (22.8%).              

Offenders are often fellow students, and most are acquaintances (69.9%), followed by strangers (43.1%). Roughly 16% of female graduate students reported the offender was a teacher or advisor compared to about 5% of female undergraduates, and 17% of female graduate students reported their offender was a co-worker or boss compared to 6% of female undergraduates.

More than half of students who didn’t report the crimes against them said they didn’t think the incident was “serious enough,” even including cases of penetration involving physical force. Another 36% of victims of penetration by physical force didn’t report the incident due to shame or embarrassment, according to the report.

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While roughly half of students believe that they would be supported by their peers and university, and that a fair investigation and appropriate action against the offender would occur, less than 40% of students believe campus officials would take action in terms of preventive measures against sexual assaults.

Most colleges have policies and resources for sexual assault, but one of the most important things to teach college-bound students is to look out for each other, Marsh says.

“One of the most important things to share with young people, particularly in a college setting, is to stick together. Most people, not just adolescents and young adults, never think they will be a victim of this crime,” Marsh says. “Look out for your friends; stay close with your friends; know where they are.”

Bystander intervention is one of the most important deterrents to sexual assault, she says. The AAU report revealed, however, that even when students noticed something was amiss, intervention was not always guaranteed.

Nearly 20% of students polled by AAU say the suspected a friend had been sexually assaulted, and more than 66% took some type of action. Another 44% of students reported witnessing a drunk friend heading for a sexual encounter, but 77% say they did nothing in those cases. Among students who saw someone acting in a sexual violent or harassing manner, 25% said they didn’t know what to do and 30% said they did nothing.

NEXT: Looking at prevention tips


In terms of prevention, less than a third of students knew about their campus policies on sexual assault, and where to get help if an assault were to occur.

“If you see something you think isn’t right or could lead to a dangerous situation, don’t intervene in a way that will put you at risk, but you can diffuse a situation,” Marsh says.

Pediatricians should also counsel college-bound students on the important or reporting assaults, and let them-or students that have already been assaulted-know that what happened was not their fault.

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“Many survivors don’t report or reach out for help. They are afraid if they were drinking they will get in trouble or that it was their fault through a bad decision,” Marsh says. “That’s not a justification for assault, so letting someone know right off the bat that if something does happen its okay to reach out.”

Pediatricians should also counsel parents of victims or college-bound students to avoid placing blame of victims of assault. Asking questions like “what were you doing drinking?” may be a natural reaction for a parent, but will result in the victim being less likely to share their experience and seek help, Marsh says.

For pediatricians who suspect a patient has suffered a sexual assault, Marsh says key signs are a striking change in behavior or attitude.

“We find with sexual assault survivors, particularly in college, they may have been enthusiastic then become withdrawn or drop out of activities. Or maybe they start partying or going out to parties all the time,” Marsha says.

Pediatricians should ask these patients about unwanted sexual contact, but not be too specific in their questioning. Most victims won’t identify their experience as rape, Marsh says, advising physicians to frame their questioning in terms of unwanted sexual contact or touching.

NEXT: What does AAP have to offer?


The American Academy of Pediatrics offers educational and counseling resources on sexual assault for pediatricians, and the American College of Emergency Physicians and the

National Sexual Violence Resource Center

both offer screening tools physicians can use in the clinical setting.

If sexual abuse has been identified, Marsh says pediatricians should advise patients about the resources available to them within their community, specifically referring them to a counseling center that has experience in sexual trauma.

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“I don’t think the resources at a local rape crisis center should be overlooked. The resources there have expertise,” Marsh says. “If they go to general therapist, they may not get therapeutic benefit and leave therapy. offers guidance for victims of sexual assault, and RAINN offers access to local crisis centers on its website, in addition to 24-hour online counseling and telephone hotline services.


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