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Citation
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Balint N, David M, Fegert JM, Fryszer LA, Helling-Bakki A, Herrmann B, Hirchenhain C, Schmidt U, Winter SM. Geburtshilfe Frauenheilkd. 2022; 82(07): 694-705. |
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Abstract
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According to the Istanbul Convention, rape (Latin: stuprum) is defined as "… non-consensual vaginal, anal or oral penetration of a sexual nature of the body of another person with any bodily part or object …" [1].
According to a representative study published in 2005 and commissioned by the German Federal Ministry of Family Affairs, Senior Citizens, Women and Youth, 5.5% of surveyed women reported that they had been raped at least once in their life since they had turned 16, 4.3% had suffered at least one attempted rape, and between 1 and 5.4% had experienced some form of sexual assault [2]. According to a study carried out in Germany, the prevalence for adolescents was 3% [3]. The impact and extent of this differs for each affected individual; for some affected persons, it can have a lifelong negative impact on their physical and psychosocial health.
As studies in the USA have shown, between two-thirds and three-quarters of sexual assaults on young people are carried out by persons who are known to them [4].
The World Health Organisation (WHO) has emphasised the importance of the initial medical care given to victims after sexual violence. This care is both an early intervention and serves to help the affected person cope with the negative experience [5] [6]. Empathic, non-judgemental and appropriate initial care is a great support for the affected person. Medical care can have a positive impact on healing processes and on processing the experience [7] [8]. At the same time, the professionals who are most often consulted in this context are doctors [2].
This Statement aims to further improve and standardise the medical care offered to persons who have experienced sexual violence, particularly young females affected by rape in Germany.
The Statement is primarily aimed at gynaecologists working in hospitals and in private practice; it is based on a Statement by Fryszer et al. published in spring 2022 on the care and support of female adults suspected of having been raped [9].
In addition, this Statement makes specific reference to the extensive 2019 Child Protection Guideline of the Federal Republic of Germany which was updated in 2022 [10].
This DGGG Statement is divided into two parts, based on the age of the affected person (about 14 to 17 years of age/pubertal; 0 to about 13 years of age/prepubertal). There are medical, structural and forensic reasons for this division.
The care and support of young females above the age of about 14 years who have suffered sexual violence, particularly if they have suffered a suspected rape, resembles the medical examinations undertaken in grown women, meaning that these duties may and should be carried out by gynaecologists (or appropriately qualified paediatricians and specialists in adolescent medicine, possibly also involving medical forensic specialists). Very often, the initial contact will occur in a paediatric emergency room, meaning that it is important to provide interdisciplinary care, depending on the local circumstances.
The specific psychological and developmental characteristics of children and adolescents must be taken into account. For this reason, the first part of this statement will focus on detailed recommendations on obtaining information and carrying out examinations. It is worth noting that because of the heterogeneous development during puberty, following a strict age limit to carry out recommendations is neither useful nor beneficial. The proposed age limits are therefore only intended as a general guide to differentiate between prepubertal and pubertal levels of development.
However, it is imperative that the paediatric gynaecological examination of prepubertal girls up to the age of about 13 years required in connection with suspected sexual abuse is carried out by an experienced specialist gynaecological or paediatric physician with specialist knowledge of paediatric and gynaecological forensic diagnostics.
The authors of this statement expressly recommend that if this specialist knowledge is not available in the hospital or the doctor's surgery, the affected child/adolescent should be referred without delay to an appropriate centre, child protection outpatient unit, or Childhood House, where available.
It should be noted in this context that in Germany, § 176 of the German Criminal Code (Strafgesetzbuch, StGB) states that any sexual activity with a person under the age of 14 years is a criminal offence. Additional offence-related aspects must be present for sexual activities involving adolescents between the age of 14 and 17 years of age to be classified as a criminal offence (§ 182 StGB) [10].
This Statement wishes to specifically refer to the recommendations issued by the German Society for Forensic Medicine (Deutsche Gesellschaft für Rechtsmedizin) on how to carry out medical forensic examinations...
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Ziele Die vorgelegten Empfehlungen sollen zur weiteren Verbesserung und Standardisierung der ärztlichen Versorgung von Betroffenen sexualisierter Gewalt, insbes. von einer Vergewaltigung betroffenen weiblichen Minderjährigen in Deutschland beitragen. Sie wendet sich vor allem an Frauenärztinnen und Frauenärzte in der Klinik und in der Niederlassung und ergänzt die umfangreiche Kinderschutzleitlinie der Bundesrepublik Deutschland.
Methoden Unter Einbeziehung der Ergebnisse einer umfassenden selektiven Literaturrecherche wurden von einer interdisziplinär besetzten Gruppe von Expertinnen und Experten in einem 3-stufigen Verfahren im Auftrag des Vorstands der DGGG diese Empfehlungen erarbeitet und im Konsens verabschiedet.
Zusammenfassung Diese DGGG-Stellungnahme ist entsprechend dem Alter der Betroffenen (ca. 14 bis 17 Jahre/pubertär; 0 bis ca. 13 Jahre/präpubertär) zweigeteilt. Dies hat medizinische, strukturelle und forensische Gründe. Es werden zahlreiche Empfehlungen zum Umgang mit den mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffenen Minderjährigen, zur Erstversorgung, zu Versorgungsformen (z. B. Vertrauliche Spurensicherung), zur Anamneseerhebung, zur medizinisch-forensischen Untersuchung, zur medizinischen, psychischen und psychosozialen Versorgung sowie zur Nachbetreuung gegeben.
Language: en |