Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

Medico-legal aspects of sexual violence

Exposure to sexual violence is associated with a range of health consequences for the survivor. Comprehensive care must address the following issues: physical injuries; pregnancy; STIs, HIV and hepatitis B; counseling and social support; and follow-up consultations.

  1. The possibility of pregnancy resulting from the assault should be discussed. If the woman is first seen up to 5 days after the assault took place, emergency contraception should be offered. If she is first seen more than 5 days after the assault, she should be advised to return for pregnancy testing if she misses her next period.
  2. If sexual violence results in a pregnancy that a woman wishes to terminate, referral to legal abortion services should be made.
  3. When appropriate, patients should be offered testing for chlamydia, gonorrhoea, trichomoniasis, syphilis, HIV and hepatitis B; this may vary according to existing local protocols.
  4. The decision to offer STI prophylaxis should be made on a case-by-case basis. Routine prophylactic treatment of all patients is not generally recommended.
  5. Health workers must discuss thoroughly the risks and benefits of HIV post-exposure prophylaxis so that they can help their patients reach an informed decision about what is best for them.
  6. Social support and counseling are important for recovery. Patients should receive information about the range of normal physical and behavioral responses they can expect, and they should be offered emotional and social support.
  7. All patients should be offered access to follow-up services, including a medical review at 2 weeks, 3 months and 6 months post assault, and referrals for counseling and other support services.

Source: adapted from WHO (2003) Guidelines for medico-legal care for victims of sexual violence

Clinical management and dosing regimes

The WHO provides standards for clinical management and dosing regimes for the following health issues (see list below).
They are published in WHO (2003) Guidelines for medico-legal care for victims of sexual violence

  • physical injuries
  • pregnancy prevention and management
  • emergency contraception
  • sexually transmitted infections (STI)
    - testing
    - prophylactic treatment for STIs
     - testing
     - post-exposure prophylaxis
  • Hepatitis B
  • patient information
  • follow-up care
  • medical review
  • follow-up visits (at 2 weeks, 3 months and 6 months post assault)
  • referrals