Version May 2024
INTRODUCTION — The identification and management of date rape will be discussed here. The epidemiology, risk factors, and prevention of date rape; an overview of adolescent relationship abuse; sexual abuse; and the evaluation and management of sexual assault are discussed separately.
●(See "Date rape: Risk factors and prevention".)
●(See "Adolescent relationship abuse including physical and sexual teen dating violence".)
●(See "Evaluation of sexual abuse in children and adolescents".)
●(See "Management and sequelae of sexual abuse in children and adolescents".)
TERMINOLOGY
Sexual assault/sexual violence – Sexual assault or sexual violence is an inclusive term that refers to any form of forced or inappropriate unwanted sexual contact ranging from forced touching or kissing to verbally or physically coerced vaginal, oral, or anal penetration [1-4]. This includes situations in which the victim is unable to consent because of intoxication, inability to understand the consequences, misperceptions because of age, or other incapacities.
Rape – The legal definition of rape varies from state to state [5]. It generally encompasses nonconsensual vaginal, anal, or oral penetration (by penis, finger, or object) that involves force or threat of force (physical or psychological), lack of consent, or inability to provide consent because of age, intoxication, or mental status [5-8]. One way in which rape is categorized is by the relationship between perpetrator and victim.
●Stranger rape describes nonconsensual sexual penetration between individuals who do not know each other before the sexual act [8].
●Acquaintance rape describes nonconsensual sexual penetration between individuals who know each other in some capacity before the sexual act [8].
•Date rape is a subset of acquaintance rape in which nonconsensual sexual penetration occurs between two people who may be romantically involved or more casually connected (eg, on a date, "hooking up") [8]. Date rape can occur when the victim is alert and able to make decisions, semiconscious, or unable to respond due to alcohol or other drug use. It can occur between two individuals who have had prior consensual sexual intercourse or other forms of intimacy. Verbal coercion, threats or use of physical force, or the use of alcohol or illicit drugs may occur as precipitating events.
In many cases, date rape occurs within the context of a heterosexual dating relationship, with the male as perpetrator and the female as the victim. Same-sex and female to male sexual violence also occur in dating relationships [9,10]. The prevalence of sexual violence victimization among transgender and nonbinary individuals is increasingly recognized [11]. However, because these types of dating and sexual violence have not yet been adequately studied, this topic focuses on heterosexual dating and sexual violence with male perpetrators and female victims. Although this topic refers to people who have experienced sexual violence as "victims," there is a growing body of literature that emphasizes the strengths of those who have been harmed, using terms such as "survivors" [12,13].
EPIDEMIOLOGY — Adolescent and young adult females (16 to 24 years of age) are more likely to be victims of sexual assault than are females in all other age groups [7,14]. Most sexual assault survivors (80 percent) experience their first assault before the age of 24 years [15]. Adolescents who have experienced a rape or attempted rape are three to four times as likely as those without this history to experience subsequent sexual assault during their college years [16-19].
The majority of rapes in adolescent and young adult females are committed by someone who is known to the victim; as many as 80 to 90 percent of rapes on college campuses are perpetrated by a date or acquaintance [16,20]. Approximately one-fourth of college-age males report having used coercion during sexual contact [21].
The epidemiology of date rape is discussed in greater detail separately. (See "Date rape: Risk factors and prevention", section on 'Epidemiology'.)
RISK FACTORS — Risk factors for date rape (table 1) are discussed separately. (See "Date rape: Risk factors and prevention", section on 'Risk factors'.)
BARRIERS TO DISCLOSURE — Many victims of date rape do not disclose the rape to police, providers, caregivers, or friends [22-29]. Male victims are less likely to report sexual assault than female victims [25,26]. Among female victims, adolescents are more likely to delay seeking medical care than are adults.
Disclosure of date rape is affected by the victim's belief in rape myths, attribution of blame (which may be related to a victim's misperception that the assault occurred due to use of alcohol), relationship with the perpetrator (eg, current partner), and the beliefs and stereotypes of the victim's culture [30]. Self-blame, shame, fear of retaliation, fear of judgment, lack of information, and limited exposure to violence prevention education may prevent the victim from seeking care or disclosure [3,7,27,31,32]. Victims who feel betrayed or question their choices may find it difficult to confide in anyone. Delayed disclosure may also delay treatment and recovery [27-29].
Victims may hold beliefs that prevent them from considering the forced sexual activity to be rape [33,34]. Many adolescent/young adult males and females believe that forced intercourse is rape only if a stranger commits the act in a violent and brutal manner, often with the use of a weapon. They also may believe that to be considered rape, the victim must have a "good reputation" and prior actions and behaviors that are beyond reproach. If any of these components is missing, the victim may not believe that they were raped – or they may fear that whomever they tell will not believe that they were raped. (See "Date rape: Risk factors and prevention", section on 'Other contributing factors'.)
Victims also may be confused about whether the incident was forced or consensual [3,35]. They may blame themselves for creating the context in which the unwanted sexual assault occurred [7,36,37]. This is especially true when underage drinking or illegal drug use is involved. Perpetrators may not believe that they are culpable or that any harm was done [30,38]. (See "Date rape: Risk factors and prevention", section on 'Situational factors' and "Date rape: Risk factors and prevention", section on 'Adolescent perceptions of sexual behavior'.)
Additional barriers to disclosure may include [3,23,39-41]:
●Decreased access to care (eg, lack of health insurance)
●Concern that the lack of physical harm or delay in disclosure may cause others to doubt the authenticity of the rape
●Lack of memory of the assault (eg, if a "date rape drug" was used) (see "Date rape: Risk factors and prevention", section on 'Drug use')
●Fear about judgment by family or communities (see "Date rape: Risk factors and prevention", section on 'Cultural considerations')
●Concern about lack of confidentiality
IDENTIFICATION
Symptoms and sequelae — Adolescent and young adult victims of date rape may develop symptoms and/or sequelae of sexual violence. These symptoms and sequelae may be the presenting complaints of victims who have not disclosed the assault. The recognition of these findings as possible manifestations of sexual assault may facilitate earlier identification of and intervention for victims of sexual violence. (See "Evaluation and management of adult and adolescent sexual assault victims in the emergency department", section on 'Psychosocial issues'.)
Symptoms and sequelae of sexual violence include (table 2) [3,5,7,42-47]:
●Disturbances in sleep (eg, taking more than 20 minutes to fall asleep, nightmares)
●Decrease in appetite; less interest in eating
●Somatic reactions (eg, chronic pelvic pain, recurrent abdominal pain, chronic headache, multiple physical complaints)
●Depressive symptoms, particularly in the first two months after the assault (see "Pediatric unipolar depression: Epidemiology, clinical features, assessment, and diagnosis", section on 'Clinical features')
●Suicidality [48]
●Anxiety, which remains at high levels throughout the first year after the assault (see "Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis")
●Signs of posttraumatic stress disorder (emotional numbing, diminished interest in everyday activities, detachment from others) (see "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical features, assessment, and diagnosis", section on 'Clinical manifestations')
●Psychiatric or behavior problems that are more common in the other sex (eg, eating disorders in males or fighting in females) [49]
●School failure
●Decreased self-esteem, self-worth, and/or confidence in their sense of judgment
●Difficulty maintaining relationships
●Sexual dysfunction (satisfaction and pleasure in sexual activities may be reduced in victims for at least a year) [7,50,51]
●Male victims may experience challenges to their sense of masculinity and confusion about their sexual orientation [52,53]
History of sexual assault is associated with alcohol or substance misuse and decreased sexual negotiation skills, which may lead to lack of contraception and condom use, pregnancy, or sexually transmitted infections [54-64]. Alcohol, substance use, and decreased sexual negotiation skills may be precursors to sexual victimization, consequences of sexual victimization, or both [61]. They also may contribute to an elevated risk for revictimization. (See 'Preventing revictimization' below.)
Creating safe space for education, support, and disclosure — Clinicians have a vital role in ensuring that young people receive information about healthy and unhealthy relationships – whether or not the young person discloses sexual violence victimization – and resources regarding sexual violence for themselves and their friends. Clinicians should also be prepared for disclosure. Creating a safe space for education, support, and disclosure is discussed in detail separately. (See "Adolescent relationship abuse including physical and sexual teen dating violence".)
Before education about and assessment for sexual assault, it is important for clinicians to be aware of the unique reporting requirements of their state and local institutions to child protective services or law enforcement, and to have a referral plan in place [65]. Clinicians should always discuss the limits of confidentiality (also called "conditional confidentiality"). (See 'Reporting requirements and confidentiality' below and 'Psychosocial support' below.)
The pediatric health care provider can facilitate discussion of date or acquaintance rape by [56]:
●Establishing an environment conducive to disclosure; victims of violence must feel that they are in a safe, trustworthy, and welcoming place to disclose the experience; creating such an environment requires that offices have educational materials about dating and sexual violence (ie, brochures and posters) that reflect the diversity of the population served; staff should be trained and able to provide education about dating and sexual violence regardless of disclosure, and to provide help when such experiences are disclosed [66] (see 'Management' below)
●Providing anticipatory guidance and educational materials (eg, pamphlets and videos); this demonstrates the provider's sensitivity to sexual violence and willingness to discuss the occurrence of sexual aggression among dating partners (see 'Resources' below)
●Providing general information about the prevalence of sexual assault in dating relationships (whether or not the patient discloses sexual violence experiences); this may help reduce the sense of isolation and reassure a victimized patient that they are not the only person who has experienced dating violence [67]
●Talking about dating violence, which opens the door to communication and possible help
Asking about dating violence — Asking adolescent and young adult patients about the symptoms and sequelae of date rape (table 2) may help to connect young people to appropriate care. Some victims may not have labeled their unwanted sexual experience as rape and therefore may not think about disclosing it; others may be ashamed or embarrassed about the event but willing to talk about their symptoms (eg, inability to sleep, poor appetite, etc). (See 'Symptoms and sequelae' above and 'Barriers to disclosure' above.)
Screening for dating violence is controversial [56,68]. Those who argue against screening suggest that screening is not a survivor-centered, trauma-sensitive approach, consistent measures for identifying at-risk groups are lacking, and appropriate resources for treatment may not be available in many communities [68]. Those who support screening suggest that screening is an important way to overcome barriers to disclosure and that disclosure may affect clinical management or anticipatory guidance [27,56]. In a survey of 645 ethnically diverse adolescent and young adult females, more than 90 percent indicated that a health care provider was the most appropriate adult to ask about interpersonal violence [69]. As an alternative to disclosure-driven screening practices, emerging research on universal education and brief counseling interventions with adolescents has shown increases in recognition of what constitutes sexual coercion, increased awareness of available resources, and reductions in abuse victimization three months later [70].
The American College of Obstetricians and Gynecologists (ACOG) recommends universal screening of women for intimate partner violence, including date/acquaintance rape and has developed tools to facilitate screening [71-73]. The American Academy of Pediatrics (AAP) guidelines for the care of adolescent sexual assault victims indicate that screening for sexual victimization should be part of visits for psychosocial problems, sexuality issues, contraception or substance abuse, and health supervision [3].
Reporting requirements and confidentiality — Legal definitions of and reporting requirements for sexual assault vary by state. Before screening for sexual assault, clinicians should be aware of the unique reporting requirements of their state and local institutions. Questions about these requirements can be answered by the state child protection agency, the district attorney's office, and/or local women's organizations [56].
The clinician should always disclose the limits of confidentiality before offering any education or counseling related to healthy/unhealthy relationships. Depending upon the age of the victim and state-reporting requirements, the evaluating provider may need to report the assault to child protective services even if the victim does not want to press charges [3,74]. Reporting requirements should be communicated to the patient in the context of the patient-provider confidentiality agreement, explicitly defining the circumstances under which confidentiality is "conditional." (See "Confidentiality in adolescent health care", section on 'Exceptions to confidentiality'.)
Examples of how to introduce the concept of conditional confidentiality follow:
●"Generally, what you say in here stays in here, but there are some exceptions. If I feel that you may hurt yourself or someone else, or that you have been abused by someone, I will need to talk to others to help make sure you get all the care you need" [5].
●"I want you to understand that when we talk about things that have to do with sex and drugs and your feelings, it is confidential. This means that what we talk about is just between you and me and that other people, including your parents, will not find out about it unless you want them to know. One exception to this is if I am concerned someone has abused or hurt you. Another exception is if I am concerned you are at serious risk of harm or are planning to or behaving as though you may hurt yourself or someone else. In these situations, I would have to talk to other adults, but I would talk to you first so we could figure out whom we should talk to and the best way to help you be safer" [75].
How to ask about dating violence — Asking about dating violence should be done without the caregivers or other individuals present and after reviewing the limits of confidentiality (this includes not using a family member as an interpreter for non-English speaking patients) [3]. Given the high prevalence of sexual and dating violence experiences among adolescents and young adults, clinicians should first offer educational materials about healthy relationships to all of their patients. In a trauma-informed approach, clinicians offer information and resources without pushing their patients for disclosure. Sharing information by encouraging patients to have dating violence resources in case they need to help a friend is one strategy to reduce the stigma associated with partner and sexual violence and facilitate offering educational materials. This can be followed by asking direct questions about dating and sexual violence or a series of general open-ended questions with the intent of leading the patient to spontaneously discuss dating violence (eg, "Tell me about your partner"; "How does your partner treat you?" or "Is any of this part of your story?") [56,65]. Direct questions are more successful and are recommended by the AAP, the ACOG, and other groups [3,56,71,76,77]. Examples of how to introduce the discussion of sexual experience include:
●"Because I want to help my patients, I ask everyone about topics that may be sensitive or may make you uncomfortable. Some young adults come to my office having been hurt by people around them. It is important that I know these things to be able to help them" [5].
●"Many teens your age experience threats, name calling, uninvited touching, sex, or violence, so I ask all my teen patients about it. May I ask you a few questions?" [76].
The AAP suggests that direct questions about sexual experiences should include questions about [3]:
●Age at first sexual experience
●Use of the internet to find romantic or sexual partners
●Unwanted or forced sexual acts (eg, "Has your partner ever forced you to have sex when you did not want to?"; "Has your partner ever refused to practice safe sex?"; "Have you ever been forced to do something sexual that you did not want to do?") [76,77]
●Relationship parameters (eg, exploitative or nonconsensual versus healthy and consensual, exchanging sex for something of value like food, shelter, or clothing)
A randomized trial evaluated the effectiveness of various screening approaches in identifying relationship violence (physical, emotional, sexual) among adolescent/young adult females (15 to 24 years of age) attending a reproductive health clinic [78]. Detection was greatest with the bidirectional approach, which acknowledges the role that both partners may play in inflicting and receiving violence. These brief screening questions were well received by both patients and providers and may be useful in a variety of busy practice settings.
●In the past year:
•My partner is suspicious that I am unfaithful.
•I am suspicious that my partner is unfaithful.
•My partner forced me to have sex when I did not want to.
•I forced my partner to have sex when they did not want to.
•My partner hit, slapped, or physically hurt me on purpose.
•I hit, slapped, or physically hurt my partner on purpose.
●At any point in the past, including the past year:
•Have you ever been slapped, hit, or otherwise physically hurt by your partner?
•Has anyone ever raped you or forced you into a sexual act?
Although other instruments have been used to evaluate relationship violence in clinic settings for research purposes, they tend to be long (eg, the Conflict in Adolescent Dating Relationships Inventory [79], the Sexual Aggression Questionnaire [80]) or limited in scope (eg, the Sexual Experience Survey [81]).
EVALUATION — The acute evaluation for sexual assault is discussed separately. (See "Evaluation and management of adult and adolescent sexual assault victims in the emergency department", section on 'Evaluation'.)
Forensic evaluation — Forensic evaluation should be offered to victims of date rape but is not mandatory and requires informed consent. Individual jurisdictions determine the maximal time interval in which forensic evidence may be collected; the interval typically varies from 36 hours to 1 week [56]. If the sexual assault is disclosed within a timeframe when collection of forensic evidence is feasible, and the victim wants to file charges, the victim should be advised not to change their clothes, bathe, shower, eat, drink, urinate, defecate, or douche until they have undergone forensic examination [3]. Clothes worn during the incident should be stored in a paper bag. In some facilities, patients may have the option of storing forensic evidence for possible use in the future if they are uncertain about filing charges at the time of presentation.
Additional information about the collection of forensic evidence is provided separately. (See "Evaluation and management of adult and adolescent sexual assault victims in the emergency department", section on 'Forensic evaluation'.)
Toxicology testing — Toxicology testing may be indicated if the victim, persons accompanying the victim, or witnesses raise concerns about possible drug involvement or if the victim presents with clinical features of substance use (eg, intoxication, fluctuating level of consciousness, physiologic instability, amnesia of the event) [3,82]. If possible, informed consent should be obtained before toxicology testing.
When indicated, toxicology testing should be performed as soon as possible; most of the drugs used to facilitate sexual assault have only a brief window of detection [3]. Consultation with the toxicology laboratory is suggested if alcohol- or drug-facilitated sexual assault is suspected. Additional caveats regarding toxicology testing and toxicology testing for forensic purposes are discussed separately. (See "Testing for drugs of abuse (DOAs)", section on 'Drug-facilitated sexual assault'.)
MANAGEMENT — The management of sexual assault involves provision of psychosocial support and prevention of pregnancy, sexually transmitted infections, and revictimization.
Psychosocial support — Adolescents and young adults who disclose that they have been sexually assaulted benefit from the opportunity to describe the experience at a comfortable pace and in their own words; sufficient time should be provided for this conversation [29,35].
The health care provider's initial response to disclosure should be one of appreciation, validation, empathy, and support (table 3) [83]. Such a reaction demonstrates respect and is critical to keeping the lines of patient-clinician communication open. The health care provider should recognize and appreciate the subjective experience from the patient's perspective. Acknowledging the patient's feelings, concerns, and fears may help to restore their belief in themselves as a normal, healthy individual. The provider can help the patient to identify individuals in the patient's social network who can provide additional support. However, providers must obtain permission from the patient before engaging family members or friends for support (see "Confidentiality in adolescent health care"). Offering the patient options for treatment or support and respecting their decisions helps them to regain a sense of control over their life and to realize that they have the ability to make decisions.
Sexual assault affects the victim's sense of self and their sexuality [5]. Internalized feelings of guilt, shame, betrayal, and anger can impede recovery [7]. The victim should be told, repeatedly if necessary, that they were not responsible: Rape is never the victim's fault [7,29]. Voluntary use of alcohol and/or drugs before sexual assault does not diminish the seriousness of sexual assault [82]. Because of the potential for long-term psychological consequences, clinicians should be prepared to offer psychological support or referral for counseling (eg, to a social worker, counselor, or dating violence hotline). The provision of mental health services (eg, support groups, group therapy, individual therapy) can help to restore a sense of normalcy and provide a therapeutic environment that facilitates recovery. Awareness of community resources can facilitate timely referrals. The names of mental health professionals who are skilled in the care of sexual assault victims may be obtained by calling a sexual assault care center [3]. Funding for care may be available through the Crime Victims Fund.
It may be helpful to encourage the victim to discuss the incident with a caregiver or other trusted adult [3]. The involvement of such a support person may ensure that the victim receives support and appropriate counseling, particularly if the victim becomes depressed and lacks the initiative or ability to access help. However, it is important to respect the victim's decisions about who and when to tell about the assault [29].
Medical issues — Health concerns that must be addressed in adolescent and young adult sexual assault victims who present soon after the incident include the possibility of pregnancy, sexually transmitted infections, and physical injury [3]. However, few adolescent victims of sexual assault seek medical care directly following the assault experience [74]. Analysis of data from the longitudinal National Women's study indicates that concern about sexually transmitted infection, injury, and having reported the assault to authorities were associated with seeking medical care [84].
Adolescent and young adult victims of sexual violence are less likely to sustain physical injuries outside of the anogenital area during the assault than are older adult victims [3,74,85]. Nonetheless, providers should conduct a thorough physical examination, with special focus on the genitalia. (See "Evaluation and management of adult and adolescent sexual assault victims in the emergency department", section on 'Evaluation'.)
Prevention of pregnancy and sexually transmitted infections are discussed separately. (See "Emergency contraception" and "Evaluation and management of adult and adolescent sexual assault victims in the emergency department", section on 'Management'.)
Safety — Victims of dating violence are at risk for suicidality, self-harm, and subsequent harm by the perpetrator. All victims of sexual assault should be screened for suicidal ideation and self-harm behavior [3]. Even if the victim does not report suicidal ideation, we advise parents and caregivers to reduce potential access to lethal means of suicide (eg, guns, medications) because of the increased risk of suicide after a sexual assault [86]. (See "Suicidal behavior in children and adolescents: Epidemiology and risk factors", section on 'Risk factors' and "Suicidal ideation and behavior in children and adolescents: Evaluation and management", section on 'Prevention'.)
Issues of personal safety should be addressed by asking if the victim is still in a relationship with the perpetrator and identifying whether the perpetrator has access to the victim's car, apartment, or any other area of the victim's life where personal safety may be compromised. Additional information about safety assessment and formulating a safety plan is available through the IPVhealth (overseen by Futures Without Violence) [77]. In addition, the MyPlan app is available as a decision aid for patients to weigh their risk for lethality. In a multicenter randomized trial, it reduced physical and psychological victimization [87].
All patients who disclose sexual violence should be offered the opportunity to connect by phone or in person with a victim service advocate and given anonymous hotline numbers. Clinicians should be aware of local domestic and sexual violence agencies and be able to provide information and referrals as necessary. Clinical practices are encouraged to establish formal partnership agreements with their local domestic and sexual violence agencies to facilitate the referral processes. In the United States, the Rape, Abuse & Incest National Network [RAINN] operates a National Sexual Assault Hotline (800-656-4673) that automatically routes the caller to the nearest sexual assault service provider; live chat is also available. The National Domestic Violence Hotline (800-799-7233) will also route callers to their local domestic violence agency, can provide safety planning, and offers counseling in multiple languages.
Preventing revictimization — Preventing revictimization is an important aspect of the treatment of adolescent and young adult victims of date rape [7]. Adolescents who have experienced a rape or attempted rape are three to four times as likely as those without this history to experience subsequent sexual assault during their college years [16-19]. Difficulty in stopping unwanted sexual contact plays a role in the cycle of sexual victimization [7].
Prevention of date rape is discussed separately (see "Date rape: Risk factors and prevention", section on 'Prevention'). Prevention of revictimization involves a special focus on helping victims to [7,88]:
●Identify sexually aggressive partners
●Identify and avoid dangerous situations
●Be more assertive in their sexual negotiations
These tasks can be particularly difficult for adolescents and young adults – the factors that contribute to the progression from normal sexual negotiation to coercive sexual activity are typical elements of adolescent and college life [88,89]. It can be difficult to balance the desire for normal adolescent and young adult social interaction with the sense of heightened vulnerability [7]. Integration of discussions about consent, communication, and intimacy should be part of comprehensive sexual health education for adolescents and young adults. Most critically, prevention requires a focus on reducing date rape perpetration. Survivors of date rape should hear consistently from their health care providers that they are never to blame for a sexual assault.
Follow-up — The American Academy of Pediatrics suggests that victims of sexual assault be seen within one to two weeks of disclosure to ensure that counseling has been arranged and to provide assessment for sexually transmitted infections and/or injury healing (as indicated) [3]. Thereafter, the frequency of follow-up should be individualized according to patient circumstances (eg, support network, ongoing relationship with perpetrator, participation in counseling). Some patients may require frequent office visits or phone follow-ups during the first few months after disclosure.
RESOURCES — Resources related to date/acquaintance rape for patients, caregivers, and providers are listed below:
●The Centers for Disease Control and Prevention Preventing Teen Dating Violence
●Futures Without Violence
•Protocol for Adolescent Relationship Abuse Prevention and Intervention
●National Center for Education in Maternal and Child Health (Georgetown University)
●The National Center for the Victims of Crime
●The National Sexual Violence Resource Center
●Rape, Abuse & Incest National Network
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Sexual assault".)
SUMMARY AND RECOMMENDATIONS
●Date rape is a subset of acquaintance rape in which nonconsensual sexual penetration occurs between two people who are in a romantic relationship, dating, or involved sexually. (See 'Terminology' above.)
●Date rape occurs most often among females between the ages of 16 and 24 years. Other risk factors for sexual assault are listed in the table (table 1). (See 'Epidemiology' above and "Date rape: Risk factors and prevention", section on 'Risk factors'.)
●Disclosure of date rape is often delayed due to self-blame, shame, fear of judgment, or failure to label the experience as rape. Victims of date rape may present with psychological sequelae of sexual assault (table 2). (See 'Barriers to disclosure' above and 'Symptoms and sequelae' above.)
●Pediatric health care providers can establish a safe, confidential, and trustworthy environment, provide anticipatory guidance and educational materials about date rape and other forms of sexual coercion to all patients, and talk to all their patients about sexual violence. (See 'Creating safe space for education, support, and disclosure' above and 'Resources' above.)
●The management of date rape involves provision of psychosocial support and prevention of pregnancy, sexually transmitted infections, and revictimization. (See 'Management' above and 'Medical issues' above.)
●Adolescents and young adults who disclose that they have been sexually assaulted benefit from the opportunity to describe the experience at a comfortable pace and in their own words. Acknowledging the patient's feelings, concerns, and fears may help to restore their belief in themselves as a normal, healthy individual. Providing them with options for treatment and respecting their decisions helps them to regain a sense of control. Patients with ongoing mental health symptoms may warrant psychological or psychiatric referral. (See 'Psychosocial support' above.)
●Victims of date rape are at risk for suicidality, self-harm, and subsequent harm by the perpetrator. They should be screened for suicidal ideation and self-harm behavior, asked about an ongoing relationship with the perpetrator, and assessed for access to firearms. (See 'Safety' above.)
●Adolescents who have experienced a rape or attempted rape are at increased risk for subsequent sexual assault. Prevention of revictimization involves helping victims to identify and avoid dangerous situations and implement harm reduction strategies. Strong prevention messages in schools and communities about stopping rape and holding perpetrators accountable are critical to supporting victims and reducing the likelihood of revictimization. (See "Date rape: Risk factors and prevention", section on 'Prevention'.)
ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Samantha Harrykissoon, JD, MPH, who contributed to an earlier version of this topic review, and Vaughn Rickert, PsyD, who also contributed to an earlier version of this topic review and passed away in June 2015.
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