Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000020.xml
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2022; 82(07): 694-705
DOI: 10.1055/a-1860-0562
DOI: 10.1055/a-1860-0562
GebFra Science
Statement
Stellungnahme der DGGG – Empfehlungen zur Betreuung und Versorgung von weiblichen Minderjährigen, die mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffen sind
Article in several languages: English | deutsch
Abstract
Objective The recommendations presented here aim to further improve and standardise the medical care of persons affected by sexual violence, particularly female minors in Germany who have been raped. The recommendations are primarily addressed to gynaecologists working in hospitals or private practices and complement the detailed child protection guidelines of the Federal Republic of Germany.
Method After an extensive selective search of the literature, these recommendations were compiled by an interdisciplinary group of experts in a three-stage process at the request of the Board of the DGGG and were adopted by consensus.
Summary This DGGG Statement is divided into two parts according to 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. The Statement provides many recommendations, ranging from how to deal with minors presumed to be victims of acute sexual violence or rape, to the initial emergency care, type of care (e.g., confidential securing of evidence), how to take the patient’s history, the appropriate medical forensic examinations, and medical, psychological and psychosocial care and aftercare.
Schlüsselwörter
Kinder und Jugendliche - sexualisierte Gewalt - Stuprum - Erstversorgung - medizinisch-forensische UntersuchungPublication History
Received: 16 May 2022
Accepted: 22 May 2022
Article published online:
07 July 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Europarat. Übereinkommen des Europarats zur Verhütung und Bekämpfung von Gewalt gegen Frauen und häuslicher Gewalt und erläuternder Bericht. Council of Europe Treaty Series No. 210. Istanbul: Council of Europe; 2011 Accessed June 25, 2022 at: https://rm.coe.int/1680462535
- 2 Müller U, Schöttle M. Lebenssituation, Sicherheit und Gesundheit von Frauen in Deutschland. Bielefeld: Zentrum für Frauen- und Geschlechterforschung der Universität Bielefeld im Auftrag des Bundesministeriums für Familie, Senioren, Frauen und Jugend; 2005 Accessed May 07, 2022 at: https://www.bmfsfj.de/bmfsfj/studie-lebenssituation-sicherhei-un-gesundheit-von frauen-in-deutschland-80694
- 3 Maschke S, Stecher L. Speak! Die Studie. „Sexualisierte Gewalt in der Erfahrung Jugendlicher“. Öffentlicher Kurzbericht. 2017 Accessed March 15, 2022 at: https://hmulv.hessen.de/pressearchiv/pressemitteilung/speak-studie-hauptrisiko-sind-gleichaltrige-jugendliche-0
- 4 Crawford-Jakubiak JE, Alderman EM, Leventhal JM. Committee on Child Abuse and Neglect, Committee on Adolescence. Care of the Adolescent after an Acute Sexual Assault. Pediatrics 2017; 139: e20164243
- 5 World Health Organization. Guidelines for medico-legal care of victims of sexual violence. Geneva: World Health Organization; 2003 Accessed May 07, 2022 at: https://apps.who.int/iris/handle/10665/42788
- 6 World Health Organization. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Geneva: World Health Organization, Department of Reproductive Health and Research; 2013 Accessed May 07, 2022 at: https://apps.who.int/iris/bitstream/handle/10665/85240/9789241548595_eng.pdf
- 7 Cybulska B. Immediate medical care after sexual assault. Best Pract Res Clin Obstet Gynaecol 2013; 27: 141-149
- 8 Jina R, Jewkes R, Munjanja SP. et al. Report of the FIGO Working Group on Sexual Violence/HIV: Guidelines for the management of female survivors of sexual assault. Int J Gynecol Obstet 2010; 109: 85-92
- 9 Fryszer L, Buettner M, Etzold S. et al. Empfehlungen zur Betreuung und Versorgung von weiblichen mutmaßlichen Stuprum-Betroffenen. Geburtshilfe Frauenheilkd 2022; 82: 384-391
- 10 AWMF. AWMF S3+ Leitlinie Kindesmisshandlung, -missbrauch, -vernachlässigung unter Einbindung der Jugendhilfe und Pädagogik (Kinderschutzleitlinie) Kinderschutzleitlinie. 2019 Accessed April 15, 2022 at: https://www.dgkim.de/dateien/2022_01_03_langfassung_update-kjsg.pdf
- 11 Banaschak S, Gerlach K, Seifert D. et al. Forensisch-medizinische Untersuchung von Gewaltopfern: Empfehlungen der Deutschen Gesellschaft für Rechtsmedizin 2014. Rechtsmedizin 2014; 24: 405-411
- 12 Deutschsprachige Gesellschaft für Psychotraumatologie (DeGPT). AWMF-Leitlinie 155/001. Posttraumatische Belastungsstörung. S3-Leitlinie der Deutschsprachigen Gesellschaft für Psychotraumatologie (DeGPT) (Federführende Fachgesellschaft) (Version 19.12.2019). Accessed May 07, 2022 at: https://www.awmf.org/uploads/tx_szleitlinien/155–001l_S3_Posttraumatische_Belastungsstoerung_2020–02_1.pdf
- 13 Mears CJ, Heflin AH, Finkel MA. et al. Adolescents’ responses to sexual abuse evaluation including the use of videocolposcopy. J Adolesc Health 2003; 33: 18-24
- 14 Herrmann B, Dettmeyer R, Banaschak S, Thyen U. Kindesmisshandlung. Medizinische Diagnostik, Intervention und rechtliche Grundlagen. 4. Heidelberg, Berlin, New York: Springer; 2022
- 15 Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med 2004; 158: 280-285
- 16 Adams JA, Kellogg ND, Farst KJ. et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol 2016; 29: 81-87
- 17 Adams JA, Farst KJ, Kellogg ND. Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018. J Pediatr Adol Gynecol 2018; 31: 225-231
- 18 Kellogg ND, Menard SW, Santos A. Genital anatomy in pregnant adolescents: “normal” does not mean “nothing happened”. Pediatrics 2004; 113: e67-e69
- 19 Alexander R, Sanders Harper N. Medical Response to Child Sexual Abuse 2e. A resource for professionals working with children and families. 2. St. Louis: STM Learning; 2020
- 20 Finkel MA, Giardino AP. Medical Evaluation of Child sexual Abuse. A practical Guide. 4. Itasca: American Academy of Pediatrics; 2019: 21-58
- 21 The Royal College of Emergency Medicine. Management of Adult Patients who attend Emergency Departments after Sexual Assault and/or Rape. (Best Practice Guideline; ). 2015. Accessed May 07, 2022 at: https://rcem.ac.uk/wp-content/uploads/2021/10/Management_of_Adult_Patients_Who_Attend_-ED_After_Sexual_Assault_and_or_Rape_revised.pdf
- 22 U.S. Department of Justice Office on Violence Against Women. A National Protocol for Sexual Assault Medical Forensic Examinations – Adults/Adolescents Second Edition. NCJ 228119. 2013 Accessed June 25, 2022 at: https://www.ojp.gov/pdffiles1/ovw/241903.pdf
- 23 Sexual Assault Response Team. National Guidelines on Referral and Forensic Clinical Examination Following Rape and Sexual Assault (Ireland). 4. 2018. Accessed May 07, 2022 at: https://www.hse.ie/eng/services/publications/healthprotection/sexual-assault-response-team-national-guidelines.pdf
- 24 Lohse K, Katzenstein H, Beckmann J, Seltmann D, Meysen T. Ärztliche Versorgung Minderjähriger nach sexueller Gewalt ohne Einbezug der Eltern. Expertise. Deutsches Institut für Jugendhilfe und Familienrecht e. V. (DIJuF). Berlin: S.I.G.N.A.L. e. V. – Intervention im Gesundheitsbereich gegen häusliche und sexualisierte Gewalt; 2018 Accessed April 18, 2022 at: https://www.signal-intervention.de/sites/default/files/2020–04/Infothek_Expertise_Aerztliche_Versorgung_Minderjaehriger_nach_sexueller_Gewalt_5_2018_0.pdf
- 25 Arbeitsgemeinschaft für Medizinrecht (AGMedR) im Auftrag der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Ärztliche Gesprächsführung, Untersuchung und Nachbetreuung von Frauen nach mutmaßlicher sexueller Gewaltanwendung. Frauenarzt 2009; 50: 622-625
- 26 Handbuch sexualisierte Gewalt: Therapie, Prävention und Strafverfolgung. Gysi J, Rüegger P. Bern: Hogrefe; 2018
- 27 Ullman SE, Peter-Hagene LC. Longitudinal Relationships of Social Reactions, PTSD, and Revictimization in Sexual Assault Survivors. J Interpers Violence 2016; 31: 1074-1094
- 28 Ullman SE, Townsend SM, Filipas HH. et al. Structural Models of the Relations of Assault Severity, Social Support, Avoidance Coping, Self-Blame, and PTSD Among Sexual Assault Survivors. Psychol Women Q 2007; 31: 23-37
- 29 Campbell R, Dworkin E, Cabral G. An Ecological Model of the Impact of Sexual Assault On Women’s Mental Health. Trauma Violence Abuse 2009; 10: 225-246
- 30 Hakimi D, Bryant-Davis T, Ullman SE. et al. Relationship between negative social reactions to sexual assault disclosure and mental health outcomes of Black and White female survivors. Psychol Trauma Theory Res Pract Policy 2018; 10: 270-275
- 31 Palmieri J, Valentine JL. Using Trauma-Informed Care to Address Sexual Assault and Intimate Partner Violence in Primary Care. J Nurse Pract 2021; 17: 44-48
- 32 National Health Service Scotland, The Scottish Government. Clinical Pathway for Healthcare Professionals Working to Support Adults who Present Having Experienced Rape or Sexual Assault. 2020 Accessed June 25, 2022 at: https://consult.gov.scot/cmo/guidance-for-healthcare-professionals/
- 33 Fryszer L, Etzold S, Sehouli J. et al. Versorgungssituation mutmaßlicher Stuprumbetroffener an Universitätsfrauenkliniken. Geburtshilfe Frauenheilkd 2019; 79: 940-944
- 34 Hornberg C. Bestandsaufnahme regionaler Projekte der Anonymen Spurensicherung (ASS) in NRW und Darstellung von Entwicklungsmöglichkeiten für eine zielgerichtete Flächendeckung. Endbericht. Bielefeld: Universität Bielefeld Fakultät für Gesundheitswissenschaften; 2016 Accessed May 07, 2022 at: https://www.gleichstellungsministerkonferenz.de/documents/studie_zu_regionalen_projekten_der_anonymen_spurensicherung_in_nrw_151026070.pdf
- 35 Schulte C, Bulin M, Kopetzky I. Landesarbeitsgemeinschaft autonomer Frauen-Notrufe in NRW. Anonyme Spurensicherung nach Sexualstraftaten und Häuslicher Gewalt: Hintergründe – Ziele – Handlungsbedarf; Auswertung einer Umfrage der Landesarbeitsgemeinschaft autonomer Frauennotrufe in NRW. 2012 Accessed May 07, 2022 at: https://www.landtag.nrw.de/portal/WWW/dokumentenarchiv/Dokument/MMV16–3760.pdf
- 36 Schweizerische Gesellschaft für Rechtsmedizin (SGRM). Erwachsene Opfer nach sexueller Gewalt. Forum Med Suisse 2009; 9: 147-150
- 37 American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 777. Sexual Assault. Obstet Gynecol 2019; 133: e296-e302
- 38 Bates CK. Evaluation and management of adult and adolescent sexual assault victims. UpToDate; 2021 Accessed May 07, 2022 at: https://www.uptodate.com/contents/evaluation-and-management-of-adult and-adolescent-sexual-assault-victims
- 39 World Health Organization. Guidelines for medico-legal Care of Victims of sexual Violence. Geneva: World Health Organization; 2013 Accessed May 07, 2022 at: https://apps.who.int/iris/handle/10665/42788
- 40 García-Moreno C, Pallitto C, Devries K, Stöckl H, Watts C, Abrahams N. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization; 2013 Accessed June 25, 2022 at: https://apps.who.int/iris/handle/10665/85239
- 41 Anderson LJ, Flynn A, Pilgrim JL. A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review. J Forensic Leg Med 2017; 47: 46-54
- 42 Jänisch S, Meyer H, Germerott T. et al. Analysis of clinical forensic examination reports on sexual assault. Int J Legal Med 2010; 124: 227-235
- 43 Madea B, Mußhoff F. K.-o.-Mittel: Häufigkeit, Wirkungsweise, Beweismittelsicherung. Dtsch Arztebl Int 2009; 106: 341-347
- 44 Scott-Ham M, Burton FC. Toxicological findings in cases of alleged drug-facilitated sexual assault in the United Kingdom over a 3-year period. J Clin Forensic Med 2005; 12: 175-186
- 45 Fryszer LA, Hoffmann-Walbeck H, Etzold S. et al. Sexually assaulted women: Results of a retrospective analysis of 850 women in Germany. Eur J Obstet Gynecol Reprod Biol 2020; 250: 117-123
- 46 Clinical Effectiveness Group: British Association for Sexual Health and HIV. UK National Guidelines on the Management of Adult and Adolescent Complainants of Sexual Assault 2011. 2011 Accessed May 07, 2022 at: https://www.bashhguidelines.org/media/1079/4450.pdf
- 47 AWMF. S2k-Leitlinie: Sexuell übertragbare Infektionen (STI) – Beratung, Diagnostik und Therapie. Registernummer 059–006. 2018 Accessed May 07, 2022 at: https://www.awmf.org/leitlinien/detail/ll/059–006.html
- 48 AWMF. S2k-Leitlinie: Diagnostik und Behandlung von akuten Folgen psychischer Traumatisierung. Registernummer 051-027. 2019 Accessed May 07, 2022 at: https://www.awmf.org/uploads/tx_szleitlinien/051–027l_S2k_Diagnostik_Behandlung_akute_Folgen_psychischer_Traumatisierung_2019–10.pdf
- 49 Welch J, Mason F. Rape and sexual assault. BMJ 2007; 334: 1154-1158