Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Research Article, J Womens Health Issues Care Vol: 6 Issue: 5

An Analysis of Sexual Violence over 7 Years: Data from the Seoul Southern Sunflower Center

Jung Yeon Park1, Kyu Ri Hwang1*, Sun Min Kim1, Byoung Jae Kim1, Taek Sang Lee1, Hye Won Jeon1 and Ki Jeong Hong2

1Departments of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

2Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

*Corresponding Author : Kyu Ri Hwang, MD, PhD
Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Boramae-ro 5-gil 20, Dongjak-gu, Seoul 07061, Korea
Tel: 82-2-870-2344
Fax: 82-2-831-2826
E-mail: [email protected]

Received: August 21, 2017 Accepted: September 04, 2017 Published: September 08, 2017

Citation: Park JY, Hwang KR, Kim SM, Kim BJ, Lee TS, et al. (2017) An Analysis of Sexual Violence over 7 Years: Data from the Seoul Southern Sunflower Center. J Womens Health, Issues Care 6:5. doi: 10.4172/2325-9795.1000285

Abstract

Objective: To investigate the epidemiology of and clinical characteristics associated with alleged sexual violence over the past 7 years in Seoul and anticipate trends of further sexual violence.
Methods: The data for cases of alleged sexual assault recorded at the Seoul Southern Sunflower Center of Boramae Medical Center during December 2008-2015 were retrospectively analyzed. Information regarding the victim’s age, parity, mental disorder status, alcohol consumption habit, time and place of the crime, relationship between the victim and perpetrator, and the time interval from the crime to declaration was recorded. Physical examinations, serology tests, vaginal swabs, and cultures were conducted. Emergency contraceptives were prescribed to victims who declared sexual violence within 72 hours after the crime.
Results: The highest percentage of victims was observed among the age group of 20 to 24 years (596 cases, 27.2%). There were 13 male victims (0.6%), 24 victims were allegedly assaulted ≥2 times, and 141 (6.4%) had a mental disorder. The number of disabled pregnant women (5 cases, 3.6%) who developed the pregnancy due to the assault was significantly higher than that of non-disabled pregnant women (17 cases, 0.8%). Furthermore, 1,257 cases (57.4%) involved alcohol consumption or illegal drugs. We found that 28.6% and 19.2% of cases occurred in summer and in winter, respectively. Furthermore, 50.4% of all crimes occurred between midnight and 6 AM. Unknown perpetrators accounted for 768 (35.0%) cases and acquaintances 1,424 (65.0%). In the majority of cases (77.7%), victims were not physically injured. Sexually transmitted disease and bacterial vaginitis were found in 380 (17.3%) and 1,152 cases (52.6%), respectively.
Conclusion: The findings of this study could help guide management and comprehensive care for sexual violence victims. It is expected that it will be able to obtain accurate basic data on the victim status and damage characteristics by the subtype classification of victims of sexual violence. Especially, it is thought that it will contribute more to the establishment of policies, laws, systems, and social services according to the characteristics of the group, by more closely analyzing the rape cases targeted by the disabled and the youth who are social weak. Additionally, it is expected that sexual violence victims will be able to systematically manage the occurrence and progress of problems related to sexual violence by objectively assessing and following up risk factors, physical diseases, and psychiatric sequelae.

Keywords: Sexual violence; Rape; Victim; Perpetrator; Epidemiology; Disabled; Sexually transmitted disease

Introduction

The history of rape of women and the youth dates back to ancient Greek mythology [1]. Since then, rape has become more violent and continues to occur even today, even though it is subject to punishment by state power. According to government statistics in Korea, crimes related to sexual violence has been steadily increasing every year since 2005 for the past 10 years. Although the government has designated sexual violence as one of the four major social evils and is implementing measures to eradicate it, the efforts have proven ineffective. Considering that the undeclared rate of sexual assault is 87.5%, the actual incidence of sexual violence-related crimes is estimated to be 6 times higher than that predicted [2].

Sexual assault is defined as any kind of sexual act in which a person is coerced or physically forced to engage against their will, or non-consensual sexual touching of a person without their consent. Sexual violence, a form of sexual assault, includes rape, such as forced vaginal, anal, or oral penetration or drug-facilitated sexual violence [3]. Rape can cause serious physical and emotional distress to the victim and can afflict serious trauma even after a long period of time. Moreover, owing to cultural, social, and economic progress, as well as the increasing influence of the media and social networking, sexual violence has become a terrifying criminal act. Accordingly, the need for emergency relief centers for victims of sexual violence is growing [4].

Our medical center has operated the Seoul Southern Sunflower Center and provided various interdisciplinary care services for women and men who have experienced sexual assault in cooperation with the Ministry of Gender Equality and Family and the Seoul Metropolitan Police Agency since December 2008. Immediate medical support and physical examination of victims of sexual violence is essential. This is not only a matter of obtaining forensic evidence at the right time but also of minimizing the window of exposure to disease due to sexual violence. In addition, immediate gentle care is required to help the victims cope with physical and mental trauma. This analysis was carried out to present the current epidemiology of and clinical characteristics associated with alleged sexual violence.

Materials and Methods

The data for cases of alleged sexual assault recorded at the Seoul Southern Sunflower Center of Boramae Medical Center between December 2008 and December 2015 were retrospectively analyzed. This study was approved by the institutional review board of Seoul Metropolitan Government Seoul National University Boramae Medical Center (IRB No. 16-2015-71). Upon obtaining informed consent, data regarding clinical history and demographics such as age, sex, parity, marital status, prior sexual intercourse history, and menstruation cycle were recorded. The victim’s health status when the attack occurred was also reviewed when obtaining the clinical history. A detailed questionnaire was administered, which recorded the following information: 1) mental disorder; 2) history of alcohol consumption at the time of the attack; 3) drug abuse or signs of intoxication at the time of the attack; 4) time and place of the attack; 5) relationship between the victim and perpetrator; 6) time interval from the crime to declaration.

Simultaneously, a careful physical examination to screen for the presence of trauma on the body and genitalia, serology tests such as the venereal disease research laboratory (VDRL) test as well as those for the hepatitis B surface antigen (HBsAg) and human immunodeficiency virus (HIV) antibodies, tests for sexually transmitted diseases including those due to Chlamydia trachomatis and Neisseria gonorrhoeae, vaginal swabs, and cultures were conducted. Following this, medication to prevent sexually transmitted diseases was prescribed. When a sexual violence victim visited the center within 72 hours of an alleged assault, an emergency contraceptive pill (levonorgestrel 1.5 mg, single dose) was prescribed.

Victims were instructed to return to the hospital 10-14 days after the first visit for confirmation of the test results. A followup examination, which comprised the VDRL test and tests for the HBsAg and HIV, was performed 4 weeks later; other follow-up tests for abnormal results were also scheduled. If the victim’s normal menstrual cycle did not resume 1 month later, a pregnancy test was ordered. The HIV test was repeated after 6 months.

The statistical analysis was performed using SPSS version 20.0 for Windows (SPSS Inc., Chicago, IL, USA). A comparison of the continuous variables was carried out using the Mann-Whitney U test, and proportions were compared using the Pearson chi-square test. A probability value of <0.05 was considered to indicate statistical significance.

Results

We examined the data for 2,192 sexual violence victims recorded over a period of 7 years. In terms of season, the highest proportion of sexual crimes occurred in summer (626 cases, 28.6%), followed by spring (614 cases, 28.0%), autumn (532 cases, 24.3%), and then winter (420 cases, 19.2%); there was no significant variations in incidence between seasons, with the exception of a slight decrease in crimes in winter (Figure 1).

Figure 1: Distribution of sexual assault victims according to seasonal variation.

Twenty-four people were allegedly sexually assaulted more than once, one of whom reported that she had been subjected to four different episodes of sexual violence during the investigation period. One victim was a transgender (male to female), and 13 male victims were identified. There were 69 cases of assault that were carried out by persons, who need socially higher morality such as religious persons, teachers, professors, mother’s male partner, sister’s boyfriend, or facility caregivers.

Of the total of 2192 victims, 1706 (77.8%) took the emergency contraceptive pill. Among them, 241 (11.0%) had no vaginal bleeding after taking the emergency contraceptive pill, and 835 (38.09%) of those who took the emergency contraceptive pill did not present to the clinic thereafter. No cases of pregnancy after taking the emergency contraceptive pill were reported. Moreover, 22 victims were identified as becoming pregnant after the rape, but they did not present within 3 days of the incident and visited the center only after the pregnancy had progressed.

Age of victims

Table 1 shows the classification of sexual violence victims according to age groups, where the age of the victims ranged from 2 to 86 years (mean ± SD, 24.6 ± 9.9 years; median, 23.0 years). When the data were observed according to 5-year intervals of age, the highest percentage of victims was observed among the age group of 20 to 24 years (596 cases, 27.2%), and the lowest among the age group of 0 to 4 years (13 case, 0.6%). Many teen victims were also identified: age group of 10-14 years and 15–19 years, which accounted for 144 cases (6.6%) and 546 cases (24.9%), respectively. Approximately, one-third of all the cases occurred in children and adolescents.

Age range (years) Patients No. (%)
0-4 13 (0.6)
5-9 27 (1.2)
10-14 144 (6.6)
15-19 546 (24.9)
20-24 596 (27.2)
25-29 386 (17.6)
30-34 178 (8.1)
35-39 108 (4.9)
40-44 70 (3.2)
45 and above 124 (5.7)
Total 2192 (100)

Table 1: Age distribution of sexual assault victims.

Previous coital history and marital status

There were 466 (21.2%) people who never had sexual intercourse before the crime. Among them, 62 infants, toddlers, and children under 12 years of age were identified. During the study period, 13 male victims were also confirmed, which accounted for 0.6% of the total victims; thus, 99.4% of the victims were female (Supplementary Table 1).

Mental health status

Of all the victims, 140 (6.4%) demonstrated mental retardation or physical disability. Among these cases, 79 (59.3%) involved offenders who were an acquaintance, which is lower than the proportion of non-disabled victims attacked by an acquaintance (65.3%). In case of disabled victims, the perpetrators of 11 cases (7.9%) were people who had higher morality, and the perpetrators of 4 cases (2.9%) were identified as family members such as relatives, the father, or the stepfather. The number of disabled pregnant women (5 cases, 3.6%) who developed the pregnancy due to the assault was significantly higher than that of non-disabled pregnant women (17 cases, 0.8%). Dementia was recorded in only one victim (Supplementary Table 2).

Alcohol consumption/ illicit drug use status

We found that 1229 victims (56.1%) were in a drunken state when the crime occurred; in 4 cases, the victim was aged 8–12 years. Only 28 victims (1.3%) reported being under the influence of an illicit drug at the time of the sexual violence (Table 2).

Alcohol consumption Yes No Drug
Infants and Toddlers (= 7) 0 32 0
Child (8-12) 4 35 0
Teenager (13-19) 313 339 7
Adult (20 =) 912 529 21
Total 1229 (56.1%) 935 (42.6%) 28 (1.3%)

Table 2: Alcohol consumption / illicit drug use status of sexual assault victims.

Time and location of sexual violence

Rapes occurred most frequently between midnight and 6 AM (1105 cases, 50.4%). Overall, the incidence of sexual violence from 6 a.m. to midday, from midday to 6 PM, and from 6 PM to midnight was 211 (9.6%), 202 (9.2%), and 342 (15.6%), respectively. We found that 332 victims could not remember the exact time when the sexual violence occurred (Table 3); 35.7% of cases occurred in specific places, including hotels or motels. Moreover, 322 (17.5%) victims were unable to remember the time when the sexual violence occurred, and 170 (7.8%) did not remember the place (Table 4). Of those who did not remember the time, 147 (185 cases involving a drunken status) did not consume alcohol and of those who did not remember the place, 94 (76 cases of a drunken status) did not consume alcohol.

Accident Time 24-06 06-12 12-18 18-24 Unknown
Infants and Toddlers (= 7) 2 1 3 3 21
Child (8-12) 6 4 5 10 11
Teenager (13-19) 275 65 75 113 131
Adult (20 =) 822 141 114 216 169
Total 1105 (50.4%) 211 (9.6%) 202 (9.2%) 342 (15.6%) 332 (17.5%)

Table 3: Time of sexual assault.

Location Victim’s home Offender’s home Outside Specific places (including accommodation) Car Unknown
Infants and Toddlers (= 7) 6 4 11 0 2 9
Child (8-12) 11 7 11 1 0 9
Teenager (13-19) 83 130 158 229 14 45
Adult (20 =) 256 209 272 553 65 107
Total 356 (16.2%) 350 (16.0%) 452 (20.6%) 783 (35.7%) 81 (3.7%) 170 (7.8%)

Table 4: Location of sexual assault.

Relationship between the victims and the perpetrators

Of all the perpetrators involved, strangers accounted for 35.0% (768 persons) of cases. That is, 1424 (65.0%) perpetrators and victims knew each other. Among the acquaintances, 639 (29.1%) were friends or partners and 45 (2.1%) were relatives. The number of sexual violence cases in the workplace was 139 (6.34%). Moreover, 45 victims were raped by a relative, and among them, 21 were raped by their own father and 11 by their stepfather. There were 69 cases in which the offenders were people with high morality (Table 5).

Relationship Acquaintance Friend/ Partner Relative Stanger
Infants and Toddlers (= 7) 10 6 6 10
Child (8-12) 17 5 5 12
Teenager (13-19) 258 191 26 184
Adult (20 = ) 455 437 8 562
Total 740 (33.8%) 639 (29.1%) 45 (2.1%) 768 (35.0%)

Table 5: Relationship between the victims and the perpetrators.

Time to center visit after sexual violence

The majority of sexual violence cases (1966, 89.7%) were examined within the first 3 days since the assault, and 90 cases (4.1%) between 4 days and 2 weeks after the crime. However, when the perpetrator was a relative, only 19 (42.2%) cases were reported within 3 days after the crime, and 26 victims visited the center late, which is significantly lower when compared to the number of victims who were assaulted by strangers and presented late to the center (Supplementary Table 3).

Physical and genitalia injuries

Most of the rape victims (1703, 77.7%) were not injured physically. There were 181 victims (8.3%) with minor genitalia injuries and 306 (13.9%) with injuries other than those to the genitalia such as bruises and lacerations. However, 2 patients were found to require surgery due to severe injuries (Supplementary Table 4).

Result of screening tests for sexually transmitted disease

When the victim arrived at the Seoul Southern Sunflower Center, an emergency medical doctor first performed a physical examination using the emergent rape kit and conducted serology tests. Subsequently, a gynecologist conducted a vaginal examination, including a vaginal discharge culture and tests for sexually transmitted disease. Overall, 1865 victims underwent an examination with the emergent rape kit and further examinations. Positive test results for HBsAg were found in 27 (1.3%) cases, and positive VDRL test results were found in 18 cases (0.8%). All patients were found to be negative for HIV infection. The test for bacterial vaginitis yielded negative results in 856 cases (39.1%) and positive results in 1152 cases (52.5%). Moreover, 342 cases (15.6%) and 20 cases (0.9%) yielded positive results for Chlamydia trachomatis and Neisseria gonorrhoeae, respectively (Supplementary Table 5).

Criminal proceedings and follow-up treatment

Many victims sustained not only physical injuries but also mental trauma. Two patients reported attempting suicide. However, of the total of 2192 victims, only 99 (4.5%) underwent psychiatric counseling. According to our protocol, the vaginal examination and serology tests comprising VDRL, HBsAg, and HIV were performed 4–6 weeks later in 374 cases (17.1%), and the HIV follow-up test was performed in 104 cases after 6 months. However, 1094 (49.9%) of the victims continue to be contacted and provided interdisciplinary care services. When we investigated the legal actions of the remaining victims, except for 1098 people who did not present for the follow-up visits at the Seoul Southern Sunflower Center, 589 victims (26.9%) accused the perpetrators and 176 victims (8.0%) debated charging their assailants or not.

Discussion

Sexual violence is a disaster, but continues to occur throughout the world. The concept of sexual violence is believed to change during the process of struggles with social myths. Previously, the concept of rape was perceived as a crime that violated women’s chastity. The reason is considered to be the male penis-centered definition of sexual violence: forced insertion of the male penis in the female vagina. However, currently, sexual violence is perceived as a matter of gender-power relations and violence that needs to be eradicated. Sexual violence is not just a matter of embarrassment for a woman, women’s empowerment, and self-determination, but rather the violation of the sexual self-determination of a woman [1,5,6].

From the perspective of the victim’s age, we found that while there are some groups that are more vulnerable to sexual violence crimes, sexual violence can occur at any age. A study of self-report surveys of victims in their late adolescence reported that the lifetime experience of 17-year-olds with sexual abuse and sexual violence was 26.6% for girls and 5.1% for boys. The study additionally reported that the lifetime experience with sexual abuse and sexual violence at the hands of adult perpetrators exclusively was 11.2% for females and 1.9% for males [7]. It is true, however, that younger age groups are more vulnerable to sexual violence. Moreno et al. revealed that sexual violence with evidence of physical injury in the examination was significantly associated with the victims’ age and sexual violence that involved penetration. Moreover, sexual violence with evidence of physical injury in the examination is inversely associated with vulnerable victims and violence committed by a known offender [8]. In our study, we found that the 20-24 year old age group is most vulnerable to sexual violence, which is similar to that observed in the United States. A study that analyzed rape and sexual violence victimization among college-age women claimed that women aged 18-24 years experienced rape and sexual violence more often than women in other age groups, and often, 3 in 4 student victims of rape and sexual violence knew the offender. Furthermore, they said that a greater percentage of student (80%) than nonstudent (67%) rape and sexual violence victimizations were not reported to the police [9].

Lastly, victims were found to be more likely to be pregnant due to the rape than general people. This is possibly because the ability to recognize the rape victim is inferior and because it is difficult to judge whether help is necessary even in case of an incident. Neville et al. conducted a cross-sectional survey of sexual violence and harassment, perceived vulnerability, and association with alcohol use in a student population and found that more likely to report experiencing sexual harassment or violence than non-hazardous drinkers.

The use of drugs in South Korea is a less important offense; the U.S., by way of comparison, in 2010 made more than 1.6 million drug arrests, which is more than 36 times that in Korea, even after accounting for differences in the population [10]. Under these circumstances, the incidence of illicit drug use among rape victims can be considered (28 cases, 1.3%) low. We also observed that, despite not being under the influence of alcohol or illicit drugs, many victims could not remember the time and place of the incident, possibly owing to psychological shock and trauma. Parcesepe et al. reported that virtually all female sexual violence survivors experience negative psychological symptoms immediately after the violence, with some continuing to experience these symptoms for years. These symptoms include post-traumatic stress disorder, depression, substance use disorders, suicidal ideation and attempts, and memory disturbance [11,12].

When examining the relationship between the perpetrator and the victim, we were able to identify several interesting facts with regard to the age of the victim. Among victims aged below 14 years, only 43 (23.4%) were assaulted by a stranger; therefore, the younger the victim, the more likely the offender was an acquaintance (141 cases, 76.7%). In addition, we found that the younger the victim (14 years old or younger), the higher the risk of sexual violence (11 cases, 6.0%) from one’s relative or a group of perpetrators with high morality (58 cases, 2.9%).

The analysis of the time elapsed until the victims visited the center revealed some correlations between the victims and perpetrators. If the perpetrator was a relative, the victim presented to the center much after the rape event. The majority of sexual violence cases (1966, 89.7%) were examined within the first 3 days of violence; however, when the perpetrator was a relative, only 19 (42.2%) cases were reported within 3 days after the crime. Thus, we can assume that if the perpetrator is a relative, the impact on the victim’s mental and psychological status will be greater.

The prevalence of sexually transmitted disease in the general population is 0.4% for chlamydia, 0.1% for gonorrhea, and 0.004% for syphilis according to CDC statistics. The ratio of the prevalence of chlamydia to gonorrhea is 4:1 [13,14]. In our study, this ratio was 15.6:0.9, and is not similar to that listed in the latest CDC report. It is possible that the difference lies in the fact that the CDC data are based on the normal American population, or perhaps because of the abnormal situation of sexual violence when compared to a normal group. After experiencing an act of sexual violence, victims are vulnerable to not only sexually transmitted diseases, but also various other physical symptoms. According to Larsen et. al., the incidence of several somatic disorders was found to be significantly higher among sexually assaulted women than in controls [15]. Therefore, multidisciplinary management of sexually assaulted women is needed instead of treating for only gynecologic diseases. Limitations of this study include the victims who visited our center are part of the total number of sexual assault victims in Korea and there was a lack of long term follow-up treatment in many cases. However, this current study provides more accurate information about epidemiology and medical results of sexual assault over 7 years.

Conclusion

This study was based on data collected from a single institution and followed up for 7 years. Our hospital attempts to completely resolve the physical and psychological problems of victims of sexual violence through multidisciplinary cooperation between the Seoul Southern Sunflower Center, Obstetrics and Gynecology Department, Emergency Medicine Department, and Psychiatric Department. If the development of coding system and analysis of big data at the national level for the identification and characterization of victims of sexual violence will be preceded on the basis of this current study, systematic prevention/ intervention / treatment model for victims of domestic sexual violence can be established.

Acknowledgments

The authors would like to thank the resident doctors of the Obstetrics and Gynecologic Department in our hospital and nurses of the Seoul Southern Sunflower Center for their assistance with the data.

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