You called down to the emergency room at 5:00 A. M. on a Saturday to evaluate an 18-yrs-old undergraduate who presented to the ER complaining of being a victim of sexual assault while attending a party the evening before. When you first encounter this patient to take a detailed history, she remains very calm but has trouble remembering the details of the experience. How would you counsel the patient regarding emergency contraception?
|A||It is morally wrong to recommend it to the patient, because it will cause an abortion|
|B||It is ineffective if taken more than 3 h after coitus|
|C||IUD placement is optimal|
|D||It can be achieved with high-dose oral contraceptives|
It can be achieved with high-dose oral contraceptives
a. As part of the rape trauma syndrome, victims of sexual assault may appear calm, tearful, agitated, or may demonstrate a combination of these emotions in addition, victims of sexual assault may suffer an involuntary loss of cognition wherein they cannot think clearly or remember things.
b. While obtaining the history from someone who has experienced a sexual assault can be uncomfortable for the health care provider, the victim is not traumatized by having to recount the details, and in fact may find this task therapeutic.
c. Victims of sexual assault frequently see themselves as partially responsible for the crime, especially in cases where they might have used poor judgment. It is a legal requirement to obtain consent prior to treating a rape victim.
d. Postcoital contraception (emergency contraception) should be offered to the patient to prevent ovulation/fertilization.
e. This can best be achieved with high-dose combination oral contraceptive and is maximally effective within 3 days of unprotected intercourse.
f. The patient should receive follow-up counseling within 24 to 48 h, and subsequent follow-up appointments can be arranged at 1 and 6 weeks. With ongoing counseling, it is possible for rape victims to fully recover.
g. In oral contra receptive levonorgestrel is the Drug of choice.