Intimate Partner Sexual Assault Against Women: Frequency, Health Consequences, and Treatment Outcomes Judith McFarlane, RN, DrPH, Ann Malecha, RN, PhD, Kathy Watson, MS, Julia Gist, RN, PhD, Elizabeth Batten, Iva Hall, RN, PhD, and Sheila Smith, RNC, PhD OBJECTIVE: To describe the characteristics and conse- quences of sexual assault within intimate relationships specific to racial or ethnic group, compare the findings to a similar group of physically assaulted– only women, and measure the risk of reassault after victim contact with justice and health services METHODS: A personal interview survey of 148 African- American, Hispanic, and white English- and Spanish- speaking abused women seeking a protection order. Extent of sexual assault, prevalence of rape-related sexually trans- mitted diseases and pregnancy, symptoms of posttrau- matic stress disorder (PTSD) and depression, and risk of reassault after treatment were measured RESULTS: Sixty-eight percent of the physically abused women reported sexual assault. Fifteen percent of the women attributed 1 or more sexually-transmitted diseases to sexual assault, and 20% of the women experienced a rape-related pregnancy. Sexually assaulted women re- ported significantly (P  .02) more PTSD symptoms com- pared with nonsexually assaulted women. One significant (P  .003) difference occurred between ethnic groups and PTSD scores. Regardless of sexual assault or no assault, Hispanic women reported significantly higher mean PTSD scores compared with African-American women (P  .005) and White women (P  .012). The risk of sexual reassault was decreased by 59% and 70% for women who contacted the police, or applied for a protection order, after the first sexual assault. Receiving medical care decreased the woman’s risk of further sexual assault by 32% CONCLUSION: Sexual assault is experienced by most physi- cally abused women and associated with significantly higher levels of PTSD compared with women physically abused only. The risk of reassault is decreased if contact is made with health or justice agencies. (Obstet Gynecol 2005;105:99 –108. © 2005 by The American College of Obstetricians and Gynecologists.) LEVEL OF EVIDENCE: III The prevalence and health effects of intimate partner physical assault against women are well chronicled. 1 Conversely, the occurrence, health consequences and, especially, treatment outcomes of intimate partner sex- ual assault are virtually unknown. The few studies that measure sexual assault separate from physical assault consistently report 40 to 50% of battered women are also sexually assaulted, 2–4 a rate of sexual assault 4 to 5 times higher than the 9 to 13% reported by women from community and national samples. 5–7 Although intimate partner sexual assault is not exclu- sively found in battering relationships, it is nearly impos- sible to find a large enough sample of women to study who have experienced sexual assault yet have not been physically assaulted by their intimates as well. The time sequencing of physical and sexual assault within intimate relationships is unknown, as are the associated physical and psychological disorders. Correct sequencing is es- sential for developing a causal model of victimization and reactions, and to establish the relative effects of physical and sexual assault in predicting symptomatol- ogy, such as depression and posttraumatic stress disor- der (PTSD). For example, if sexual assault severity is uniquely related to PTSD severity, then professionals who care for these women will need to focus on sexual assault treatment. Furthermore, outcome data after treat- ments, such as victim use of health and justice services, and the risk of reassault are unknown. When we under- stand the unique contribution of sexual assault to wom- en’s health, professionals can better tailor their services for, and validate the experiences of, this often under- served and silent population. The purpose of our study was to describe the fre- quency, sequencing, and consequences of sexual assault From the Texas Woman’s University, College of Nursing, Houston, Texas; Baylor College of Medicine, Houston, Texas; Harris County District Attorney’s Office, Houston, Texas; Lamar University, Department of Nursing, Beaumont, Texas. Supported by Grant No. 2002-WG-BX-0003 awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Points of view in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice. VOL. 105, NO. 1, JANUARY 2005 99 © 2005 by The American College of Obstetricians and Gynecologists. 0029-7844/05/$30.00 Published by Lippincott Williams & Wilkins. doi:10.1097/01.AOG.0000146641.98665.b6