Rape is frequently a private crisis owing to the isolation that many survivors feel because of a lack of support or the tendency of some to blame us. This creates a unique and difficult set of reactions that may also be experienced by women who have been battered, sexually harassed, abused as children, robbed violently, or hurt by other forms of violence. (In fact, sexual assault and battering often go hand in hand.)

While no two women respond in the same way, many feelings are common among survivors. You may experience a wide range of reactions immediately after the assault or years later. You are coping with a difficult situation that never should have happened in the first place. There is no one correct or preferred way to deal with the feelings and reactions you may find yourself having. As you move through a healing process, different reactions may intensify or lose intensity. You may experience feelings that you thought you had already addressed.

Self-blame and feelings of guilt. This is probably one of the most common reactions because of the false yet common myths about rape. We may feel humiliated, ashamed, or embarrassed about what we were forced or coerced to do. We often feel responsible for decisions that we made before the assault that we (or others) may later think led to the assault. Even talking about the sexual assault can be difficult because we risk being disbelieved or rejected. THE TRUTH IS THAT RAPE IS NEVER THE FAULT OF THE VICTIM.

Like many victims of sexual attacks, I was silenced by my shame, guilt, and the mistaken belief, reinforced by the police and society in general...that I was "responsible" for what these men did to me. It is that silence that revictimizes rape and incest victims, over and over again, and I won't be silent anymore.

Fear, terror, and feeling unsafe. Intense fear may be experienced in many aspects of a woman's life. If you feared for your life or the lives of others during the assault, you may be afraid that the perpetrator will return. You may find that fear and terror become generalized to other areas or to situations that are similar to the assault.

There is nowhere that feels safe anymore. When I'm home I'm afraid that someone will break into my house; when I'm out, I'm afraid that I'll be attacked. My guard is always up.

Anger and rage. While it is normal to feel angry, this emotion can be difficult for women to express. We have been socialized to be nice, to hide our anger. For many women, directing anger toward the perpetrator may feel too threatening or may bring intense feelings of terror. You may sometimes direct your feelings of anger toward others in your life, where it feels safer. While this can be confusing for loved ones, it is normal.

I feel angry all of the time, even toward people who had nothing to do with the rape like my kids and my co-workers.

Anger turned inward. If you have a hard time recognizing or expressing anger, you may turn it inward. This can lead to forms of depression and suicidal thoughts, feelings, or even attempts. If you experience signs of depression that are long-lasting and don't seem to be alleviated by talking about it with friends, consider seeking help through counseling. Many communities have specialized mental health services for survivors of sexual assault.

I barely manage to function all day. When I wake up in the morning I just want to stay in bed. I feel like there is a dark cloud following me around. I feel sad and can't remember what it feels like to be happy.

Grief and loss. You may experience loss in many ways. For many women, rape or abuse may have conflicted with our ideas of whom we can trust or where we are safe. Throughout the healing process, you may experience grief over parts of your life that you felt you missed. Some survivors talk about a loss of innocence or a loss of their sense of power.

I feel like a part of me died, like my life will never be the same. Because I was raped by my boyfriend as a teen, I feel like I missed the chance to have a normal adolescence when everyone says those should have been the best years of my life.

Loss of control, powerlessness. Rape and sexual abuse rob women of the power and control that they have in that moment. You may feel powerless in general or in certain situations.

My life is not my own anymore; what's the use of making decisions when I have no power to change my life?

Isolation. You may feel as though no one can possibly understand. Or you may feel embarrassed that your healing process is taking as long as it is. Family members may be encouraging you to "just put it in the past" or "get on with your life" while your feelings are still very real and troubling. You may not want to talk to anyone about the rape for fear of being disbelieved or rejected.

I can't think of anyone that I can trust or talk to. I just want to be by myself even though I feel lonely.

Flashbacks and nightmares. Flashbacks and nightmares can feel overwhelming and frightening, although they are common and normal. A flashback is a memory that is experienced with one or more of the physical senses. A nightmare is a dream that sometimes involves aspects or pieces of the assault but can be combined with other events or aspects of the person's life.

I close my eyes to go to sleep and all I can see is the rape. I feel as though it is happening to me over and over.

Triggers: seasons, smells, circumstances. Survivors remember being raped with all of our senses. Triggers are circumstances that are the same or similar to those that occurred during the rape and that bring up feelings related to the rape. Certain smells, sights, places, or even times of the year may bring about feelings related to the assault.

Every year around this time I start to feel sad and have trouble sleeping. Because I was raped during the springtime, the signs that make everyone else happy make me feel isolated and nervous.

Changes in sexuality, intimacy. Changes in sexuality are common for women who have been sexually assaulted. While you may experience fear and aversion to sex and intimacy, on the other hand you may want to have more sexual experiences than before the rape. This may change throughout your healing process.

I want my partner's support, but I can't stand the idea of having sex. Even though it's been almost a year since the rape, I feel afraid of getting too close. I'm afraid that he'll touch me and that I'll react as if my partner is the rapist.

Spiritual crisis. Sexual assault often results in an intense spiritual crisis, especially for those who have operated within a spiritual framework before the rape. You may feel angry at a supreme being or may lose your faith completely. You may be told that the rape is a punishment for your "sins." The crisis of rape can create a crisis of self at a very personal and deep level.

The God that I believed in would never allow something like this to happen. I've lost my faith and sense of who I am.

If you were sexually assaulted, you may have experienced any number of these reactions and others not listed here. The process that you are going through may feel overwhelming and never-ending. Yet, it is very much a process of healing and empowerment. You have had your sense of control taken away as a result of the rape, and healing can occur when you begin to regain a sense of power. Reflecting on the following points can help you move through the healing process:

Sexual assault was not your fault. Myths about sexual assault get expressed in any number of destructive ways: "It must have been who she was, what she was wearing, where she was...." These have nothing to do with the fact that you were assaulted. You did not ask to be violated, and you did not do anything to deserve it.

You made the best choices and decisions you were able to make. You may have been forced to make life-or-death decisions before, during, and after the assault. Even if you feel you would make a different decision today, whatever you did at the time was okay.

There is no right way to feel or to heal. Your reactions and your healing process are connected to who you are as a person. Your culture and economic background can influence your healing process in both negative and positive ways.

You deserve support. Reach out to whomever you think can be a support person to you. There are rape crisis centers in most locations across the country. You may prefer to talk with a family member or friend, a clergy member, or a counselor. You may decide to find a support group, or try other kinds of healing support based on art, music, writing, physical activity, or meditation.¹⁷

Believe in your strength and your capacity to heal. While the process of healing may take time and may be difficult, you will find ways to reclaim the strong and capable parts of yourself.

If you have been raped, the first thing you may want to do is take a shower or bath and try to forget what happened. What you do is completely your decision, but consider two things:

• It is very important both physically and emotionally that you receive medical attention as soon as possible, even if you have no obvious injuries.

• Don't bathe or shower if you think you may later decide to prosecute, as you will wash away evidence that may be crucial to your case.

If you decide to go to a hospital, try to have a friend, relative, or local rape crisis counselor go with you to act as an advocate on your behalf. If you feel reluctant to go because you may not be able to afford it, be aware that most states have passed legislation that assures that rape exams are free of charge. If you go to the hospital, bring a list of any medications that you are taking, bring a change of clothing if you're still in the same clothes; if you have changed clothes, bring the clothing that you were wearing during the assault.

At the hospital, you have three basic concerns: your emotional well-being; medical care; and the gathering of evidence for a possible prosecution. You can refuse to be examined for evidence if you are absolutely sure that you will not want to prosecute. Some hospitals have specialized programs that attempt to assure that sexual assault survivors are given the best treatment possible. These programs are staffed by nurses or doctors who receive extensive training in the medical, legal, and emotional issues associated with sexual assault. They are set up to provide medical exams that are sensitive and provide the best evidence possible for prosecution.

Physical injuries to any part of the body can result from a rape; therefore, a thorough examination is necessary. That examination should include and/or result in the following:

A verbal history of the sexual assault and of related medical concerns. You will be asked to give a detailed description of the assault, which will be written down. While it may be difficult to talk about these details, they are important so that the medical provider will know where to check for injuries and where to document evidence such as bruises, scrapes, or other injuries. Pictures may be taken or evidence collected that wouldn't be noticed unless this information is known. Sometimes bruises may emerge later, in which case you should be encouraged to call the examiner back so that they can be added to your record. You will also be asked some questions that may seem unrelated, such as whether you have had sexual activity recently, whether you may be pregnant, and whether you use any birth control methods.

A pelvic exam. In collecting evidence, the practitioner will look for the presence of semen. (It is also possible to be raped vaginally with no semen or sperm present.) She or he will also comb your pubic hair for the possible presence of the man's pubic hair. All this medical evidence will be available to others, including the police, only with your written permission. You or the person with you at the hospital should check the record for accuracy and objectivity as soon as possible after the exam. If possible, do this while the doctor is still present. (If you were raped vaginally, see chapter 24, Selected Medical Practices, Problems, and Procedures, for more information about a pelvic exam. You will get a rectal exam if you were raped anally.)

Examination and treatment of any external injuries. The practitioner will examine you for any external injuries and may photograph bruises or other marks to document the assault.

Treatment for the prevention of sexually transmitted disease (STD). The practitioner will want to give you two shots of antibiotic in your buttocks. If you don't want this, be sure to say so. (Some women may not want to be given an antibiotic unless an STD is diagnosed; however, it is used as a preventive measure). Some STDs are not detectable until six weeks later, so it is a good idea to return for a six-week checkup (see chapter 14, Sexually Transmitted Diseases).

Treatment for the prevention of pregnancy. If you suspect that you will become pregnant as a result of the rape, the doctor or nurses may offer you emergency contraception (see chapter 13, Birth Control). A pregnancy resulting from rape cannot be detected until several weeks later. If you find that you are pregnant and are considering abortion, see chapters 16, Unplanned Pregnancies, and 17, Abortion.

Information about AIDS/HIV. There is a chance that you could contract HIV through a sexual assault. Should you want to, it may be possible to get immediate morning-after" medication to treat potential HIV infection. If you are offered testing for HIV, be aware that it's too soon for HIV antibodies to show up from the assault. Also, testing results could become a part of your medical and legal record and could be used against you. For information see chapter 15, HIV, AIDS, and Women.

A follow-up exam. Although you may feel physically recovered shortly after the rape, a follow-up visit, to include tests and treatment for STDs and a pregnancy test if indicated, will assure you that you are taking care of yourself.

It is common for survivors of sexual assault to experience changes in overall physical health. Some find that their sleep and eating patterns change. Some experience headaches, body aches, stomach and intestinal problems, and fatigue. Some cope with the emotions with drugs or alcohol. While all of these are normal, it is important to take care of yourself and get help if any of them persist or get worse over time.

Ever since I was raped, my body doesn't feel like my own. I have pain in my back and I'm always on the alert for signs of sexually transmitted infections.

• Because the legal system can be confusing and difficult, it will help tremendously to have a friend or rape crisis counselor with you throughout the process.

• You will have to prove that you were sexually assaulted against your will and that the man used force or threatened force against you.

• Rape is a crime against the state. It is prosecuted by the district attorney's office. You will be the state's witness, and you will not have your own lawyer unless you can arrange for one to advise you.

• A trial can last from six months to several years. You will need to be prepared to continue thinking and talking about the rape for a long time, including giving an account of the event over and over while people judge whether you are telling the truth.

• You will need to prepare yourself for any outcome. Rape is one of the most difficult crimes to prove. Remember that even if your case does not end in a conviction, this does not mean that the rape didn't happen or that you didn't do your best to prosecute.

If you are a friend or family member of someone who has been sexually assaulted, you may feel that you don't know what to say, or you may have feelings of your own that get in the way of supporting her. You can be most helpful if you keep in mind that she is capable of healing and that you are capable of providing support. You are being supportive when you do these things:

Validate and believe her. If she feels ashamed or guilty, reassure her that the rape was not her fault and that her feelings are normal. Although you feel you might have reacted differently, remember that her reactions are uniquely hers.

Help create a safe place for the survivor. Help her to think about what changes, if any, she would like to make that will help her feel safer, whether related to her physical surroundings or to how she interacts with people at home or at work.

Allow her to express a full range of feelings. The feelings of a survivor of sexual assault can be very strong. Expressing these powerful feelings in a safe environment is an important part of the healing process. If you can feel comfortable supporting her in expressing her feelings, this can be very helpful.

Offer options, not advice. Survivors often struggle with important and complex decisions. You can be most helpful by helping her identify all of the options available and supporting her in her decision-making.

Dispel myths about rape. You can help empower a woman who has been sexually assaulted by being prepared to help her dispel destructive myths about rape and by assuring her that you do not believe these false ideas.

Advocate. She may need someone to help ensure that her feelings are validated and her rights are upheld in the medical or legal system.

Believe in the possibility of healing. Let her know that you believe that healing is possible and that she has the strength and capacity to heal.

Even though most sexual assaults are committed by someone we know rather than a stranger, we can take some steps to protect ourselves. Listing these suggestions reminds us how wrong it is for women to be and to feel unsafe in our homes and our communities. Yet, until men stop raping women, we need to take precautions. The most effective protection comes from being with other women. Arrange to walk home together. Set up a green-light or safe-house program in your neighborhood. Get to know the women who live in your apartment building or on your street.

Safety at home. Make sure that entrances are well lit and that windows and doors are securely locked. Use only your last name on your mailbox. Find out who is at your door before opening it to anyone.

Safety on the street. Be aware of what is going on around you. Walk with a steady pace, looking as if you know where you are going. Dress so you can move and run easily. Walk in the middle of the street, avoiding dark places and groups of men. If you fear danger, yell "Fire," not "Help" or "Rape." Carry a whistle around your wrist. Always check the backseat of your car before getting in and keep the car doors locked while driving. Avoid groups of men on public transportation. If you can possibly avoid it, don't hitchhike; it is just too dangerous.

Safety in social situations. Pay attention to how you feel and trust your instincts. If you want to end a date or leave a party, say so, even if you are afraid or embarrassed. If you drink alcohol, keep an eye on your drink. Drugs are available that can be slipped into drinks to tranquilize a woman and create a blackout. For example, a drug called Rohypnol, or "Roofies," causes severe memory loss so that a woman can be raped but will not be able to remember anything.

These tactics can help you, but they are not foolproof. Practice tactics for the situations that make you feel most at risk and least powerful. Try to remain calm and to act as confident and strong as you can.

Copyright � 1984, 1992, 1998 by the Boston Women's Health Book Collective. All rights reserved. Published by Touchstone, a division of Simon & Schuster Inc.

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