An estimated one in five women and one in 16 men in Australia have experienced sexual violence.

After such a traumatic experience, it’s understandable many are unsure if they want to report it to the police. In fact, less than 10% of Australian women who experience sexual assault ever make a police report.

In Australia there is no time limit on reporting sexual assault to police. However, there are tight time frames for collecting forensic evidence, which can sometimes be an important part of the police investigation, whether it’s commenced at the time or later.

This means the decision of whether or not to undergo a medical forensic examination needs to be made quite quickly after an assault.

I work as a medical forensic examiner. Here’s what you can expect if you present for a medical forensic examination after a sexual assault.

A team of specialists

There are about 100 sexual assault services throughout Australia providing 24-hour care. As with other areas of health care, there are extra challenges in regional and rural areas, where there are often further distances to travel and staff shortages.

Sexual assault services in Australia are free regardless of Medicare status. To find your nearest service you can call 1800 RESPECT (1800 737 732) or Full Stop Australia (1800 385 578) who can also provide immediate telephone counselling support.

It’s important to call the local sexual assault service before turning up. They can provide the victim-survivor with information and advice to prevent delays and make the process as helpful as possible.

The consultation usually occurs in a hospital emergency department which has a designated forensic suite, or in a specialised forensic service.

The victim-survivor is seen by a doctor or nurse trained in medical and forensic care. There’s a sexual assault counsellor, crisis worker or social worker present to support the patient and offer counselling advice. This is called an “integrated response” with medical and psychosocial staff working together.

In most cases the victim-survivor can have their own support person present too.

Depending on what the victim-survivor wants, the doctor or nurse will take a history of the assault to guide any medical care which may be needed (such as emergency contraception) and to guide the examination.

Sexual assault services are always very aware of giving victim-survivors a choice about having a medical forensic examination. If a person presents to a sexual assault service, they can receive counselling and medical care without undergoing a forensic examination if they do not wish to. https://www.youtube.com/embed/CGlbTgia0Ek?wmode=transparent&start=0 Sexual assault services are inclusive of all genders.

Collecting forensic samples

Samples collected during a medical forensic examination can sometimes identify the perpetrator’s DNA or intoxicating substances (alcohol or drugs that might be relevant to the investigation). The window of opportunity to collect these samples can be as short as 12 hours, or up to 5–7 days, depending on the nature of the sexual assault.

In most of Australia, an adult who has experienced a recent sexual assault can be offered a medical forensic examination without making a report to police.

Depending on the state or territory, the forensic samples can usually be stored for 3 to 12 months (up to 100 years in Tasmania). This allows the victim-survivor time to decide if they want to release them to police for processing.

The doctor or nurse will collect the samples using a sexual assault investigation kit, or a “rape kit”.

Collecting these samples might involve taking swabs to try to detect DNA from external and internal genital areas and anywhere there may have been DNA transfer. This can be from skin cells, where the perpetrator touched the victim-survivor, or from bodily fluids including semen or saliva.

The doctor or nurse carrying out the examination do their best to minimise re-traumatisation, by providing the victim-survivor information, choices and control at every step of the process.

How about STIs and pregnancy?

During the consultation, the doctor or nurse will address any concerns about sexually transmitted infections (STIs) and pregnancy, if applicable.

In most cases the risk of STIs is small. But follow-up testing at 1–2 weeks for infections such as chlamydia and gonorrhoea, and at 6–12 weeks for infections such as syphilis and HIV, is usually recommended.

Emergency contraception (sometimes called the “morning after pill”) can be provided to prevent pregnancy. It can be taken up to five days after sexual assault (but the sooner the better) with follow-up pregnancy testing recommended at 2–3 weeks.

Things have improved over time

When I was a junior doctor in the late 90s, taking forensic swabs was usually the responsibility of the busy obstetrics and gynaecology trainee in the emergency department, who was often managing multiple patients and had little training in forensics. There was also usually no supportive counsellor.

Anecdotally, both the doctor and the patient were traumatised by this experience. Research shows that when specialised, integrated services are not provided, victim-survivors’ feelings of powerlessness are magnified.

But the way we carry out medical forensic examinations after sexual assault in Australia has improved over the years.

With patient-centred practices, and designated forensic and counselling staff, the experience for the patient is thought to be empowering rather than re-traumatising.

Our research

In new research published in the Australian Journal of General Practice, my colleagues and I explored the experience of the medical forensic examination from the victim-survivor’s perspective.

We surveyed 291 patients presenting to a sexual assault service in New South Wales (where I work) over four years.

Some 75% of patients reported the examination was reassuring and another 20% reported it was OK. Only 2% reported that it was traumatising. The majority (98%) said they would recommend a friend present to a sexual assault service if they were in a similar situation.

While patients spoke positively about the care they received, many commented that the sexual assault service was not visible enough. They didn’t know how to find it or even that it existed.

We know many victim-survivors don’t present to a sexual assault service or undergo a medical forensic examination after a sexual assault. So we need to do more to increase the visibility of these services.

The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.

Mary Louise Stewart, Senior Career Medical Officer, Northern Sydney Local Health District; PhD Candidate, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.

Drugs like Ozempic are very effective at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.

But does weight come back when you stop using it?

The short answer is yes. Stopping tirzepatide and semaglutide will result in weight regain in most people.

So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.

It’s a long-term treatment, not a short course

If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.

For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.

Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)

Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.

Why do people stop?

Research trials show anywhere from 6% to 13.5% of participants stop taking these drugs, primarily because of side effects.

But these studies don’t account for those forced to stop because of cost or widespread supply issues. We don’t know how many people have needed to stop this medication over the past few years for these reasons.

Understanding what stopping does to the body is therefore important.

So what happens when you stop?

When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to move out of your system. As it does, a number of things happen:

• you start feeling hungry again, because both your brain and your gut no longer have the medication working to make you feel full

• blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a low glycemic index to stabilise your blood sugars
• over the longer term, most people experience a return to their previous blood pressure and cholesterol levels, as the weight comes back
• weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.

While you were on the medication, you will have lost proportionally less skeletal muscle than fat, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.

Is stopping and starting the medications a problem?

People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of yo-yo dieting.

When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to deal with spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can stress your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.

Interestingly, the risk to the body from weight fluctuations is greater for people who are not obese. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.

How can you avoid gaining weight when you stop?

Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:

• getting quality sleep
• exercising in a way that builds and maintains muscle. While on the medication, you will likely have lost muscle as well as fat, although this is not inevitable, especially if you exercise regularly while taking it

• addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is fat-phobic and discriminates against people in larger bodies
• eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.

Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.

Read the other articles in The Conversation’s Ozempic series here.

Natasha Yates, General Practitioner, PhD Candidate, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.