rape is defined by the world health organization ( who ) as any sexual act or attempt to obtain sexual act , with unwanted sexual comments or advances against a person s sexuality using coercion ( 2 ) . brazilian law defines rape as  embarrassing someone through violence or serious threat to have sexual intercourse or to perform or allow the practice of other libidinous acts  ( 3 ) . between 1% and 12% of women , over 15 years of age have been sexually assaulted by unknown perpetrators ( 4 ) . in the united states , the prevalence is 18% in adult women with an annual incidence from 0.3% to 1.1% ( 5 ) , whereas in south africa , the prevalence is also high , but hardly ever measured ( 4 ) . in brazil , the impact of sexual violence is multiplied when attacked women become pregnant and violence is passed from generation to generation ( 7 ) . less than 10% of cases of sexual assault are registered in police stations ( 8) . the number of confirmed cases of rape using physical violence during practice increases when the perpetrators are unknown . the violence practiced by current partners is as prevalent as that perpetrated by strangers , but since cohesion is often not physical , it leaves no trace and therefore , the complaint is not performed ( 5 ) . the assistance to victims of rape is divided into physical and psychological care ( 4 , 810 ) and collection of evidence for criminal prosecutions ( 11 ) . the collection involves physical , emotional and health examination and observations about body injuries including the genital area with collection of samples for dna analysis ( 4 , 9 ) . given the above and the relevance of this topic , this study aimed to characterize rape committed against brazilian women and to identify possible associations between its occurrence and variables related to the victims , to perpetrators , to the aggression and to the resulting injuries . a retrospective study design was undertaken by the analysis of expert medical reports derived from medical forensic exams performed at the department of forensic medicine of the city of campina grande , pb , brazil , between january 2005 and december 2009 . the city of campina grande presented a considerable cultural , social and economic disparities , average monthly income of $ 110 per capita and human development index of 0.72 . about 886 forensic medical reports of sexual violence committed against female victims ( children , adolescents , adults and elderly ) were analyzed . the inclusion criterion was the crime of sexual abuse presented by the patient or her legal representative consistent with the provisions of articles 213 and 217-a of brazilian criminal law . article 213 criminalizes as rape any non - consensual sexual act committed with the use of physical force or serious threat . article 217-a , dealing with rape of vulnerable individuals , covers sexual acts against children under 14 years or against those of any age who can not offer resistance or give consent ( 1 ) . information regarding socio - demographic variables ( year , age , marital status and educational level ) were collected related to the offenders ( known or unknown ; single or multiple and age ) and aggression ( location , time elapsed between the event and forensic examination , previous virginity , use of violence , body injuries and collection of material for dna testing ) . the information from the forensic medical reports were gathered and transferred to specific registration forms . data analysis involved descriptive statistics ( frequency distribution ) and analytic statistics . to test the association between the occurrence of rape and other variables a process of bivariate analysis was conducted , using the exact versions of the nonparametric pearson s chi - squared test or fisher s exact test . the level of statistical significance was set at 5% with a confidence interval of 95% . this study followed ethical guidelines recommended by the brazilian legislation and was approved by the human research ethics committee of the state university of paraiba . a retrospective study design was undertaken by the analysis of expert medical reports derived from medical forensic exams performed at the department of forensic medicine of the city of campina grande , pb , brazil , between january 2005 and december 2009 . the city of campina grande presented a considerable cultural , social and economic disparities , average monthly income of $ 110 per capita and human development index of 0.72 . about 886 forensic medical reports of sexual violence committed against female victims ( children , adolescents , adults and elderly ) were analyzed . the inclusion criterion was the crime of sexual abuse presented by the patient or her legal representative consistent with the provisions of articles 213 and 217-a of brazilian criminal law . article 213 criminalizes as rape any non - consensual sexual act committed with the use of physical force or serious threat . article 217-a , dealing with rape of vulnerable individuals , covers sexual acts against children under 14 years or against those of any age who can not offer resistance or give consent ( 1 ) . information regarding socio - demographic variables ( year , age , marital status and educational level ) were collected related to the offenders ( known or unknown ; single or multiple and age ) and aggression ( location , time elapsed between the event and forensic examination , previous virginity , use of violence , body injuries and collection of material for dna testing ) . the information from the forensic medical reports were gathered and transferred to specific registration forms . data analysis involved descriptive statistics ( frequency distribution ) and analytic statistics . to test the association between the occurrence of rape and other variables a process of bivariate analysis was conducted , using the exact versions of the nonparametric pearson s chi - squared test or fisher s exact test . the level of statistical significance was set at 5% with a confidence interval of 95% . this study followed ethical guidelines recommended by the brazilian legislation and was approved by the human research ethics committee of the state university of paraiba . the incidence of rape was 32.8% ( n = 291 ) , with the largest percentage of cases ( 22.7% ) being recorded in 2005 . the average age of victims was 15.68 years (  6.36 ) , with minimum of two years and maximum of 68 years . most were between 10 and 19 years ( 89.9% ) , were single ( 98.8% ) and had low educational level ( 86.9% ) . there was an association between rape and marital status ( p = 0.02 ) ( table 1 ) . distribution of victims of rape according to sociodemographic variables a small number of medical reports contained information regarding the age of the aggressor , but reveal that the majority had 20 years or more ( 69.2% ) with mean of 27.4 years (  11.0 ) , minimum of 16 years and maximum 50 years . when evaluating the relationship between victim and sex offender , in 84.2% of cases the perpetrators were known to the victims , being the current partner responsible for 31.8% of cases . sex offenders with blood ties ( biological father , uncle and brother ) totaled 5.7% of cases . regarding the number of offenders , association between rape and variables related to aggressor among the cases where the number of attackers was multiple , 12 cases involved two perpetrators , one involved three perpetrators and one case involved five perpetrators . an association was observed between rape and the age of the sex offender ( p = 0.03 ) , type of relationship ( p = 0.001 , pr = 2.32 ( 1.62 to 3.33 ) ) and known offenders ( p = 0.001 ) . information concerning the site of rape occurrence was not present in 76.4% of medical reports . in situations in which the site of rape occurrence was identified , most rape occurrences were recorded in the home environment ( n = 35 ; 49.3% ) , and eighteen cases ( 51.4% ) were recorded in the victim s residence and seventeen ( 48.6 ) were recorded in the aggressor s residence . regarding the date of occurrence , 70.5% of cases had 20 days or more from the completion of the forensic examination and 80.9% of victims were virgins before the rape . the presence of violence during the rape practice was found in 72.3% of cases , but physical injuries were identified in only 5.2% of victims . in only 34.8% of occurrences , collection of material for dna testing was performed ( table 3 ) . there was an association between rape and date of occurrence ( p = 0.001 ) , previous virginity ( p = 0.001 ) and violence during practice ( p = 0.001 ) . the data presented here demonstrate that victims of violence do not have a homogeneous profile and differ regarding the sociodemographic characteristics and those related to the event . of the 886 analyzed cases of sexual violence , the existence of rape was found in about one third of victims , a result higher than that reported among american women ( 12 ) . the divergence between results is due to the collection site of studies , since while this research was conducted at the institute of forensic medicine and dentistry , institution for which brazilian victims of sexual violence are referred , another study was carried out in a hospital unit . about 6.8 million cases of rape and physical assault in the united states are estimated each year , with 2.6 million resulting in physical injuries ( 9 ) . when the perpetrator is known to the victim , the complaint is inhibited , reflecting a false prevalence . women are afraid of reprisals and feel ashamed , humiliated and guilty ( 13 ) . the lack of information ; however , prevents measuring the frequency of this fact , thereby contributing to under - reporting ( 14 ) . most of the victims were 19 or younger , a result similar to that observed in the united states , with predominance of adolescent victims aged from 12 to 17 yr ( 5 , 9 ) . hospital revealed mean age of 26.2 years ( 9 ) , which is higher than that found in this work . brazilian researchers found that the prevalence of victims aged under 19 yr ranges from 47.6 ( 16 ) to 77% ( 15 ) . the prevalence of this crime in this age group may be related to the greater consumption of alcohol and illicit drugs , increased frequency of relationships with others , greater exposure to domestic violence , greater public exposure and finally the earlier sexual development primarily driven by the media ( 17 ) . most victims had low educational level , a result similar to that seen in the united states ( 12 ) and brazil ( 16 ) . in this research , predominance of young victims , mostly students was found , corroborating the findings of other brazilian authors ( 16 ) . aggressions against women are mainly committed by intimate or known people ( 8) . in this study , 84.2% of offenders were known to the victims , with predominance of the current partner , corroborating previous findings ( 5,11,14,16 ) . in the united states , more than half of women reported that at some point in their lives , they had been victims of physical aggression or sexual assault by their current partners ( 12 ) . it could be inferred that while father , stepfather , uncles and brothers are the most frequent aggressors against children , spouse or intimate partners are the most frequent perpetrators against adult women . in 6.2% of cases , more than one perpetrator participated in the violence , which is in accordance with literature that reports a low frequency of multiple aggressors ( 11 ) . in this study , the number of offenders varied from two to five . psychological sequelae may be more severe when the crime involves multiple perpetrators ( 1 ) . a significant number of cases of rape occurred at home , both the victim and the aggressor , diverging from data described in literature , where most cases of sexual violence occurs on public roads ( 16 ) . women attacked at the domestic environment are those that least denounced violence to authorities , since most are abused by known people ( 8) . many victims of this research had suffered aggression for more than 20 days from the date of the forensic medical examination . the literature reports that most women present complaint within 72 h after sexual violence ( 5 ) . however , if the aggressor is known to the victim , it takes longer to seek emergency care . on the other hand , when the victim does not know the aggressor , the seek for health services is faster , as identified by brazilian researchers who reported that two thirds of women sought health services within 24 h after sexual violence and emergency care was performed within the first 72 h in 87.6% of women ( 16 ) . more than two thirds of the victims reported the use of force - ( fists or choking , knife , gun , restraints , blindfold , or other means ) , confirming previous findings ( 16 ) . when violence involves children , usually there is use of physical force , but among adolescent and adult women , sexual violence requires physical violence because victims have greater physical size and strength to resist . physical injuries confirm violence during practice , thus becoming an important material evidence for criminal cases , but their absence does not eliminate the possibility of crime ( 18 ) . in this study , few victims exhibited physical injuries resulting from sexual abuse during forensic examination , which was also observed by other authors ( 11 ) . however , this fact may be related to the time elapsed since the sexual violence , which in most cases , the victims were examined for sexual violence only after 20 days . another possible explanation for the absence of injuries is the use of weapons for coercion , preventing occurrence of fights with physical signs of resistance ( 14 ) . research conducted in south africa showed that the confirmation of sexual violence is more common when there is presence of physical injuries and when dna collection is performed ( 4 ) . in this study , the number of victims who had material collected for dna testing was extremely low . it was not possible to identify why this occurred ; however , it may be due to the fact that there were few victims who immediately sought the institute of forensic medicine for collecting material . the first is the fact that it was developed in a unique institute of forensic medicine of a single city . another limitation was the large number of medical reports with missing information ( unfilled , unanswered or inconclusive ) ; however , the findings described here faithfully depict the characteristics of perpetrators and women victims of sexual violence in campina grande , brazil ; being extremely important for public policy planning and resource allocation in public safety . over one third of women were victims of rape , predominantly adolescents , unmarried and with low educational level . the aggressors were known to the victims , and acted alone in most situations , making use of physical violence . ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc . ) have been completely observed by the authors .
background : violence against women is a serious social problem and affects mainly young women . 
 this study aimed to evaluate sexual violence against women in campina grande , brazil.methods:a retrospective study with analysis of 886 forensic medical reports of sexual violence from the institute of legal medicine of campina grande , brazil , was conducted between january 2005 and december 2009 . 
 sociodemographic variables related to victims , offenders and aggressions were analyzed . 
 significance level of 5% was adopted.results:two hundred and ninety - one cases of rape ( 32.8% ) were confirmed , the majority of victims aged between 0 and 19 years ( 89.9% ) , were single ( 98.8% ) and had low educational level ( 86.9% ) , with association with marital status ( p = 0.02 ) . the sex offender was known to the victim in 84.2% of cases and in 93.8% of cases , he acted alone . 
 there was an association between rape and the relationship with the offenders ( p = 0.01 ) and the age of the offenders ( p = 0.03 ) . 
 the rape occurred in most cases at the home of victims ( 49.3% ) , with the use of violence in 72.3% of cases , but only 5.7% of the victims exhibited physical injuries . 
 there was an association between rape and variables date of occurrence ( p = 0.001 ) , previous virginity ( p = 0.001 ) and violence during practice ( p = 0.001).conclusion : over one third of women were victims of rape , predominantly adolescents , unmarried and with low educational level . 
 the offenders were known to the victims , and acted alone in most situations , making use of physical violence .