One metric used by the WHO to determine the severity of global rates of coercive, forced sexual activity was the question "Have you ever been forced to have sexual intercourse against your will?" Asking this question produced higher positive response rates than being asked, whether they had ever been abused or<unk> d. The WHO report describes the consequences of sexual abuse: * Gynecological disorders * Reproductive disorders * Sexual disorders * Infertility * Pelvic inflammatory disease * Pregnancy complications * Miscarriage * Sexual dysfunction * Acquiring sexually transmitted infections, including HIV/AIDS * Mortality from injuries * Increased risk of suicide * Depression * Chronic pain * Psychosomatic disorders * Unsafe abortion * Unwanted pregnancy (see Pregnancy from<unk>  Emotional and psychological Frequently, victims may not recognize what happened to them was<unk> . Some may remain in denial for years afterwards. Confusion over whether or not their experience constitutes<unk>  is typical, especially for victims of psychologically coerced<unk> . Women may not identify their victimization as<unk>  for many reasons such as feelings of shame, embarrassment, non-uniform legal definitions, reluctance to define the friend/partner as a rapist, or because they have internalized victim-blaming attitudes. The public often perceives these behaviors as 'counterintuitive' and, therefore, as evidence of a dishonest woman. During the assault, a person will respond with fight, flight, freeze, friend (sometimes called fawn), or flop. Victims may react in ways they did not anticipate. After the<unk> , they may be uncomfortable/frustrated with and not understand their reactions. Most victims respond by 'freezing up' or becoming compliant and cooperative during the<unk> . These are common survival responses of all mammals. This can cause confusion for others and the person assaulted. An assumption is that someone being<unk> d would call for help or struggle. A struggle would result in torn clothes or injuries. Dissociation can occur during the assault. Memories may be fragmented especially immediately afterwards. They may consolidate with time and sleep. A man or boy who is<unk> d may be stimulated and even ejaculate during the experience of the<unk> . A woman or girl may orgasm during a sexual assault. This may become a source of shame and confusion for those assaulted along with those who were around them. Trauma symptoms may not show until years after the sexual assault occurred. Immediately following a<unk> , the survivor may react outwardly in a wide range of ways, from expressive to closed down; common emotions include distress, anxiety, shame, revulsion, helplessness, and guilt. Denial is not uncommon. In the weeks following the<unk> , the survivor may develop symptoms of post-traumatic stress syndrome and may develop a wide array of psychosomatic complaints. PTSD symptoms include re-experiencing of the<unk> , avoiding things associated with the<unk> , numbness, and increased anxiety and startle response. The likelihood of sustained severe symptoms is higher if the rapist confined or restrained the person, if the person being<unk> d believed the rapist would kill them, the person who was<unk> d was very young or very old, and if the rapist was someone they knew. The likelihood of sustained severe symptoms is also higher if people around the survivor ignore (or are ignorant of) the<unk>  or blame the<unk>  survivor. Most people recover from<unk>  in three to four months, but many have persistent PTSD that may manifest in anxiety, depression, substance abuse, irritability, anger, flashbacks, or nightmares. In addition,<unk>  survivors may have long-term generalised anxiety disorder, may develop one or more specific phobias, major depressive disorder, and may experience difficulties with resuming their social life and with sexual functioning. People who have been<unk> d are at higher risk of suicide. Men experience similar psychological effects of being<unk> d, but they are less likely to seek counseling. Another effect of<unk>  and sexual assault is the stress created in those who study<unk>  or counsel the survivors. This is called vicarious traumatization. Physical The presence or absence of physical injury may be used to determine whether a<unk>  has occurred. Those who have experienced sexual assault yet have no physical trauma may be less inclined to report to the authorities or to seek health care. While penetrative<unk>  generally does not involve the use of a condom, in some cases a condom is used. The use of a condom significantly reduces the likelihood of pregnancy and disease transmission, both to the victim and the rapist. Rationales for condom use include: avoiding contracting infections or diseases (particularly HIV), especially in cases of<unk>  of sex workers or in gang<unk>  (to avoid contracting infections or diseases from fellow rapists); eliminating evidence, making prosecution more difficult (and giving a sense of invulnerability); giving the appearance of consent (in cases of acquaintance<unk> ; and thrill from planning and the use of the condom as an added prop. Concern for the victim is generally not considered a factor. Sexually transmitted infections Those who have been<unk> d have relatively more reproductive tract infections than those who have not been<unk> d. HIV can be transmitted through<unk> . Acquiring AIDS through<unk>  puts people at risk of suffering psychological problems. Acquiring HIV through<unk>  may lead to behaviors that create a risk of injecting drugs. Acquiring sexually transmitted infections increases the risk of acquiring HIV. The belief that having sex with a virgin can cure HIV/AIDS exists in parts of Africa. This leads to the<unk>  of girls and women. The claim that the myth drives either HIV infection or child sexual abuse in South Africa is disputed by researchers Rachel Jewkes and Helen Epstein. Victim blaming, secondary victimization and other mistreatment In this Roman depiction of a fight between a Nymph and a Satyr (Naples National Archaeological Museum), the Nymph is shown vigorously resisting the Satyr's sexual advances, punching him on the mouth – an example of the idealized female resistance, lack of which might be construed as implying consent. Society's treatment of victims has the potential to exacerbate their trauma. People who have been<unk> d or sexually assaulted are sometimes blamed and considered responsible for the crime. This refers to the just world fallacy and<unk>  myth acceptance that certain victim behaviors (such as being intoxicated, flirting or wearing sexually provocative clothing) may encourage<unk> . In many cases, victims are said to have "asked for it" because of not resisting their assault or violating female gender expectations. A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. Women who have been<unk> d are sometimes deemed to have behaved improperly. Usually, these are cultures where there is a significant social divide between the freedoms and status afforded to men and women. "Rape victims are blamed more when they resist the attack later in the<unk>  encounter rather than earlier (Kopper, 1996), which seems to suggest the stereotype that these women are engaging in token resistance (Malamuth & Brown, 1994; Muehlenhard & Rogers, 1998) or leading the man on because they have gone along with the sexual experience thus far. Finally,<unk>  victims are blamed more when they are<unk> d by an acquaintance or a date rather than by a stranger (e.g., Bell, Kuriloff, & Lottes, 1994; Bridges, 1991; Bridges & McGr ail, 1989; Check & Malamuth, 1983; Kanekar, Shaherwalla, Franco, Kunju, & Pinto, 1991; L'Armand & Pepitone, 1982; Tetreault & Barnett, 1987), which seems to evoke the stereotype that victims really want to have sex because they know their attacker and perhaps even went out on a date with him. The underlying message of this research seems to be that when certain stereotypical elements of<unk>  are in place,<unk>  victims are prone to being blamed." Commentators state: "individuals may endorse<unk>  myths and at the same time recognize the negative effects of<unk> ." A number of gender role stereotypes can play a role in rationalization of<unk> . These include the idea that power is reserved to men whereas women are meant for sex and objectified, that women want forced sex and to be pushed around, and that male sexual impulses and behaviors are uncontrollable and must be satisfied. For females, victim-blaming correlates with fear. Many<unk>  victims blame themselves. Female jurors might look at the woman on the witness stand and believe she had done something to entice the defendant. In Chinese culture, victim-blaming is often associated with the crime of<unk> , as women are expected to resist<unk>  using physical force. Thus, if<unk>  occurs, it is considered to be at least partly the woman's fault, and her virtue is called into question. Honor killings and forced marriages In many cultures, those who are<unk> d have a high risk of suffering additional violence or threats of violence after the<unk> . This can be perpetrated by the rapist, friends, or relatives of the rapist. The intent can be to prevent the victim from reporting the<unk> . Other reasons for threats against those assaulted is to punish them for reporting it, or of forcing them to
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