Prevalence of Victimization and Perpetration of Sexual Aggression in Undergraduate Students: A Systematic Review 2008-2018 / Prevalencia de victimización y perpetración de agresión sexual en estudiantes universitarios: una revisión sistemática 2008-2018 / Prevalência de vitimização e perpetração de agressão sexual em estudantes universitários: uma revisão sistemática 2008-2018

Abstract Introduction: Sexual aggression (SA) is a public health problem present throughout the life of people, for this reason it is necessary to know its magnitude and scope. The objective of this study was to conduct a systematic review of empirical studies that include information on the prevalence of sexual aggression in undergraduate students. Materials and Methods: Two authors independently searched for publications between 2008-2018 in the Scopus®, Web of Science®, Scielo®, Redalyc® and Eric® databases. As inclusion criteria, empirical studies that report the prevalence of victimization and/or perpetration of sexual aggression in students since their admission to the university were considered. The evaluation was carried out independently by two evaluators who determined the risk of bias. In total, 35 articles were selected that met the inclusion criteria. Used methodology, sample sizes, measurement instruments, prevalence of victimization-perpetration of sexual aggression and perpetrator-victim relationship are indicated. Results: Although there are differences between the studies analyzed, the results indicate that unwanted sexual contact is the most frequent type of sexual aggression in both victimization and perpetration; however, several studies did not perform this subdivision and showed only general data of some type of sexual aggression. Discussion: The findings of the estimation of prevalence of sexual aggression and its subtypes in undergraduates since they enter university life are discussed, as well as future considerations related to terminology unification that allows to estimate more precise figures of the types of sexual aggression.

Resumen Introducción: la agresión sexual (AS) es un problema de salud pública que está presente en la vida de las personas, motivo por el cual es necesario conocer su magnitud y alcance. El objetivo de este estudio fue realizar una revisión sistemática de estudios que incluyeran información de prevalencia de agresión sexual en estudiantes universitarios. Materiales y métodos: dos autores de manera independiente realizaron la búsqueda de publicaciones entre los años 2008-2018 en las bases de datos Scopus®, Web of Science®, Scielo®, Redalyc® y Eric®. Como criterios de inclusión se consideraron estudios empíricos que reportaran prevalencia de victimización y/o perpetración de agresión sexual en estudiantes desde su ingreso a la universidad. La evaluación fue realizada de manera independiente por dos evaluadores, quienes determinaron el riesgo de sesgo. En total 35 artículos cumplían con los criterios de inclusión. Se indica la metodología empleada, tamaños de muestra, instrumentos de medida, prevalencia de victimización-perpetración de agresión sexual y relación perpetrador-víctima. Resultados: aunque existen diferencias entre los estudios analizados, los resultados indican que el contacto sexual no deseado es el tipo de agresión sexual más frecuente; sin embargo, diversos estudios no realizaron esta subdivisión y mostraron únicamente datos generales de algún tipo de agresión sexual. Discusión: se discuten los hallazgos de la estimación de prevalencia de la agresión sexual y sus subtipos en estudiantes desde que ingresan a la universidad y se plantean consideraciones futuras relacionadas con la unificación de la terminología que permita estimar cifras más precisas de los tipos de agresión sexual.

Resumo Introdução: a agressão sexual (A.S.) é um problema de saúde pública que está presente ao longo da vida das pessoas, motivo pelo qual é necessário conhecer sua magnitude e alcance. O objetivo deste estudo foi realizar uma revisão sistemática dos estudos empíricos que incluíram informação de prevalência de agressão sexual em estudantes universitários. Materiais e métodos: dois autores de maneira independente realizaram a busca de publicações entre os anos 2008-2018 nas bases de dados Scopus®, Web of Science®, Scielo®, Redalyc® e Eric®. Como critérios de inclusão consideraram-se estudos empíricos que reportaram prevalência de vitimização e/ou perpetração de agressão sexual em estudantes desde seu ingresso à universidade. A avaliação foi realizada de maneira independente por dois avaliadores quem determinaram o risco de sesgo. Em total foram selecionados 35 artigos que cumpriam com os critérios de inclusão. Indica-se a metodologia empregada, tamanhos de amostra, instrumentos de medida, prevalência de vitimização-perpetração de agressão sexual e relação perpetrador-vítima. Resultados: ainda que existem diferenças entro os estudos analisados, os resultados indicam que o contato sexual não desejado é o tipo de agressão sexual mais frequente tanto em vitimização como perpetração; no entanto, diversos estudos não realizaram esta subdivisão e mostraram unicamente dados gerais de algum tipo de agressão sexual. Discussão: discutem-se os resultados da estimação de prevalência da agressão sexual e seus subtipos em estudantes, desde que ingressam à vida universitária e se apresentam considerações futuras relacionadas com a unificação da terminologia que permita estimar cifras mais precisas dos tipos de agressão sexual.

Mitos sobre la Agresión Sexual: Validación de una Escala en Universitarios en México / Myths about Sexual Aggression: Validation of a Scale in University Students in Mexico

Resumen La agresión sexual es un problema psicosocial muy poco reconocido debido a los mitos a su alrededor, graduados y media-tizados por la cultura del grupo social (Caballero, 2006). En el presente estudio se asume la agresión sexual como la base para todo tipo de violencia de tipo sexual. Se realizaron dos estudios, el primero valida la escala AMMSA, en versión mexicana, originalmente desarrollada en Alemania (Gerger, Kley, Bohner, & Siebler, 2007); el segundo, determina el grado de aceptación de los mitos de agresión sexual en estudiantes universitarios del Norte de México. La muestra no probabilística fue de 128 y 400 estudiantes para cada estudio, respectivamente. Los resultados del primer estudio indican una consistencia interna de la versión mexicana del AMMSA (α = .93), concordantes con los resultados de la prueba original (α entre .90 y .95); y la externa, presenta una correlación positiva alta y significativa con la versión mexicana del Inventario de Sexismo Ambivalente (r = .68, p < .001), demostrando propiedades psicométricas adecuadas. Se encontró mayor aceptación de los mitos de agresión sexual entre los hombres en comparación a las mujeres, y el menor grado de aceptación de estos en la Facultad de Medicina y Psicología.

Abstract Sexual aggression is a psychosocial and public health problem rarely recognized socially as such, due to the myths around it, graded and mediated by culture of social group in which the phenomenon occurs (Caballero, 2006). In the state of Baja California, Art. 180 of the criminal code defines sexual abuse as the act "that without the consent of a person executes in it or makes it execute a sexual, without the purpose of reaching copulation" (p. 48). In the present study we assume, like the authors of the AMMSA, originally developed in Germany (Gerger, et al., 2007) that sexual aggression is the basis for all types of sexual violence. Two studies were carried out, the first with the purpose of validating the AMMSA scale in the Mexican version; and the second, to determine the degree of acceptance of the sexual aggression myths in students of a public university in Northern Mexico. A sample of 128 students was obtained for the first study and 400 students for the second, a non-probabilistic method was used. The results of the first study indicate an internal consistency of the Mexican version of AMMSA (α = .93), which agrees with the results of the original test (α between .90 and .95); and external presents a high and significant positive correlation with the Mexican version of the Ambivalent Sexism Inventory (r = .68, p <.001). It is demonstrated that the psychometric properties of AMMSA were adequate during its application in university students of the northwest of Mexico, obtaining a high degree of reliability and validity. It is important to note the fact that men tend to accept the myths of sexual assault. This coincides with the popular belief that, within the role of men, one must be tough, aggressive and dominant in their interpersonal relationships (Herman, 1988, Hirigoyen, 2006). This is shown when reviewing that men are, by a wide margin, the biggest aggressors when it comes to issues of sexual violence. When comparing the degree of acceptance among the Faculties under study, the lowest average was observed in the Faculty of Medicine and Psychology.

Perfil epidemiológico de adolescentes mujeres con antecedentes de agresión sexual consultantes en el área de salud mental de un centro de salud sexual y reproductiva / Characteristic of child sexual aggression in adolescent women admitted to the mental health unit of an adolescent sexual and reproductive health centre

Objetivo: conocer la frecuencia y describir las características de las agresiones sexuales infantiles en adolescentes mujeres ingresadas a la unidad de salud mental de un Centro de Salud Sexual y Reproductiva Adolescente. Método: estudio de diseño transversal y analítico, se revisaron las fichas clínicas entre enero de 2006 y diciembre de 2009. Las variables estudiadas fueron: edad de la agresión, tipo y frecuencia de ésta; sexo, edad y tipo de relación con el agresor; revelación y persona a la que se le informa de la agresión sexual y denuncia de la agresión. Resultados: la mayor frecuencia de agresión sexual se presenta en la edad pre-escolar (28,1 por ciento) y la más común es el abuso sexual (73,8 por ciento), tipo de agresión que es la más común en todas las edades. La mayoría de las agresiones fue un episodio único (59,3 por ciento). La totalidad de los agresores eran conocidos o familiares de la víctima, todos varones, el 29,1 por ciento eran menores de 18 años. El 36 por ciento nunca reveló la agresión sufrida. El 31,8 por ciento de las agresiones sin revelar ocurrieron en la edad pre-escolar. Sólo un 14,1 por ciento realizó denuncia. Conclusión: la mayoría de las agresiones sexuales ocurridas durante la infancia y adolescencia no son reveladas, ni denunciadas legalmente, manteniendo un alto nivel de silenciamiento y dificultades por parte de los equipos de salud para apoyar y tratar a las víctimas.

Objective: to describe the frequency and characteristic of child sexual aggression in adolescent women admitted to the Mental Health Unit of an Adolescent Sexual and Reproductive Health Centre. Method: this is a cross-sectional and analytical study, clinical records were reviewed the between january 2006 and december 2009. The variables studied were: age of aggression, type and frequency of this aggression, sex, age and type of relationship with the perpetrator; disclosure and person who is informed and judicial complaint of sexual aggression. Results: the highest frequency of sexual aggression occurs in the preschool age (28.1 percent) and the most common is sexual abuse (73.8 percent), type of aggression is the most common in all ages. Most of the attacks were a single episode (59.3 percent). All the attackers were males and acquaintances or relatives of victims, 29.1 percent were under 18 years old. 36 percent never disclosure the assault. The 31.8 percent of unveiled attacks occurred in preschool. Only 14.1 percent made a judicial complaint. Conclusion: the majority of sexual assaults that occurred during childhood and adolescence are unveiled, nor legally reported maintaining a high level of silencing and difficulties by health equipment to support and treat victims.

Pornografia, desigualdade de gênero e agressão sexual contra mulheres / Pornography, gender inequality and sexual aggression against women

Apesar do alto consumo e produção de pornografia no Brasil, parece não haver estudos empíricos no país que investiguem a relação entre o uso de pornografia e agressão sexual. O presente artigo investigou empiricamente a relação entre consumo de pornografia e perpetração de agressão sexual em estudantes universitários do sexo masculino. Os resultados mostraram que 99,7% da amostra já tiveram contato com material pornográfico, sendo que 54,3% faziam uso ocasional ou frequente. Os dados sugeriram que perpetradores apresentavam médias mais altas de consumo de pornografia em comparação a não perpetradores, e ainda, que o consumo de pornografia violenta aumentava a severidade da agressão sexual perpetrada. Por tratar-se de um estudo transversal, recomenda-se cautela na análise dos resultados. Implicações e recomendações para pesquisas futuras são apontadas.

Despite the high production and consumption of pornography in Brazil, there seems to be no empirical study in this country that investigates the relationship between the use of pornography and sexual aggression. The present study addressed empirically the relationship between pornography consumption and perpetration of sexual aggression in male college students in Brazil. The results showed that 99.7% of the sample had contact with pornographic material and, of those, 54.3% used it occasionally or frequently. The data indicated that perpetrators showed higher means of pornography consumption than non-perpetrators and suggested that the consumption of violent pornography increased the severity of the sexual aggression perpetrated. Because of the study was based in a cross-sectional design, the results should be taken with caution. Implications and recommendations for future research are pointed out.

Factores de vulnerabilidad y de protección del impacto emocional en mujeres adultas víctimas de agresiones sexuales / Risk and protective factors in the emotional impact of adult female victims of sexual aggression

El objetivo de este estudio fue describir las reacciones psicopatológicas de las víctimas según las circunstancias de la agresión sexual, la historia previa y el apoyo familiar/social. La muestra constó de 269 mujeres adultas víctimas de una agresión sexual en la infancia o en la vida adulta. Se evaluaron las reacciones postraumáticas, la sintomatología ansioso-depresiva, la autoestima, las conductas sexuales y el funcionamiento cotidiano. Los resultados mostraron una alta prevalencia de malestar emocional (63,6%), de baja autoestima (59,7%), de TEPT (44,5%), de sentimientos de culpa (48,3%) y de evitación sexual (38,9%), así como problemas de adaptación. La gravedad de la sintomatología estaba relacionada con las circunstancias de la agresión sexual, tales como la penetración vaginal/anal o las heridas provocadas, la historia de victimización, los sucesos estresantes recientes y la falta de apoyo socio-familiar. Sin embargo, las conductas de evitación sexual no estaban relacionadas con circunstancias específicas de la agresión sexual.

The aim of this paper was to describe the psychopathological reactions of the victims according to the circumstances surrounding sexual aggression, the previous clinical record, and the role of family/social support. The sample consisted of269 adult female victims who suffered any kind of sexual aggression either in childhood or in adult life. Participants were assessed with the PTSD Severity Scale, the STAI, the BDI, the Self-Esteem Scale and the Misadjustment Scale. The results showed a high prevalence of emotional trouble (63.6%), low self-esteem (59.7%), PTSD (44.5), guilt feelings (48.3%), sexual avoidance (38.9%), as well as a poor adaptation to daily life activities. The severity of emotional problems was related to the circumstances of sexual aggression, such as vaginal/anal penetration or physical injuries, the history of victimization, the recent stressful life events and the lack of family/social support. However sexual avoidance behaviors were not associated with circumstances of sexual aggression.

Himen complaciente y peritaje médico-legal / Dilatable or complacent hymen legal medical expert work

Se define como himen complaciente (HC) aquel himen que se distiende sin dañarse durante la penetración al momento de la relación sexual, por lo que no quedan lesiones atribuibles al acto sexual. Su hallazgo al momento de realizar el peritaje médico-legal impide afirmar la existencia de penetración total o parcial en el acto denunciado. El objetivo de este trabajo es determinar la prevalencia de HC junto con analizar variables socio-bio-demográficas en mujeres que denuncian ser víctima de una agresión sexual. Se realizó un estudio retrospectivo-descriptivo, seleccionándose de la Unidad de Sexología Forense del Servicio Médico Legal de Temuco las denuncias por violación realizadas entre Enero/2000­ Diciembre/2003 (n=509). Los datos se registraron en planilla Excel y analizados con el software Winstat para Excel. Se verificó 46 mujeres con HC (9 por ciento). El 74 por ciento de las víctimas con HC pertenecía al área urbana, siendo el promedio de edad 16,7 años. El 51,2 por ciento denunció múltiples violaciones y el 89,2 por ciento de los imputados resultaban ser conocidos de la víctima. Al examen físico se constató lesiones extragenitales y coloproctológicas en el 29,9 por ciento y 4,4 por ciento respectivamente. Dentro de las pruebas biológicas realizadas, en el 8,7 por ciento se evidenció la presencia de espermios. En el 9 por ciento de las mujeres que denuncian ser víctima de violación se constata HC. Al examen físico se encuentra algún tipo de lesión en sólo el 28,3 por ciento, mientras que en el 8,7 por ciento se demuestra la presencia de espermios. Con estos resultados son escasas las evidencias que permiten al médico sugerir la existencia de un atentado sexual con o sin penetración total o parcial.

Dilatable or complacent hymen is defined as that which can be stretched without being damaged during sexual intercourse, and is the reason as to lack of injuries present that are attributable to the sexual act. The findings at the time the legal medical expert work is carried out, cannot confirm the existence of total or partial penetration in the denounced cases. The objective of this study was to identify the prevalence of dilatable or complacent hymens and analyze the social-bio-demographic factors of the victims of sexual assault. A descriptive, retrospective study was carried out selecting the reports of rapes from the Sexology Unit of the Legal Medical Service in the city of Temuco, between January 2000 and December 2003 (n=509). The information was registered with Excel program and analyzed by Winstat Software for Excel program. Dilatable or complacent hymen in 46 cases (9 percent), 74 percent of the victims were from urban areas, with an average of 16.7 years of age. 51.2 percent reported several episodes and 89.2 percent of the aggressors were individuals familiar to the victim. During physical examination extra genital and colorectal injuries were noted in 29.9 percent and 4.4 percent respectively. During biological exams presence of spermatocytes was confirmed in 8.7 percent. Dilatable or complacent hymen was reported in 9 percent of the rapes. During physical examination evidence of injury is reported only in 28.3 percent, while there is evidence of spermatocytes in 8.7 percent of the victims. As result there is little evidence that allows the physician to determine the existence of a sexual assault with or without penetration.

Características demográficas y psicosociales de los agresores sexuales / Demographics and psychosocial characteristics of sexual

El artículo describe algunas características demográficas y psicosociales asociadas con las conductas de los agresores sexuales. Las primeras que se describen son: el estado civil, el número de empleos, la edad del primer delito, y el parentesco con las víctimas. Respecto a los antecedentes socio familiares, se describen: la historia de fracaso escolar, la historia de maltrato, la historia de alcoholismo en la familia de origen y antecedentes de violencia sexual en los participantes. Se encontraron relaciones significativas, entre el maltrato, edad del primer delito, fracaso escolar y maltrato físico, así como maltrato sexual en la historia del sujeto. No se encontró relación entre el número de empleos y la agresión sexual, y aunque la literatura plantea que hay más casos en que los agresores son conocidos y familiares de las víctimas, en el estudio sólo se encontró esta variable en el 25% de los casos.

The article describes demographic and psychosocial characteristics associated with the behavior of sexual aggressors. The first characteristics described are: Marital status, number of jobs, age of the first commited crime, and the relationship with the victims. According to the socio-familiar background, some points described are: The story about failure during school years, the story about abuse in the family of origin and the sexual abuse background and the story of alcoholism in the family of origin. Significant connections were found between the abuse, the age of the first commited crime, failure in the school and the physical and sexual abuse. Connections between the number of jobs and the sexual aggression were not found, and even though the literature indicates that there are more cases were aggressors were relatives or known by the victims, in this research this particular variable was found in only 25% of the cases.