The World Health Organization defines sexual violence as any sexual act or attempt to obtain a sexual act by violence or coercion.  The definition also covers unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting.

A European Union-wide survey conducted by the EU Fundamental Rights Agency among over 40,000 women in 2014 showed that 13 percent of Estonian women, that is every eighth woman in Estonia, has been subjected to sexual violence over the age of 15. Very few turn to the police or health care professionals for help.

The survey showed that 54 percent of victims of sexual violence in Estonia do not seek help, whereas the corresponding average figure in Europe was 39 percent. While in other European states, 15 percent of victims turned to the police and 34 percent to a health professional, the respective figures reported for Estonia were 10 and 23 percent.

The low number of cases of sexual violence getting reported may stem from a culture of victim blaming, which is widespread among Estonian people. A 2014 survey by pollster TNS Emor showed that half of the respondents in Estonia, regardless of gender or nationality, blame the victim of rape for the abuse they have suffered.

A sexual assault is unexpected, arbitrary and unpredictable. Neurobiological reactions guide the victim to fight and flee; however, as the balance of power is unequal in the case of a sexual assault, fleeing is mostly perceived as impossible and fighting back as ineffective. Few women successfully fend off their attacker.

Studies show that around 80 percent of rape victims do not fight back as a result of extreme biological survival mechanisms causing tonic immobility, which is characterized by reduced heart rate, hypotension of skeletal muscles and dissociation.

As a result, victims of sexual violence may not remember their assault in detail and subsequent memories thereof may be fragmented, which is why they are occasionally deemed unreliable in procedural processes. For that reason, it is crucial that officials handling cases of sexual violence should be made aware of these factors.

The first person to come into contact with a victim of sexual assault holds the key to either their healing or re-victimization. 

Sexual violence causes both mental and physical harm to the victim. Health problems have been reported to worsen if the victim does not speak to anyone about the assault they have suffered. Frequent sexual violence induced health issues include depression, anxiety, panic and sleep disorders and phobias. Victims may suffer from physical injuries to the body and genitals, and a sexual assault may result in an unwanted pregnancy or sexually transmitted diseases.

Around 50 percent of the victims develop post-traumatic stress disorder, and the likelihood of experiencing negative psychological effects increases if the violence is ignored or trivialized or if the victim is blamed for their assault or presumed unreliable.

The summary is based on a presentation by Made Laanpere, gynecologist at the University of Tartu Hospital, given at a conference of the Institute of Clinical Medicine of the University of Tartu faculty of medicine.

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