Case 9: Intimate partner violence in the gay community

A 19-year-old male presents to the emergency department with a complaint of painful rectal bleeding. The triage note is otherwise blank. The patient enters the examination room alone, appearing sullen and withdrawn. A young male resident assigned to his care becomes frustrated during multiple attempts at a history and a physical. The patient is quiet, slow to answer questions, and offers little detail. The resident makes several requests for the patient to fully undress. Physical examination is remarkable for a bloody laceration extending close to the ventral aspect of the anal sphincter. Multiple bruises are noted on the extremities. After the examination, the physician shakes his head and asks, "How did all this happen?" The patient starts to cry and states, "I can’t believe my life has gotten so out of control."