Sexual Assault Clinical Presentation

Updated: Nov 10, 2015
  • Author: William Ernoehazy, Jr, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Presentation

History

After performing a preliminary survey to establish the presence of any potentially serious injury or illness, obtain further history from the victim. [8] Address the following:

  • A brief description of the incident
  • Location of the assault
  • Identity of the assailant or assailants, if known
  • Home and workplace of the assailant, if known
  • Method by which the assailant left the scene
  • Whether or not a weapon was used to coerce the victim
  • Whether or not drugs were proffered to render the victim incapable of resistance
  • Whether or not the patient has changed clothes, showered, or douched since the incident

A standard obstetrics and gynecology (OB/GYN) history should also be taken to facilitate appropriate pregnancy and STD prophylaxis. This should include last menstrual period, birth control method, and time of last consensual intercourse.

Next:

Physical

In many jurisdictions, sexual assault centers provide trained examiners (generally Sexual Assault Nurse Examiners, or SANE teams) to perform evidence collection and to provide initial contact with the aftercare resources of the center. In such cases, the physician may confidently defer the gynecologic examination to the SANE; studies have repeatedly demonstrated the accuracy of sexual assault examinations performed by SANE teams. Clinicians must nonetheless be diligent and exacting in their general examination and in their documentation. Discrepancies between the ED record and the SANE report can sow doubt about the facts of the case in the minds of juries. Defense lawyers will not fail to exploit such discrepancies.

If no dedicated SANE teams or resources are available in the hospital's area, the assault examination falls to the ED physician.

  • Evidence of the use of force and/or lack of consent (eg, presence of blood and/or sperm, contusions, lacerations, other injuries consistent with resistance) should be sought.
  • Evidence of other injuries and diseases should be sought during the ED examination and treated where present. Again, the physical examination must be thorough and accurately documented.
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