History

After performing a preliminary survey to establish the presence of any potentially serious injury or illness, obtain further history from the victim.^[10]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.

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.

Differential Diagnoses

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Author

Marian Sackey, MD Resident Physician, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Marian Sackey, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association, Student National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Heather Murphy-Lavoie, MD, FAAEM, FACEP Associate Professor, Assistant Residency Director, Emergency Medicine Residency, Associate Program Director, Undersea and Hyperbaric Medicine Fellowship, Section of Emergency Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert Harwood, MD, MPH, FACEP, FAAEM Senior Physcian, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine

Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Residency Directors in Emergency Medicine, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Gil Z Shlamovitz, MD, FACEP Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

William S Ernoehazy, Jr, MD, FACEP Attending Physician, Department of Emergency Medicine, Flagler Hospital; Attending Physician, Baptist Emergency at Town Center

William S Ernoehazy, Jr, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous editor, Charles V Pollack Jr, MD, to the development and writing of this article.

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