Survivors usually don’t look physically injured
Most sexual assault survivors don’t have any obvious physical injuries. This doesn’t mean they aren’t hurt physically, emotionally and spiritually. We can’t judge whether someone is telling the truth about a sexual assault based on how they look.
People who have been strangled by a partner are at highest risk for being murdered
Strangulation significantly increases the risk that she will be killed by her partner during a future assault. Reports of strangulation should be taken very seriously and frank discussions should be had with women about their ongoing risks and safety planning.
Being strangled can cause serious harm or even death up to 5 days later
Strangulation can injure blood vessels in the neck and/or fracture small bones around the airway. This can lead to swelling/bleeding that can occur over the next few days. It’s very important that anyone reporting strangulation has a full medical assessment (including a head and neck CT) and be given clear instructions about returning to the emergency department with worsening signs and symptoms.
A “Rape Kit” cannot tell if someone has been sexually assaulted or not
First of all, it’s not a “rape kit,” it’s a forensic exam (or a sexual assault exam). It’s a medical assessment that includes the collection of specimens that might possibly be used as evidence and documentation that is objective and accurately describes all findings. A forensic exam cannot prove that someone has been sexually assaulted or not. This is disappointing for many patients presenting for an exam in the worst moments of their life… and we tell them we can’t give them answers. Some findings might lead us to a certain conclusion, but it still cannot prove assault. Which leads me to #5…
Do not expect to find sperm during a forensic exam
Most forensic health care providers do not look for sperm. They simply collect the specimens and then hand them directly to police who then take them to a police lab…where the specimens will sit until they are directed to process them. Most specimens are never processed because the accused pleads guilty, the case does not go to court, or the specimen results won’t matter to the case (e.g. “I thought she said yes”).
Waiting for toxicology results can be problematic
There are many things to consider about toxicology testing. First, it can take up to 2 – 3 weeks for a result. During this time, if the victim has not reported to police, the case grows colder and evidence is lost (from the scene or by witnesses). Secondly, Positive or negative toxicology results cannot prove or disprove assault. Finally, many drugs are metabolized and excreted so quickly that they may not be detectable. All of this is affected by factors such as food and water intake, liver and kidney health, other drug interactions, timing, amount ingested, method of drugging, method of toxicology analysis, etc.
Bruises can’t be dated
The research is clear so don’t get stuck on this. There is no objective way to determine if a bruise is 3 hours old or 3 days old. When forensically documenting a bruise, describe its shape, colour, size and location but refrain from providing a timeline for when the bruise occurred.
It’s still valuable to come for a medical and forensic exam even if a patient has showered or changed clothes or done any of the things that you’re “not supposed to do”
Sure, maybe there’s some potential evidence that’s washed down the drain but a medical exam can also give someone peace of mind. We can still try to prevent sexually transmitted infections and pregnancy. We can still do some testing and if it’s been within 7 days there’s still possible evidence. A forensic exam isn’t just about evidence collection—it’s also about a patient’s physical and mental well-being. We can help them take the next steps toward healing and moving forward.
It’s not the job of a survivor to protect others
Well meaning friends, family and professionals encourage reporting to police because maybe she can prevent it from happening to someone else. This is not her job. It’s a way of pressuring and guilting her into doing something we think is best. Reporting to police needs to be considered in the context of many other factors that we can’t fully understand. Reporting may be the difference between being safe and being homeless, being kicked out of family or losing a job. It’s not her role to prevent future sexual assaults. It’s our job. It’s everyone else’s job to speak out about violence against women and hold others accountable for their actions.
You can integrate forensic practices into your care
Anyone can do a forensic assessment. It means measuring and describing injuries without drawing conclusions as to what happened. During any medical exam, you are integrating a forensic approach when you use defensible assessment techniques and objectively describe your findings. This is forensic care! Of course, there are many more things you can do to integrate forensic science into your practice. If you’re interested in learning more or have questions, leave a comment below!