Providing Post-Sexual Assault Care? 10 things you should know

  1. 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.

  1. 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.

  1. 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.

  1. 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…

  1. 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”).

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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!

I live with a disability. It’s never stopped me from living my life to the fullest – and I have no complaints when it comes to my sex life. I recently started seeing this great girl and we’re totally into each other but when it comes to sex, she gets really nervous about hurting me or doing something wrong. I know my body and tell her constantly that she’s doing fine and what I need from her. What can I do?

co-written by Shaw Chard

Let’s discuss why being sexual with a person with a disability may be novel to your partner and how you both can use this information to grow and learn together.

Time for some background knowledge. Few of us are raised with adequate sexual education, and an oft-excluded factor which contributes to a good (hopefully great!) sex life is communication [1]. At the same time, the dominant discourse of sexuality is not inclusive of people with disabilities, both visible and invisible, and those people are seen as childlike, naïve, and incapable of sexual desire [2]. Sex-ed programs typically don’t include disability or communication in their curricula, and neither do media representations of sexuality. Because it’s never talked about, sexuality among people living with disability is assumed to either be non-existent or fundamentally “different”, which creates a divide between “normal people” and people living with disability [3].

Now, consider how these things may be affecting your partner and your sexual relationship. You’ve made it clear that you enjoy your sex life, that everything between you two in sexual situations is fine, and that you tell her what you need from her. But really, how much of that does she understand? Dominant sexual discourse is so exclusive; nobody talks about pleasure, planning, communication, and alternatives, so it’s no wonder that so many people are lost when it comes to any other idea of what sex can be. Both you and your partner were more than likely taught sexual education through this narrow lens, and although you have been able to find pleasure in tandem with, not despite of, your disability, it may be hard for your partner to get past what she’s learned. Change is not easy, and you can help each other by being as supportive as possible. Try to help her by introducing planning and open communication into your relationship.

When I say open communication, what I mean is that you not only be open with her, but with yourself: you have to be aware of and understand your own desires, as this is crucial to being able to communicate these things to your partner. If you care that she understands what you want, then you need to know what you want beforehand [4]. Even though you say you tell her she’s doing fine, and that you’ve let her know what you need from her, her nervousness could mean that she still doesn’t fully understand. Let your partner know that many people with disabilities, including yourself, don’t see their disabilities as detracting from their sex lives; on the contrary, many feel that their disabilities allow them to get more creative in the bedroom and allow for more open communication in sexual relationships [5]. Further, make sure you are inviting her to explain her wants and needs, and are validating and supportive of them when she opens up. This will facilitate better communication, and you two will likely feel closer, which cycles back to increasing confidence in sharing your desires and your abilities to achieve them in the future [6].

At the same time, you should both make an effort to be understanding of each other’s situations. You both learned that discussing sex is not the norm, but for you two that may simply not work. This is where planning comes into play. Sit down and discuss your respective wants, needs, and how to achieve both in an environment where you can really hear each other. Though the planning may seem like it detracts away from features we associate with good sex like ‘spontaneity’ or ‘immediate, silent understanding’, research has shown that this kind of open communication not only helps in the realm of sexual pleasure, but can also bring more closeness and intimacy into the relationship as a whole [7].

My advice may be starting to sound repetitive; how many times can I say communication? The point of it all is that, in any relationship, partners need to communicate with each other to make sure that everyone involved is getting the most out of their sexual relationship. Sometimes, you just need to be told what to do, and some relationships require more communication than others. There’s no reason that planning and discussion should be an impetus to your sex; on the contrary, it’ll likely make your relationship stronger and the sex better. I’ll dare to assume that most people want to enjoy their sex lives, and the best way to make sure that happens is to talk about your desires, your needs, and the desires and needs of your partner (or partners!). Now go forth, have a discussion with this great girl of yours, and then reap the benefits.

[1] Kaufman, M., Silverberg, C., & Odette, F. (2003). The ultimate guide to sex and disability: For all of us who live with disabilities, chronic pain, and illness (1st ed., pp. 1-345). San Francisco, California: Cleis Press

[2] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z

[3] Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

[4] Kaufman, M., Silverberg, C., & Odette, F. (2003). The ultimate guide to sex and disability: For all of us who live with disabilities, chronic pain, and illness (1st ed., pp. 1-345). San Francisco, California: Cleis Press

[5] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z

[6] Katari, S. (2014). Sexuality and Disability. Sexual experiences of adults with physical disabilities: Negotiating with sexual partners, 32, 499-513. doi:10.1007/s11195-014-9379-z