Sexual assault is any sexual contact without consent, and survivors need care that is medical, emotional and, if they choose, forensic. A calm, trauma-informed approach that gives the patient control over each step helps prevent further harm.
Key symptoms
- Pain or bleeding in the genital, anal or oral area
- Injuries elsewhere: bruises, scratches, choking marks
- Fear, numbness, shame or a calm, flat manner
- Memory gaps, which may point to drugs or alcohol
- Later: sleep problems, flashbacks, depression
What you find on exam
- Ask consent for every step and let the patient stop at any time
- Offer a trained sexual assault nurse examiner (SANE) and an advocate
- Full body exam and documentation of injuries with body maps
- Collect forensic evidence if the patient agrees, ideally within 5 days
Tests
- Pregnancy test
- Testing for HIV, hepatitis B, syphilis and other sexually transmitted infections
- Urine and blood toxicology if drug-facilitated assault is suspected
- Imaging for injuries, including strangulation
Treatment basics
- Emergency contraception such as levonorgestrel or ulipristal
- Preventive antibiotics: ceftriaxone, doxycycline and metronidazole
- HIV post-exposure prophylaxis if within 72 hours; hepatitis B and HPV vaccines
- Crisis counseling, safety planning and follow-up in 1 to 2 weeks
- Report as required by law for minors and vulnerable adults
Red flags
- Strangulation or serious injury
- Suicidal thoughts or severe distress
- Patient is a minor, or still unsafe at home
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.