Sexual Assault Evaluation

Survivors of sexual assault constitute one of the most vulnerable patient populations encountered in the emergency department. Over the past 15 years, sexual assault-related emergency department visits have risen drastically by 1533%. Data from the National Intimate Partner Violence and Sexual Violence Survey conducted by the Centers for Disease Control and Prevention (CDC) indicates that approximately 1 in 5 women (21.3%) in the United States have experienced rape or attempted rape in their lifetime, with 43.2% of these assaults occurring before 18. For men, 2.6% have experienced rape or attempted rape in their lifetime, with 51.3% of the encounters occurring before 18. In addition, more than one-third of women (37.0%) and one-fifth of men (17.9%) reported experiencing unwanted sexual contact. Data may not accurately reflect the true incidence of rape and sexual assault, as various barriers deter individuals from reporting or seeking medical care, potentially underestimating the actual figures. Survivors may experience covert rape, be assaulted while incapacitated, or encounter drug- or alcohol-facilitated rape. Perceived stigma, blame, disbelief, and the fear of retaliation may result in individuals not seeking medical care or reporting to legal authorities. Several factors that increase the likelihood of an individual seeking medical care following sexual assault or rape include acknowledging the assault, sustaining a physical injury, reporting to law enforcement, and fear of sexually transmitted infections (STIs) or pregnancy. From a systems perspective, initiatives that encourage survivors to seek medical care after rape or sexual assault include enhancing public health education on the definitions of consent, sexual assault, and rape, as well as ensuring legal protections for survivors who seek care or report incidents. Once survivors pursue care, they should be met by well-trained staff to facilitate medical examinations, evidence collection, and resource delivery. There is a critical need to prioritize staff preparedness and resource availability to address the growing number of sexual assault-related emergency department visits. This effort includes ensuring equitable access to Sexual Assault Nurse Examiners (SANEs) in underserved or rural areas. Ongoing initiatives to improve care for this patient population require a multifaceted approach, focusing on reducing barriers, implementing trauma-informed practices, and optimizing resource distribution for those affected.[SAMHSA. Practical Guide for Implementing a Trauma-Informed Approach]