Sexual Assault Summary

Legal Definitions

  • Rape: Non-consensual penile penetration
  • Assault by penetration: Object/body part insertion
  • Age of consent: 16 years
  • Under 13: statutory rape

Initial Assessment

  • SARC referral preferred
  • Life-threatening injuries first
  • Non-judgmental approach
  • Gender choice offered

Infection Risks

  • HIV PEPSE within 72h
  • Hep B vaccination
  • STI testing
  • GUM follow-up

Pregnancy Risk

  • Emergency contraception
  • Pregnancy testing
  • FSRH guidelines
  • Timely intervention

Safeguarding

  • Children: mandatory reporting
  • Vulnerable adults
  • Weapons involvement
  • Capacity assessment

Documentation

  • Accurate contemporaneous notes
  • Forensic evidence preservation
  • Clear examination findings
  • Decision rationale

Sexual Assault Management

Comprehensive clinical guide for assessment and management of sexual assault victims

Legal Definitions (Sexual Offences Act 2003)

Rape

  • Non-consensual penetration
  • Vagina, mouth, or anus
  • By a penis
  • Without consent

Sexual Assault by Penetration

  • Non-consensual insertion
  • Object or body part (not penis)
  • Into vagina or anus
  • Intentional act

Age Considerations

  • Age of consent: 16 years
  • Under 13: statutory rape
  • 13-15: sexual offence
  • Mandatory safeguarding

Initial Response Protocol

Initial Response Protocol Flowchart

Step-by-step protocol for initial management of sexual assault cases

Epidemiology & Risk Factors

Key Epidemiological Facts

  • Majority of assaults unreported to police
  • Infrequent ED presentations
  • Limited accurate data available
  • Under-reporting common

Victim Demographics

  • Majority: women of childbearing age
  • Children and elderly at risk
  • Men can be victims
  • All ages and genders affected

Assailant Characteristics

  • Majority known to victim
  • Acquaintances or partners
  • Alcohol involvement common
  • Domestic violence links

Presentation Patterns

  • Initial non-disclosure common
  • Domestic violence cases
  • Emergency contraception requests
  • Psychological symptoms

Consequences of Sexual Assault

Physical Consequences

  • Genital and extra-genital injuries
  • Bruising, abrasions, lacerations
  • Bite marks
  • Patterned injuries

Infectious Diseases

  • Sexually transmitted infections
  • HIV exposure risk
  • Hepatitis B and C
  • Bacterial STIs

Reproductive Health

  • Unwanted pregnancy
  • Emergency contraception needs
  • Pregnancy testing
  • Reproductive trauma

Psychological Impact

Psychological Symptoms

  • Post-traumatic stress disorder (PTSD)
  • Sleeping difficulties and nightmares
  • Poor appetite and eating disorders
  • Flashbacks and intrusive memories
  • Emotional numbness or detachment
  • Anger, shame, and denial
  • Avoidance behavior
  • Depression and anxiety
  • Suicidal ideation and self-harm
  • Relationship and sexual difficulties

Clinical Assessment Protocol

Priority Management

  • Life-threatening injuries take priority over forensic examination
  • ABC assessment and stabilization first
  • Major bleeding control
  • Airway management if compromised

Assessment Environment

Ideal Setting

  • Sexual Assault Referral Centre (SARC)
  • One-stop service location
  • Trained professional staff
  • Comprehensive support services

ED Management

  • Respect patient's decision if SARC declined
  • Non-judgmental, confidential approach
  • Senior or appropriately trained doctor
  • Offer choice of doctor's gender

History Taking

tr>
Information Required Clinical Importance
Time and location of assault Forensic timeline, evidence collection
Assailant characteristics Identification, risk assessment
Physical violence used Injury pattern, weapon involvement
Sexual acts performed Infection risk, injury sites
Penetration details (vaginal, oral, anal) Medical and forensic implications
Contraception status Pregnancy risk assessment

Comprehensive Assessment Pathway

Comprehensive Assessment Pathway

Detailed clinical pathway from presentation to comprehensive care

Examination & Forensic Considerations

Examination Limitations

  • Do NOT perform pelvic examination unless significant bleeding
  • Avoid disrupting potential forensic evidence
  • Forensic examination by trained FME only
  • Document clearly for potential court testimony

Physical Examination

General Examination

  • Full body inspection
  • Bruising, abrasions, lacerations
  • Patterned injuries (fingertip marks)
  • Bite marks assessment and treatment

Oral Examination

  • Inspect inside mouth
  • Look for trauma evidence
  • Document findings clearly
  • Avoid evidence contamination

Evidence Preservation

Patient Instructions

  • Avoid showering or bathing
  • Do not brush teeth
  • Preserve clothing worn during assault
  • Avoid eating or drinking if oral assault
  • Do not clean under fingernails
0-24 Hours

Forensic evidence collection optimal

24-72 Hours

Some evidence still recoverable

72-120 Hours

Limited evidence recovery

5+ Days

Minimal forensic evidence

Infection Risk Management

Bloodborne Viruses

HIV PEPSE

  • Within 72 hours of exposure
  • Risk assessment required
  • Transmission risk >1/1000
  • Increased risk with genital injury
  • GUM follow-up essential

Hepatitis B

  • Accelerated vaccination schedule
  • Start within 24 hours (up to 1 week)
  • HBIG in high-risk situations only
  • Vaccine highly effective alone

Hepatitis A & C

  • Hep A: only if known contact
  • Within 2 weeks of exposure
  • Hep C: baseline testing
  • Monitoring and follow-up

Bacterial Infections

STI Testing & Prophylaxis

  • Follow current BASHH guidelines
  • Consider incubation periods
  • Routine prophylaxis not recommended
  • Consider in high-risk cases
  • GUM follow-up essential

Infection Risk Management Algorithm

Infection Risk Management Algorithm

Systematic approach to infection risk assessment and management

Pregnancy Risk & Emergency Contraception

Pregnancy Risk Assessment

  • Assess all victims for pregnancy risk
  • Offer pregnancy testing
  • Provide emergency contraception
  • Follow FSRH guidelines

Emergency Contraception Options

Method Timeframe Efficacy Considerations
Levonorgestrel 72-96 hours Good First-line option
Ulipristal acetate 120 hours Very good Extended timeframe
Copper IUD 120 hours Excellent Most effective

Information Sharing & Safeguarding

Confidentiality Principles

  • Clinical information is confidential
  • Offer police involvement
  • Respect decision not to involve police
  • Consultant-level decisions for information sharing

Mandatory Disclosure Circumstances

Child Protection

  • Any sexual assault of a child
  • Activate safeguarding procedures
  • Mandatory reporting
  • Multi-agency involvement

Vulnerable Adults

  • Lacks capacity to consent
  • Unlikely to regain capacity
  • Welfare concerns
  • Safeguarding protocols

Weapons Involvement

  • Guns or knives used
  • Serious physical harm risk
  • Public safety concerns
  • Police notification required

Documentation Requirements

  • Clear rationale for information sharing
  • Consultant discussion documented
  • Communication with patient where practical
  • Comprehensive case notes

Referral & Support Services

Medical Services

  • Genitourinary medicine
  • Infectious diseases
  • Mental health services
  • Women's health services

Support Organizations

  • Victim Support
  • Rape Crisis centres
  • Social Services
  • Community Safety Units

Specialist Services

  • Sexual Assault Referral Centres
  • Forensic Medical Examiners
  • Psychological therapy services
  • Legal advice services

Comprehensive Care Pathway

Comprehensive Care Pathway

Integrated care pathway from acute management to long-term support