In our center, we currently have two sexual assault nurse examiners (SANEs). SANEs work with sexual assault patients and are specially trained in treatment and forensic evidence collection. Our SANEs alternate call 24/7 to provide adequate access to children and adolescents in need.
The purpose of the sexual assault medical exam is to assess a victim's health care needs, coordinate treatment of any injuries and collect evidence for potential use during case investigation and prosecution (U.S. Department of Jusice, 2004, pp. 30-2). The examination is still recommended even if there are no visible injuries as a result of the assault, the victim does not wish to have evidence collected, or the assault was not recent. In these cases, the victim may have injuries or health related concerns that are not apparent or acute.
Patient's always have the right to refuse a medical exam. Some reasons to consider having the exam are to assess for treatable injuries or other health related concerns, it may assist in prosecution, and there is no cost for the victim or family.
Generally, the SANE and the client's advocate will accompany the child to the medical room. Sometimes, the child or adolescent requests a primary caregiver to accompany them as well. This is ultimately left up to the child and he or she may be asked in private what their wishes are. It is imperative that the child understand they have autonomy over his or her body and experience at the CAC.
Again, your child should know that they have autonomy over their body. A head-to-toe assessment will be performed and a urine sample is collected. An anogenital exam to assess the genitalia will take place at the end of the physical exam. This is generally a non-invasive exam and should not be painful. It can certainly be an awkward exam, but the nurses do everything in their power to make your child feel safe and comfortable. They will have time to discuss and review any questions they have before the exam. The nurse will not force your child to do anything they do not wish to do; however, the nurse may provide further education and encourage the exam for health purposes.
If the assault occurred within 72 hours of being seen in the CAC, evidence collection is highly recommended. Evidence is collected by way of a sexual assault kit (historically known as a rape kit). The kit includes several swabs for the mouth, vagina, and rectum. The nurse is considerate of the client's wishes through each step of the process. A sample of blood taken from a fingerstick or the arm is typically collected, depending on the age of the child and circumstances of the assault. Labs are individualized by client age and history. Your child's underwear or clothing may be taken as evidence. In this case, new underwear and clothing will be provided by the CAC.
You can expect to know whether your child has any injuries or other health related issues that require further treatment. You can expect referrals or follow-up appointments to be individualized based on your child's needs (follow-up at the CAC, follow-up with PCP, mental health, etc.). Many times, parents leave the center knowing that their child is physically healthy.
It's possible; however, the vast majority of sexually abused children and adolescents have normal exams. A large number of consensually sexually active teenagers even have normal exams. It is important to know that there is often no way to determine if even an old injury is from a sexual encounter or is a congenital finding (meaning they were born with it).