What to Expect at the ER

If you decide to go to the hospital for a sexual trauma exam, here’s what you can expect.

Time-sensitive information

A sexual trauma exam can be completed within 120 hours of a sexual assault. The sooner you are able to go to the hospital, the greater your options will be, as certain types of treatments and evidence collection are time sensitive:

  • Preventative treatments for pregnancy and STIs are most effective within 48 hours of the sexual assault.
  • Evidence collection is possible within 120 hours of the sexual assault. Remember that you can choose to have forensic evidence collected without filing a police report and that having a forensic exam may provide you with more options if you do decide to pursue legal action later.
  • Toxicology screening, to determine whether there is a detectable amount of a substance that may indicate the sexual assault was drug-facilitated.

Before you go

Before the exam, try to preserve the evidence: there is generally more evidence if you don’t wash, change your clothes, eat, drink, brush your teeth, brush your hair, or go to the bathroom. If you already have, that’s okay, it’s still possible to collect evidence. If you haven’t, though, as much as you probably want to shower, try not to – doing so destroys evidence that could be useful if you decide to make a report to law enforcement. If you already have changed your clothes, put them in a paper bag, and bring them to the hospital with you.Bring a change of clothing with you to the exam if you can, since the clothes that you were wearing during the assault may be collected as evidence.

If you think it would be good for you, call a friend – it can help to have someone you trust with you and to have a hand to hold. An advocate from WISE will also be available at the hospital to walk you through the exam and the police reporting process if you want.

At the hospital

At DHMC, the sexual trauma exam will probably be conducted by a Sexual Assault Nurse Examiner (SANE), an RN who has been trained to provide care for sexual assault survivors, including conducting forensic evidence collection.The exam typically takes 3 to 4 hours and can be intrusive and uncomfortable, but remember that you are in control of the entire process. Before each step, the SANE will explain what’s going to happen and ask if you want to continue. Nothing will be done unless you agree to it.

  • Initial interview: The first part of the exam consists of an interview, in which the examiner will ask you to tell them what happened. This is not a police report. The purpose of this interview is so that the examiner will know what kind of care you need and where to look for evidence.
  • Clothing collection: If you are wearing the clothes that you wore during the assault, the examiner may ask you to take them off while standing over a sheet of paper, so as not to lose any evidence. Each article of clothing will be placed in a separate paper bag. If you already changed clothes, bring the clothes that you were wearing at the time of the assault with you to the hospital (in a paper bag, if possible, to prevent decomposition of the evidence).
  • Head-to-toe exam: The examiner will conduct a head-to-toe exam, looking for injuries that need to be treated or recorded. Any marks on your body will be photographed, with your permission, as evidence.
  • Hair collection: The examiner may take a number of “samples” from your body. The SANE might want to collect fibers and hair from your head as evidence and to provide samples for comparison. The same process might be followed for your pubic hair.
  • Swabs: Next, the examiner might want to swab different parts of your body, including your mouth, and vaginal or penile and anal areas depending on how you were violated. This can be a very difficult part of the exam, and it can help to have someone with you, either a trusted friend or an advocate. The examiner might also draw blood samples, to establish a difference between your DNA and any other that is found and to test for possible sexually transmitted infections and pregnancy. If it’s suspected that the assault was drug-facilitated, an additional blood sample might be taken for toxicology testing. The examiner may also look at your body using a “Woods Lamp,” a fluorescent lamp that allows her to see evidence that cannot be see with the naked eye.
  • Fingernail scrapings: The examiner may ask to scrape underneath your fingernails to collect trace evidence such as skin, blood or hair samples. This can be an especially important step if you scratched your assailant.
  • Genital exam: The last part of the exam is a genital exam. For women, this will be similar to getting a Pap smear. For men, it will include collecting samples from the penis. Depending on the assault, there may also be collection from the anus. This part of the exam can feel particularly invasive given the nature of sexual assault, but can be an incredibly important part of evidence collection.
  • Pregnancy prevention and STI testing: If your assault included vaginal penetration, the examiner will give you a pregnancy test and can prescribe emergency contraception if necessary. You may also be prescriber an antibiotic regimen to protect you against gonorrhea, chlamydia and syphilis. The examiner will also administer an HIV test, but you should be tested again three and six months later to be certain that you haven’t been infected.

After the exam, the hospital will provide you with toiletries and you’ll be able to wash or shower. If you didn’t bring a change of clothes, the hospital will provide you with clothing, usually sweats or something comfortable.

Next steps

Sexual Assault Evidence Collection kits are analyzed only when you report the assault to the police, if the assault was perpetrated in NH. Other states, including VT, send the kit to the laboratory whether or not you give a statement to law enforcement. Remember that you don’t need to report immediately – the kit will be kept in storage for at least 60 days after the exam, allowing you some time to decide what you want to do. If you do decide to report the assault to the police, you can find more information about that process here.