The Alliance is excited to begin a new series of monthly articles with the generous contribution of our journalism volunteer, Carly Lanning. A cat mom of two living in Brooklyn, Carly Lanning works as a Books Editorial Lead by day, and a writer by night, blending her passions for survivor advocacy and the written word throughout all of her work.
You can find more of Carly’s work here:
While education around sexual assault and consent continues to gain momentum nationwide with the greater intent of addressing the nearly 433,000 rapes and sexual assaults that happen each year in the United States, sexual assault forensic exams and rape kits continue to be an area of mystery for many individuals. What exactly is a sexual assault forensic exam, and how powerful is it as a tool for a survivor’s recovery?
While the national average in the United States estimates that 1 in 7 women and 1 in 71 men will experience rape at some time during their lifetime — with statistics increasing for communities of color and the LGBTQ+ community — over 60 percent of assaults and rapes go unreported. In New York City, this means 50,000 individuals in the city may experience rape each year, with the majority of these assaults being at the hands of a person the survivor knows. This low reporting number can be due to a variety of factors including a lack of knowledge around what medical and legal services are available to survivors, the effect of society’s larger victim blaming mentalities, fear of retribution from the perpetrator or mutual acquaintances, past harmful experiences with medical personnel or law enforcement, or the desire to not sit through the invasive and often triggering process of engaging the judicial system.
Every survivor is entitled to make their own decisions surrounding their healing process, including if they want to receive a sexual assault forensic exam and have evidence collected. This exam and evidence collection can be one of a survivor’s most powerful tools in regaining control over the situation especially if they decide to take their perpetrator to court, and if you’re in the process of making that decision for yourself, here are some key things to know.
What is a sexual assault forensic exam?
A sexual assault forensic exam is a comprehensive exam done by trained sexual assault medical professionals in an emergency room that provides a survivor medical treatment for injuries, the collection of evidence of the assault, medication for STIs, HIV, and pregnancy prevention, and further resources for therapy and police intervention. A survivor has the option of engaging in as many or as few of these options as possible and can come in to receive STI, HIV, and pregnancy prevention medication or treatment for injuries without having a forensic exam completed. Should a survivor decide to have a forensic exam completed, the survivor will be offered the resource of having a sexual assault evidence kit — more commonly known as a “rape kit” — collected during which they can consent to all or some of the steps.
This kit collects physical evidence of the assault through swabs and photographs. In addition to DNA collection, if it was a drug facilitated sexual assault then blood and urine samples are also taken. Survivors are not required to report their assaults to law enforcement during or after their exam, though they will be provided with police referrals should they later decide to take these next steps. Unless it is a case of child abuse or neglect, minors’ confidentiality is maintained. A survivor’s kit will be kept for 20 years allowing the survivor the opportunity to report at any point during this time.
While the life of a collected kit doesn’t expire for two decades, there is a short window in which forensic exams can be collected.
Where should I go for a sexual assault forensic exam?
While all hospitals are required to provide free sexual assault forensic exams, there are 18 hospitals in NYC that are designated SAFE Centers of Excellence. These hospitals have trauma-informed forensic examiners available 24/7 along with on-call volunteer advocates to provide support, a private room, and access to a separate shower dedicated to forensic exams.
How long after being assaulted can a forensic exam be completed?
The window to receive a sexual assault forensic exam is up to 96 hours following the assault. But the window to receive certain STI, STD, HIV, and pregnancy prevention medications is only up to 36 hours after an assault for the medication to be as effective as possible. The sooner medical attention can be provided and evidence collected, the better preserved it will be.
What should you do before arriving at a sexual assault forensic exam?
If possible, a survivor should avoid the following before their sexual assault forensic exam so that evidence can be preserved: drinking, showering, changing clothes, using the bathroom, or combing one’s hair. If you have done any of these things, that’s okay! Evidence can still be collected so don’t let this deter you from seeking an exam and be sure to share this information with the nurse practitioner to include in your file.
Though clothes will be provided at the hospital, bringing an extra set of clothes of your own clothes to the hospital might provide a level of comfort as the clothes worn during the assault will be bagged for evidence during the forensic kit collection (although a survivor may refuse to provide their clothes and personal effects if they don’t feel comfortable doing so). Survivors are allowed to bring a loved one into the exam with them, but should a survivor arrive alone, they will be offered the assistance of a trained advocate who will walk through and advocate for their needs during their entire time in the emergency room.
What does the exam and kit collection entail?
After checking into the emergency room (more information for NYC found here), the survivor will then be taken into a private room in which they’ll receive a head-to-toe exam from a Sexual Assault Nurse Examiner (SANE) or a Sexual Assault Forensic Examiner (SAFEs). This medical exam will include questions about physical injuries, current medications, pre-existing health conditions, recent consensual sexual activity — in order to distinguish this from any evidence of the assault — a survivor’s recollection of the assault, and if consented to, an internal exam of the mouth, vagina, and anus. (Invasive exams of the vagina are not done in minors.) The nurse will walk the survivor through all the options that are available to them including reporting, evidence collection, medications, and follow-up resources, and will give the survivor the choice if they want to engage in all, none, or some of these.
As described by long-time Sexual Assault Nurse Examiner and Professor of Nursing Amy Smith, this exam is about giving a survivor back control of their body following an assault in which they were robbed of their consent — though she notes how retriggering the collection of evidence can often be.
“Because [collecting evidence for the sexual assault forensic kit] can be so triggering, I always address that prior to anything,” Smith shares. “Even though we get consent from the patient to do the steps they choose, I verbally re-consent them with every step. A really good way to give patients back their autonomy is to give them choices. I find it easier and more comfortable for the patient if I re-consent and explain each step. ‘Step one, this is to be able to collect DNA the perpetrator may have left in your mouth. I use a swab. It’s not going to be painful and it takes 30 seconds. Is it okay if I do this step?’ And the survivor can make that choice. I do that with every step.”
Should a survivor decide to have evidence collected, they’ll receive a 15-step sexual assault forensic kit in which they have the right to engage in or decline any step. These steps include collecting biological evidence of the assault with swabs of the inside of the mouth, vagina, or anus, urine and blood samples, photographs of physical injuries, the combing of body hair to detach evidence, and the collection of physical items such as clothing.
The exam can take up to a few hours if a survivor decides to pursue all the resources offered. During the exam, the survivor will be offered the services of a trained sexual assault forensic advocate who will arrive in the emergency room to provide support and advocate for their needs during their exam. The advocate will also provide post-exam resources such as law enforcement referrals, mental health resources, and financial assistance for the survivor to get home from the hospital.
Do you have to report your assault to law enforcement as a part of this exam?
Mandatory reporting is only required of minors (under the age of 18) who disclose details of their assault during a sexual assault forensic exam or when seeking other medical assistance if it falls under child abuse or child neglect. Survivors over the age of 18 are not required to report their assault at any point during the medical exam or their sexual assault forensic kit collection, though referrals to law enforcement will be provided. However, if a sharp instrument or a gun was used a police report does need to be made. The sexual assault may be left out of the report if the survivor so chooses but the threat on life has to be reported by the hospital team. A survivor’s forensic kit will be kept for 20 years by the emergency department in which it was collected as the survivor now has up to 20 years to report their assault to law enforcement. By having their evidence collected within that 96-hour window, a survivor will at least have this tool at their disposal if down the line, after having more time to heal from their assault, they decide to pursue criminal charges.
How much does the exam cost?
Under the Violence Against Women Act, all sexual assault forensic exams are free to all survivors of all genders. Should a survivor receive a bill, they should contact the provider who administered the exam for help. It is important to note, however, that any medical procedures that are not directly related to a forensic exam can be billed.
What are the benefits of receiving a forensic sexual assault exam?
While the statute of reporting has increased to 20 years, the window of evidence collection is a narrow window of 96 hours in order to capture the most evidence of a survivor’s assault. While the exam can most immediately address any physical injuries a survivor has received during the assault, what it more largely provides is a comprehensive set of resources the survivor now has at their disposal to begin their healing journey. Whether a survivor decides to report their assault or not, having their forensic evidence kit available allows them more of an opportunity to later pursue charges should this be the right option for them.
By: Carly Lanning