1. Your Safety Comes First
You were violated. In all likelihood, you’re traumatized and shocked. It’s okay to process that. It’s okay to not be okay. It’s okay to feel dirty. It is okay to feel whatever it is that you are feeling. What happened is not your fault and you don’t have to walk through this alone. Call a friend, family member, or someone you trust; go somewhere that you feel safe. If you do not feel that you want to tell anyone yet (or ever), that’s also okay. The Nation Sexual Assault Hotline is here for you. A trained staff member will connect you to local resources and support. They can be reached at 800-656-HOPE (4673). You can also reach out to us on our site and we will personally do everything we can to guide you through this difficult process.
2. Consider Immediate Medical Care
Many medical offices are equipped to take care of you after a sexual assault of any kind. Seeing a physician can be therapeutic in and of itself: you took an affirmative step to get help and take back some of the control. Healthcare workers are there to help and take care of you, and it is their job to hear your story. With that said, the Emergency Room (ER) is the best place to go after being raped, and we strongly encourage you to make this your first stop.
I wish I had known this right after I was assaulted; I went to several different places (my university health center, a women’s clinic, and an urgent care center) in search of medical care and none of them were equipped with the resources to help me. Specifically, none of them could perform SANE or SAFE (Sexual Assault Nurse/Forensic Examiner) exams for rape kits.
What to Expect at the Emergency Room
Taking this step can be extremely daunting after you have been raped. In all likelihood, you haven’t fully processed what happened to you yet—you may not even fully understand that what happened to you was rape yet—and you’re probably terrified about what’s going to happen if you saying anything (even to a physician) about being raped. That feeling is normal.
Going to the ER for medical care after being assaulted does NOT mean you have to report your rape to the police at that time. With that said, if you decide later on to file a report (as many survivors do), having gone to the ER significantly expands your options.
If you go to an emergency room and say you may have been raped, your wait will likely be expedited. Hospitals have a policy against telling anyone about your location, room number, or even if you are physically in the building or not without your permission. Your safety is their priority, thus, if someone were to come to the hospital and ask for you, the ER administration would not disclose any information: it is as if you were never there. The ER is one of the safest places you can go after an assault; it’s impossible for anyone (including your attacker) to find you. You will also be given several options at the ER. For instance, you may decide if you would like to have an advocate from your local advocacy center physically with you. This person will be with you for the duration of the hospital visit unless you tell them otherwise.
You will also have the option of having a police officer meet you in the ER and take a recorded statement. Reporting to law enforcement is something we’ll get into in a separate post. Within 5 days post-assault, a medical provider can present options for pregnancy prevention, sexually transmitted disease treatment, toxicology testing, and evidence collection.
i.Immediate Medical Care: Pregnancy Prevention
If you’re in an emergency room, the medical providers will likely offer you emergency contraceptive. These medications are typically referred to as the “Morning After Pill” or “Plan B”. They can be taken up to 120 hours after the incident but are most effective when taken within the first 24 hours. There are three options for emergency contraception: one over the counter, and two by prescriptions only.
· Levonorgestrel (what you’d recognize as “Plan B” on a shelf)
· Single-dose or two-dose
· Over the counter
· Less effective in overweight and obese women
· Available at most drug stores
· $37 dollars on Amazon.com
· Ulipristal acetate (Prescription-grade Plan B)
· Single dose
· Preferred medication for those who are more than 72 hours from the incident
· Found to be more effective than Levonorgestrel
· Copper Intrauterine Devices (IUD)
· A copper IUD placed into your uterus provides emergency contraception and continued pregnancy prevention for up to 10 years
· Copper is toxic to sperm and drastically decreases the motility (ability to swim)
· Should be avoided in individuals with a copper allergy and/or Wilson’s disease
· These devices are typically implanted by gynecologists, obstetricians, and primary care physicians- They may not be available for insertion in the emergency department.
ii. Immediate Medical Care: Sexually Transmitted Infection (STI) Prevention and Treatment
The rate of infection after an assault is difficult to measure. One study in France found that up to 20% of victims were positive for either gonorrhea or chlamydia when they arrived for post-rape evaluation. Another study from Norway found that only 6% of victims were positive for chlamydia after the assault. The United States Center for Disease Control and Prevention (CDC) recommends prophylactic antibiotic treatment for assault victims. Here is what you can expect to receive:
· Ceftriaxone, one 250mg intramuscular injection, for gonorrhea
· Azithromycin, 1g single-dose pill, for chlamydia
· Metronidazole, 2g single-dose pill, for trichomonas
Antibiotic treatment is optional and if you choose to forgo the medication you can choose to be tested and follow up with any positive results with your primary care provider or gynecologist. It is important to remember that throughout this whole process that there are many options, that you, as the patient, continue to have control.
iii. Immediate Medical Care: Other Infections
· Hepatitis B is another disease that your doctor should consider, however, most American born children complete the vaccination series by six months of age.
· Human immunodeficiency virus (HIV) should also be discussed with rape survivors and is a controversial topic. There is a low risk of transmission and a lack of scientific evidence supporting post-exposure prophylaxis. However, many specialists encourage the use of antiretroviral therapies. They are best used within the first four hours of possible exposure and should not be prescribed if it has been over 72 hours. The risk of contracting HIV from consensual vaginal intercourse with an HIV positive male is only 1% but it is likely to be higher in sexual assault cases due to trauma.
· Human Papillomavirus (HPV) now has a vaccine that is recommended for those women ages 9-26 and men 9-21. If a victim has not received HPV vaccines prior to the assault the vaccine series may be initiated.
· Urinary Tract Infections (UTIs) are bacterial infections within any part of the urinary system (kidneys, ureters, bladder, and/or urethra) that is fairly common after sex. Of note, these infections are not considered STIs. Women are at higher risk of contracting a UTI when compared to men due to their shortened urethra. If left untreated, UTIs can spread to the kidneys and cause serious illness. UTIs need to be treated with antibiotics and we strongly encourage you to see a physician if you exhibit any of the following symptoms:
· Increased frequency of urination
· Urinary urgency (feeling you need to pee immediately)
· Burning with urination
· Suprapubic pain
iv. Toxicology testing
Part of the workup in the emergency department (ED) involves a toxicology report. This is testing medical providers can perform to find out if drugs and alcohol were involved in the assault. Substances may be detected for up to 96 hours, but many will be cleared sooner than that. A negative result does not mean that the substance was not used in the attack. On average, results for this take up to 12 weeks.
v. Side effects of post-rape medical care
· Nausea and vomiting are very likely after antibiotics, emergency contraception, and HIV prophylaxis. If you are prone to these symptoms with medication, or if you would like something on hand just in case, ask your doctor for anti-nausea medication before leaving the ER/office
· Emergency contraception can cause you to have irregular periods and cramping
3. SANE Exams/Rape Kits
What’s a SANE Exam?
A SANE exam is an examination by a nurse specifically trained in helping victims of sexual assault. After being evaluated in triage, if you consent, you can have a SANE exam performed in conjunction with the exam and questioning performed by the ED medical provider. The examination includes a thorough physical examination; the SANE nurse will collect swabs of evidence and take photographs of your body for evidentiary and medical purposes. This process can take several hours, and your advocate will remain with you throughout if you wish. The SANE exam is the examination that provides evidence for a rape kit. You have control over this process. You can skip a step of the process if it makes you uncomfortable (for example, victims may choose not to have photos taken), take a break, or stop at any time. SANEs are trained specifically to work with sexual assault victims and to be extremely sensitive to their needs.
A rape kit is the physical evidence collected from the SANE exam as well as any other evidence obtained from the scene of the crime. This will be used in an investigation of your assault if you choose to report to law enforcement.
How to Prepare and What to Bring to the ER
If you can avoid showering, bathing, and using the bathroom post-rape, you maximize your chances of providing law enforcement with forensic evidence for their investigation. We recognize, however, that this is often impractical for most rape victims; it’s normal to feel dirty and have the urge to shower after. One of the most common things rape victims are told is that showering after their assault “ruins all the evidence.” This is inaccurate. While it is ideal to avoid showering, bathing, cleaning the area, and using the bathroom after being assaulted to maximize preserving the evidence, all is not lost if you have; it is still worth it to get a SANE exam. Depending on how soon after the assault you present to the ER, if your rapist did not use a condom, you may still have his DNA inside of you—even if you showered—which can be swabbed and put into the rape kit after the SANE exam. If your rapist did use a condom, there’s a chance the condom is still somewhere at the crime scene—whether it be in the trash, in the bed, or on the floor—and the used condom should have his DNA on the inside and yours on the inside.
If you can, bring any clothes, jewelry, and accessories you were wearing when you were attacked in a paper bag to the hospital with you. The sooner you do this, the higher your chances are of preserving any evidence. In most cases, these items should be collected within 72 hours if you decide to report. This advice is especially important for a friend who is helping you: remember to bring the victim’s clothes, especially undergarments, to the hospital—and if you can, pick them up with gloves on so as to not taint the evidence. These will be examined for DNA as part of the rape kit as well.
4. Crime Victims’ Compensation
Many victims are concerned about the medical bills associated with undergoing a SANE exam after an assault. Under the Violence Against Women Act (VAWA), states are required to provide SANE exams free of charge if states as a condition of their anti-crime grant funding. If you are charged for your SANE exam, you can contest the charge with the medical provider. Under federal law, you are NOT required to report your rape as a condition of obtaining a SANE exam and rape kit.
Information about reporting options will be addressed in another post.
All our love,
Becky & Kailey