Sexual Assault Nursing Examinations: What’s it like?

Warning: graphic material.

Disclaimer: all identifying information of victims have been kept confidential

First, a little back story

During my graduate program I interned at my local crime victim crisis center. This agency, specifically, works with victims of sexual assault, rape, physical assault, stalking, and survivors of murder. The agency has two parts to it: the “prevention” side and the “clinical” side. The “clinical” side works with victims of these crimes mostly through counseling services, but also through accompaniment in court proceedings, filing for crime victim compensation, and filing other legal documents such as protective orders. The “prevention” side works to prevent these things from happening in our community. They regularly go out to our local school’s to talk about topics such as healthy relationships vs unhealthy relationships. They also respond to crisis calls. I vaguely remember a colleague mentioning that they respond to crisis calls other than sexual assault, but because they cannot guarantee the safety of interns during situations that may involve violence, I did not go out on those. We respond to our local hospital to be a victim advocate with those going through a sexual assault nursing examination (SANE).

In order to become a certified victim advocate, I completed a 40 hour training program that is certified through the office of the attorney general. This training included statistics on these specific crimes, societal and political issues relating to these topics, stories of victims, as well as how to respond and behave on the crisis calls. After completing this training, I “shadowed” other victim advocates in order to get my feet wet before diving in. Then, it was my turn to be called out. I am now going on 7 months of being a certified victim advocate. And it has been one of the most rewarding experiences of my life.

So, what are SANE exam’s like? What have I learned thus far? What are some stories from the calls I’ve been out on? That’s what I’m here to tell you!

Each SANE exam is different. The age, gender, victimization, perpetrator, and background information are different for each call. I’ve been out on calls that span a wide range of details. But they all proceed basically the same way.

Sometimes, SANE exam’s are scheduled. Typically this is when an individual (child or adult) comes forward with what we call an “outcry” of sexual assault. The individual usually proceeds with either our local Child Advocacy Center for an interview, or the police department (depending on the age), to the hospital for a SANE exam. When the exam’s are not scheduled, the person has typically been recently victimized and is seeking an exam to proceed with legal action against the perpetrator. They typically come in immediately after the victimization because the window to get the best evidence is within 72 hours after the assault. In all cases, the police department is notified because they have to give the “ok” for an exam to be done. If the exam is scheduled, two victim advocates respond at the correct time to help the victim through the exam. If the exam is unscheduled, we get a call and (typically) two victim advocates respond to the hospital within 20 minutes of the call.

When I arrive at the hospital, I immediately go to the ER check in area to let the nurses know that I am with our local crime victim crisis center and I am here for the exam. Typically, they tell me the victim, and potential family members or friends accompanying the victim, are in the “family room.” This is a room specifically designated for privacy. Usually, when I enter the family room, the victim is sitting on the couch, sometimes surrounded by family and friends. There is usually a police officer or detective in the room writing down all the information about the perpetrator and the situation. Sometimes, there is a police officer there specifically because they provided transportation to the hospital for the victim. It is at this time I tell the victim, and potential family and friends, my name, the agency I am with, and what I am there for. I briefly explain that I am there to help them through this process.

Next, the victim, myself, the other victim advocate, and the police officer wait for the SANE nurse to arrive. Usually between an hour to an hour and a half. During this time, depending on the specific details of the victimization, the victim may not be able to change clothes, eat or drink anything, or shower. If it is a child, I provide coloring books, beanie babies, and related items to occupy their minds. If it is an adult, I provide a blanket if they are cold, my cell phone if they want to call a friend or family, and any other potential items to help them. Then, the nurse leads us to the SANE room, which is on a quiet floor, private, and secured by two locked doors. The nurse sets up their equipment–camera, SANE exam box, paper for notes, and get’s clothes from the hospital storage for the victim to wear afterword, while me and the victim find our places at the exam table. The victim is instructed to remove all of their clothes and put on a hospital gown. At this point, the nurse proceeds with the exam.

First, the nurse asks the victim what happened and writes down every specific information the victim offers–name, address, phone number, race, gender, age, and any other identifying information of the perpetrator, then writes down the specific information about the assault–place, time of day, what happened, victims response, etc. During this time, there cannot be a person the victim has known prior to the exam in the room. If there is, we risk the evidence being deemed inadmissible in court because of potential coercion of the victim. This is where I come in. I sit with the victim, sometimes holding their hand, as they detail to strangers what may be the worst experience of their life.

The rest of the exam depends on the specific victimization. Oral assault? The nurse will swab the mouth. Vaginal or anal assault? The nurse will swab these areas–hoping to get DNA from the perpetrator. Bite marks? The nurse will swab these areas as well as measure them to get the best idea of the perpetrators teeth and mouth size. Then, the nurse proceeds with photographing everything that may be related to the assault. Vaginal or anal areas, mouth, bite marks, hair on the table from the perpetrator pulling the victims hair, scratch marks, literally anything. This is one of the worst parts for the victim. In all likelihood, the victimization just happened hours before arriving at the hospital. Now, they have to endure their bodies being violated again by swabbing, sometimes physical examination of private areas, and photographing their body. With strangers. I reassure the victim that it will be over soon, that this is hopefully collecting evidence to bring the perpetrator to justice, that I will speak up for them if they are experiencing the effects of trauma–one of which may be an inability to speak. I hold their hand and, sometimes, help the nurse push the camera button as she opens the vaginal or anal area to get a good picture. After the exam is done, I make sure the victim has clothes, information about services at our agency, a ride home, and makes sure their ride is there before I leave. If they are comfortable with hugs, I hug them.

Now, you know what happens during a SANE exam. So, what are some experiences I’ve had responding to sexual assault crisis calls? I’ve experienced just about everything. I’ve been on calls with children, adolescents, and adults. All races. Male and female. Victims that are intoxicated from drugs or alcohol. Victim’s who are normal, upstanding, respectable citizens that were the victim of a random rape. All socioeconomic status’. Victims who were in the “rich” area of town when the victimization occurred. Victims who had no family and victims who had a large family with them. Victims who had their people believe them and victims who have had nobody believe them. Victims who were temporarily catatonic (unable to speak or move) and victims who were balling their eyes out. Victims who were a part of sex trafficking. The common denominator with all of them? NONE of them asked for this to happen.

They asked for drugs. They didn’t ask for their bodies to be violated.

They asked for a friend. They didn’t ask for their friend to ignore their firm “no.”

They asked for a ride. They didn’t ask to be held down and repeatedly bitten.

They asked for safety, security, and acceptance. They didn’t ask to be trafficked.

They asked to be believed. Not to be hung up on.

They chose to be drunk. They didn’t choose for their perpetrator to get intoxicated beyond the point of rational thinking.

They chose to be friends with their cousin. They didn’t choose to be repeatedly raped.

They were given a stepfather. They weren’t asking to be raped.

They chose to be a respectable person. They didn’t choose to be the target of a rape.

They asked to bring the perpetrator to justice. They didn’t ask to be blamed for someone else’s actions.

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