How Nurses Can Recognize and Respond to Signs of Sexual Violence

Nurses and other first responders frequently have to care for victims of sexual violence. Sexual violence is any attempted or committed sexual act where one person cannot or does not consent. While sexual violence can be difficult to discuss, nurses need to be able to recognize the signs of sexual violence and know how to respond appropriately.

Populations at risk

Anyone can be a victim of sexual violence. People of all genders, backgrounds, socioeconomic status, and occupations can be affected. However, there are some populations that are at a higher risk than others. While assault is never the fault of the victim, there are some behaviors that put a person at higher risk of being attacked.

While both men and women can experience sexual violence, women are at a much higher risk. According to American Family Physicians, about 43% of women report having been the victim of sexual violence at some point in their lifetime.

Other at-risk populations include:

People with a physical or intellectual disability
LGBTQ individuals
Transgender men and women
Frequent users of drugs or alcohol
People living in poverty
People experiencing homelessness
People who engage in sex work

Warning signs of domestic and sexual violence

Most people who are sexually assaulted know their attacker. This can make it difficult for the victim to report the abuse, for fear of retaliation, or not wanting to get family members or friends in trouble. Victims of domestic abuse may want to protect their abuser, and some may feel embarrassed or too traumatized to share what happened to them.

Because of this, healthcare workers should be aware of subtle warning signs of domestic and sexual violence. Signs to watch for include:

Becoming withdrawn
Personality changes
Unexplained bruises, cuts, or scrapes, especially around the genitals or thighs
Complaints of genital pain
Sudden changes in clothing
Sleep disturbances

Domestic and sexual violence in the media

Exposure to sexual violence in the media is directly correlated to a rise in sexual abuse in the community, and not all of the messages encouraging sexual violence are obvious. Many popular television shows and books encourage abuse and sexual violence by portraying abusive men as desirable “bad boys” and women as wanting to be taken advantage of or controlled.

This media portrayal may lead assailants to believe that they can and should be aggressive. It may even cause people in the justice system to blame the victim for asking for it or not saying no firmly enough.

Mandated reporting for licensed professionals

If anyone reports a sexual assaulted, the most important first step is to believe them. Studies show that less than 2% of rape reports turn out to be false. Whether or not a nurse is a mandated reporter varies by state. If a registered nurse suspects abuse, they should write a report that contains only objective facts and report it to the proper authorities.

Understanding the laws in your own state can help you decide if you are a mandated reporter. Most states have laws that require reporting any suspicion of elder abuse, child abuse, and abuse of the mentally disabled.

Standard steps of an evidentiary exam

If a patient comes into the hospital after a sexual assault, a Sexual Assault Nurse Examiner, or SANE, will see them. SANEs receive special training that allows them to help assault victims and collect evidence that can bring the attacker to justice.

Nurses must follow specific protocols and standards while collecting evidence against the attacker. This prevents contaminated evidence and protects the victim from re-traumatization. Keeping the victim of assault safe and as comfortable as possible is the number one priority.

Caregivers may collect blood, hair, skin cells, or other body fluids as evidence of the sexual assault. They will also document any cuts, scrapes, bruises, or other injuries that are a result of the assault.

Evidence collected by a SANE nurse can help:

Identify the suspect;
Document recent sexual contact;
Document force, threat, or fear; and
Corroborate the facts of the assault.

These nurses can also educate the patient on options for emergency contraceptive pills such as plan B or getting an IUD within 5 days of sexual contact.

Evaluating and treating potential exposure to sexually transmitted infections (STI)

Sexual crimes may lead to sexually transmitted infections such as herpes, gonorrhea, and even HIV. Victims of these crimes must often return to the hospital or a healthcare clinic several days or even weeks after their assault for testing. It’s vital for victims to get tested for all sexually transmitted diseases, even if they do not show symptoms right away.

Clinical and community resources

Victims of sexual violence often need support, education, and healthcare resources. Nurses who suspect that their patients are victims of assault can help by sharing any of the following resources: