Rape / Recovery / Volunteering

Medical Exams After Sexual Assault: What you need, and what you need to know

There’s been a story in the news recently about a doctor who refused to offer emergency contraception to a young woman who had been raped because, the doctor said, “it is against my beliefs.”

Now, I don’t know what the doctor was thinking. Perhaps he or she is a strict Catholic, in which case contraception is generally on the verboten list. But even then, the Vatican hedges its bets as far as emergency contraception after rape goes. A communication issued in 2008 fell short of saying Catholic hospitals should not offer the “morning after” pill to women who have been raped, and instead hazed the issue in a cloud of words that left everyone guessing what the Pope might have meant.

Perhaps more likely, the doctor was simply “pro-life” and didn’t want to offer a pill that would end a pregnancy. In which case, that doctor would be ignorant, as Plan B doesn’t end a pregnancy that exists – it merely prevents a new one from starting.

Glad to say, the young woman in question would eventually get the pill she wanted. Even so, the episode probably left a lot of questions about what goes on in an exam after a rape – how things should be, and what they shouldn’t be. Since I’ve been volunteering as a sexual assault survivor advocate for two years now, I thought I’d explain a bit about what I’ve seen.

First, disclosure. I am speaking now not as a survivor of rape, but as a volunteer advocate. Though I have been sexually assaulted three times, I have never reported the attack or sought medical treatment. The first time, I was too young to know what had happened. The second, there was no penetration and I just wanted to forget about it. And the third, I thought I had to go to the police first, and I didn’t want to go to the police because I felt sure I would be blamed for what had happened.

  • If you get nothing else from this post, please understand this: You do not have to report your rape to police in order to receive medical help. Again. As the survivor of a rape, you can get medical treatment and not report what happened to police. Women who have been attacked can have many reasons to hesitate reporting the assaults. Whatever they are, that should not stop a woman from deciding to get treatment, including a full medical exam for injury, obtaining emergency contraception and preventative treatment for disease.
  • If you ask for medical help after a rape, I can nearly guarantee you will not have to pay for it. I can’t speak for the way things are in other states, but in Michigan, I can promise you won’t have to pay for it. I believe it is this way in most other states as well. A few years ago, Sarah Palin created a scandal when she wanted rape survivors to pay for their own rape kits in her town in Alaska, and she backed down. It was an outrage. That leads me to believe that in most places, getting medical treatment is cost-free for survivors. I can tell you that in my state, a person seeking treatment has the option to either bill their insurance or have the state reimburse the hospital or clinic for the expense. Money should never be a reason to not seek help.
  • As the survivor, you have the right to decide what services you receive. During the attack, your power was taken from you. Now, as you start to heal, you get to take it back. That means that you can decide what you want to do and what you don’t want or cannot handle. If that means you want all services available – police interview, medical exam, contraception, preventative medicine and counseling – you can choose that without fear that you are inconveniencing others or don’t deserve it. If you only want emergency contraception and medicine but don’t feel up to the rest, that’s OK, too. If you want the medical exam but don’t want to talk to the police, you have the right to do that. Sometimes, nurses I work with do try to push the woman into doing everything, which, to be honest, irritates me. You do not have to report a rape or seek medical help if you feel unready for it. You don’t have to do these things even if someone is guilting you into doing them (“If you don’t put him away, he’ll do it again.” In reality, it is not up to the survivor to punish the criminal – that is the job of a truly flawed criminal justice system). If someone is pushing you to do something you don’t want to do or don’t feel ready to do, speak up. You have the power to decide for yourself.
  • You have the right to have as many or as few people with you as you like. Most of the time, the women I accompany at the hospital have someone else with them – most often a family member, but sometimes a friend, roommate, coworker or partner. Sometimes they come alone. Sometimes there are six or seven people with her. Sometimes they want at least a few friends or family members in the exam room (it’s a rather small space, so it really couldn’t hold a group of seven friends). Sometimes, she wants to be alone in the exam room with only the nurse, or with the nurse and an advocate. All of these things are acceptable.
  • You should have access to free counseling. That is the way it is where I am, and I truly hope it is the same everywhere. At my organization, a survivor of rape and his or her friends and family are eligible for free short-term counseling. This can start immediately after the rape, or – as is most often the case – sometime down the road. It’s not unusual for me to start counseling with a woman who was raped as a child and only now, in her 30s, is ready to talk about it. I have also done counseling with the mother of a child who was assaulted. To find counseling services in your area, please contact the RAINN hotline at 1-800-656-HOPE (4673).

 When I meet a survivor and her friends and family at the hospital, they usually want to know what to expect during the process. While no two exams are the same, this is typically what happens.

  1. The survivor arrives at the hospital. Sometimes, she comes here directly, while other times the police bring her after a police interview.
  2. Once she checks in at the emergency desk, the hospital staff sends out a page to the Sexual Assault Nurse Examiner (SANE) team. This team includes the specially trained nurse and the advocate.
  3. Unfortunately, now comes the waiting. Where I volunteer, there is a separate waiting area for SANE patients that offers more privacy than the regular waiting area. The time it takes for a nurse and advocate to respond depends on how far away they are. If the SANE nurse is on shift at the hospital, there will be little waiting at all, while the wait can take an hour or longer if the nurse and advocate have to drive in.
  4. Once the nurse arrives, the patient is taken to an exam room. Where I volunteer, the SANE exam room is in a separate part of the building not normally used by patients, so it is quiet and secure (you need a security card to enter that part of the building).
  5. The nurse will first take a complete medical history, including a narrative of the assault. While this is upsetting and difficult, the nurse needs to know this because he or she is qualified to speak during a rape trial as an expert witness. If you need to take  a break during this part of the exam, or to take it slower, please say so. We know it’s an immensely difficult thing to do.
  6. A full medical exam is given. The nurse will literally check from head to toe for injuries, including cuts, bruises and tears. Photos will be taken of any injuries. This will include a pelvic exam if the details of the assault indicate there may be evidence to obtain. Again, I know this is hard. If you don’t feel up to it, that is your choice and your right. And if you need a friend with you (or if you don’t want them to be with you), again, that is your call. I have held the hand of many women as they go through this. Whatever it is that you need to get through, just speak up.
  7. Emergency contraception and preventative medicine for sexually transmitted diseases are offered. It is your call which ones you want to take. Please note, however, that it impossible to test for STDs acquired during a sexual assault in the hours following the attack. You will need to check in with a doctor in the weeks and months following the assault to make sure you are healthy and to obtain whatever medicine you might need.
  8. Unfortunately, if you wore the same clothes you had on during the assault, they will be taken as evidence. You will be provided with a clean set of underwear and sweatpants/sweatshirt. Ask about filing a crime victim’s compensation claim to recover all of your out-of-pocket costs related to the assault.
  9. The SANE nurse and advocate will probably ask about your safety after leaving the hospital, including your method of getting home, the safety of your home and preventing further contact with your assailant. If they fail to start this conversation, please speak up and ask them to discuss safety with you. They may be able to help by providing you with a voucher for a free cab ride home, providing you with information on how to obtain a personal protection (“restraining”) order or requesting increased police patrols by your home.
  10. You will be provided with a packet of information, including important phone numbers and information about recovering from rape. Even if you don’t feel up to reading the information right away, I urge you to set it aside in a place where you can later find it if you need it.

Again, while I have survived multiple assaults, I never sought immediate help for them. That is why I volunteer now – because I believe no one should have to go through this alone if they don’t want to. I didn’t know what options I even had. I hope others will know what services are available so that they can make the best choices about what kinds of help they need.

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