Sexual Assault Aftercare in the Emergency Department

Authors: Ellisiv Clarke, Michelle Tun / Editor: Lauren Fraser / Codes: / Published: 28/07/2022

This session will outline a standardised approach to providing care for a haemodynamically normal patient presenting following rape or sexual assault.

It will include details regarding history taking, measures to take to preserve evidence, examination, documentation and investigations to consider.

Management options discussed in this section will include Post-Exposure Prophylaxis after Sexual Exposure (PEPSE), prophylactic antibiotic management, psychosocial care and information sharing.

Take-home messages include:

• Remember to build good rapport with these patients and approach their patient encounters in a sympathetic and sensitive manner.
• Forensic examination should only be performed by a clinician with suitable training; usually a forensic medical examiner.
• Pelvic examination in the Emergency Department should be performed only in the event of acute clinical need e.g. uncontrolled haemorrhage.
• Personal identifiable information should not usually be shared without patient consent; exceptional circumstances in which this might not apply are discussed later in the module.
• Offer emergency contraception to these patients where appropriate.
• Offer post-exposure prophylaxis for blood-borne viruses and sexually transmitted infections for these patients.
• Victims of rape and sexual assault should be assessed in a Sexual Assault Referral Centre where possible.
• There is no requirement for emergency physicians to take pre-transfusion blood samples for the police.

Learning objectives

• Perform a detailed and systematic history and examination of victims of sexual assault who present to the Emergency Department.
• Maintain patient confidentiality throughout and after the encounter.
• Risk-assess each patient encounter and initiate appropriate management e.g. emergency contraception or post-exposure prophylactic medications.
• Signpost to, and encourage patients to access, appropriate follow up, including the closest Sexual Assault Referral Centre (SARC).

References

1. National Institute for Health and Care Excellence. Domestic violence and abuse: Scenario: Managing domestic violence and abuse | Management | Domestic violence and abuse. | CKS | NICE. 2018. [Accessed 14 December 2021].
2. Legislation.gov.uk. 2021. Sexual Offences Act 2003. UK Public General Acts. 2003. [Accessed 14 December 2021].
3. Ministry of Justice, 2013. An Overview of Sexual Offending in England and Wales. Gov.UK, pp.16-17.
4. Ons.gov.uk.  Sexual offences in England and Wales – Office for National Statistics 2017. 2017. [Accessed 14 December 2021].
5. Royal College of Emergency Medicine. Management of Adult Patients who attend Emergency Departments after Sexual Assault and / or Rape. 2015. [Accessed 14 December 2021].
6. Sugar NF, Fine DN, Eckert LO. Physical injury after sexual assault: findings of a large case series. Am J Obstet Gynecol. 2004 Jan;190(1):71-6.