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Sexual assault is any forced, coerced, unwanted sexual contact. Sexual assault can include different forms of violence. Remember, sexual assault is never the victim’s fault.

Sexual assault can include, but is not limited, to:

• rape
• sexual threats and intimidation
• incest - sexual contact with a family member
• sexual assault by intimate partners
• child sexual abuse - a form of child abuse that includes sexual activity with a minor (1)
• human sexual trafficking
• sexual harassment and street harassment
• other forms of unwelcome, coerced or non-consensual activity  

(1) Retrieved from: https://www.rainn.org/articles/child-sexual-abuse

Law enforcement officials say it is best for the criminal investigation for victims to report as soon as possible. However, if you aren’t ready, you can have evidence collected and preserved confidentially for up to 2 years. That way, the evidence will still be there if you choose to report later. Many survivors choose this option if they need time to think.

If you do get an exam without reporting to police, the hospital will assign a confidential identification number to your evidence. The evidence and ID number will be sent to the Department of Public Safety (DPS). Be sure to ask what the number is, and write it down/store it somewhere safe. If you want to report to police later, you can use the number to retrieve your evidence. DPS will store your evidence confidentially for two years. After two years it will be destroyed.

There are four important reasons why you need medical attention:

1. To determine if you have been injured in any way. Following an assault, the survivor is frequently in a state of shock and may be unaware of any injuries.

2. To take the first step towards regaining control of your life.

3. To be tested for and to discuss treatment and prevention options available in regards to sexually transmitted diseases and pregnancy.

4. To collect medical evidence for possible further prosecution if and when a suspect is caught. It is vital that this evidence be collected as soon as possible. It will be destroyed as time passes and you begin to resume everyday activities (eating, drinking, urinating, bathing, etc.) Any wait, no matter how short or how long, may be uncomfortable. You may want to use this time to concentrate on yourself and your health. You are the survivor of a sexual assault, and you have the right to whatever medical treatment you need.

Texas law gives you the right to receive an examination for medical treatment and to have evidence collected. You have this right even if you decide not to make a police report. You also have the right to have a sexual assault advocate present during your examination. Many victims find the presence of an advocate very helpful. Advocates provide support and counseling, and they are specially trained on your legal rights during this time of crisis. If no one offers you an advocate, you can request one from the nearest sexual assault program. You can find out where the nearest sexual assault program is by calling 1-800-656-HOPE (4673).

Depending on what hospital you arrived at, you might have a choice to make about where to receive the exam. Some hospitals have specially trained Sexual Assault Nurse Examiners (“SANEs”), but others do not. If you are at a facility without a SANE, Texas law gives you the right to choose whether to be transferred to a SANE facility or to receive an examination where you are.

Receiving an examination from a certified SANE is ideal, because of their extensive training and experience. If it’s possible for you to accept a transfer to a SANE facility, that is usually best. SANEs are trained to provide compassionate, sensitive, and comprehensive care to victims and are prepared to testify in court proceedings if necessary.

However, sometimes victims are unable to make the trip to another hospital, and that’s OK. You can still receive the medical care you need and have evidence collected where you are now. Texas law requires staff from every emergency room to have at least basic training on forensic evidence collection. 

No matter whether you make a report, police will pay for a portion of the exam (the “forensic” portions). However, you will be billed for part of it too (the medical portions that are unrelated to evidence). If you report to police, you will be eligible for reimbursement for medical costs through the Crime Victims’ Compensation program. You may seek reimbursement from the CVC program as either a CVC claim or an Emergency Medical Care claim. Learn more about Reimbursement for Forensic Sexual Assault Examinations. 

The medical treatment you may receive should include the following, but not necessarily in this order: Your blood pressure, pulse, temperature and your medical history—allergies, medicines, last menstrual period, etc.—should be taken. At this time you should be told what to expect during the examination. If not, ask someone to explain it.

Before the examination, you will be asked about the sexual assault. It is very important that you tell someone what sexual acts were performed (vaginal intercourse, oral copulation, anal intercourse, or any other sexual acts). You may want to point to pictures rather than talk in detail about what happened. You may not understand the questions, or you may feel embarrassed when you answer them. It is all right to feel uncomfortable. Let the nurse or doctor know of your discomfort, and feel free to ask questions as needed. You are not expected to know all the medical terms, so do not be afraid to ask for explanations.

After all the paperwork is completed, you will be asked to undress. If you are wearing the clothes you wore at the time of the assault, these clothes will be taken to be used as evidence. The nurse should put these items in separate paper bags. The paper bags will be sealed and stored with the rest of the evidence that is collected. You will most likely not receive your clothes back, although it may be possible after the investigation or prosecution are complete. Often the hospital or rape crisis center volunteer will have clothes that you can wear home. It is better to bring a change of clothes from home, if possible. The exam will take about 2-3 hours. As part of the exam, swabs, hair samples, and blood samples will be taken. In addition, photographs of injuries may also be taken. Collection of evidence may not always be comfortable, but it is important. Feel free to ask for a break if you need it.

Before beginning the exam, you will be asked to sign a consent form allowing medical evidence to be collected and then turned over to law enforcement. Medical evidence will not be collected if you do not sign the form. If you need help in filling out the form or have any questions, be sure to ask someone.

Now the doctor or a nurse specifically trained in sexual assault examination (sexual assault nurse examiner or SANE) will tell you about the exam and what to expect. They should also tell you that it is your right, and the law, to have a support person present during the exam if you desire.

After you have talked about the exam, they will ask you to give a brief description of the assault so they will know where to look for injuries and evidence.

Now the doctor or nurse will listen to your heart and lungs, press on your abdomen and back, examine your chest, and check for general signs of injury. If you have any areas of pain, soreness, or discomfort, be sure to mention them to the doctor or at this time. Marks and bruises should be noted on your medical chart.

You will then be asked to remove your clothing while you stand over a large piece of paper. The piece of paper is to catch evidence (loose hairs, debris, etc.) that may fall from your clothes. The nurse will help you put each piece of clothing into a separate paper bag. You will be provided with a hospital gown, and the nurse or doctor will start collecting evidence.

Evidence is collected through the following means:

• oral swabs
• head hair combings
• pulled head hair samples
• debris collection (collection of dried blood, semen, saliva, hair, dirt, leaves, fibers that may be on your person.
• anal swabs
• vaginal or penile swabs
• pubic hair combings
• pubic hair samples
• fingernail scrapings
• blood sample
• saliva sample

Collecting swabs is typically painless and involves merely wiping cotton swabs over the area where the evidence (semen, blood or saliva) may be. Collecting hair samples may be uncomfortable since the hairs typically need to be pulled.

Following the general examination, a pelvic (or internal) exam will be done on female victims. The exam for male victims will be similar to the one for female victims, except for the vaginal examination.

For females, the pelvic exam will be almost identical to the exam you have probably received from your doctor. If you have never had a pelvic exam, be sure to tell the doctor or SANE.

You will be asked to lie flat on the examining table and place your legs in metal foot-rests with your knees apart. You will be asked to slide to the edge of the examining table. A speculum will be inserted to help the nurse or doctor take a swab and see any tears or bruising. Try to relax your stomach and back muscles and breathe slowly and deeply through your mouth. This will help you to relax your muscles and make the exam more comfortable.

Many women find this position very distressful and uncomfortable, especially following a sexual assault. Since this procedure may be very similar to the assault you have just endured, you may find yourself losing control of your emotions. It is okay to cry and let your feelings out. You may want to ask the doctor or SANE to wait a moment before the examination continues. Even though it may seem like hours, the pelvic exam is usually over in 5 to 10 minutes.

You will be given information about sexually transmitted infections (STIs). You may also be tested for STIs, but it is too early for the tests to pick up any STIs that were transmitted during the sexual assault. However, medication may be given to prevent STIs at the time of the exam. Testing and treatment of STI’s will depend on your specific circumstances.

Female victims of child-bearing age should be asked to give a blood or urine sample for a pregnancy test. You should also be offered options for the prevention of pregnancy. If those options are not offered, ask someone about them. Chances of becoming pregnant are small (about 5 times out of 100), but you may want to talk about a possible pregnancy and your options with a rape crisis counselor.

If you are under the influence of alcohol or drugs at the time of the attack, you may feel that your ability to resist the assault was impaired. The presence of substances in your system can be used against your attacker to show your lack of consent or capacity to consent. Therefore, you can ask the doctor or nurse to take a blood and urine test for traces of alcohol or drugs.

Sometimes bruises show up 6 to 21 days after the assault. If bruises appear, call the sexual assault investigators handling your case so pictures can be taken.