Sexual assault: examination of the victim

The majority of sexual assault disclosures are by females although most sexual abuse remains undisclosed. There are many factors feeding into this reluctance. Sensitive and appropriate management of disclosures is essential to re-empower victims in making choices on the course of events following disclosure. Not all victims opt to engage with the criminal justice system. However, the option of police engagement to some degree may be supported by the offering of third-party reporting, providing police with intelligence that would otherwise be inaccessible. The presence of genital injuries is more likely with non-consensual than consensual sexual activity, but genital injuries are still more likely to be absent following sexual assault. Physical examination following sexual assault seeks to identify any peripheral injuries associated with restraint or non-compliance. Screening to exclude the possibility of sexually transmitted infections should be informed by the incubation periods of common pathogens, and prophylactic treatment guided by local resistance patterns. Emergency contraception, ongoing contraception and safer sex advice should form part of the consultation. In addition, self-harm and suicide risk assessments should be undertaken to ensure onward safety. Finally, the potential impact of disclosures on clinicians should be acknowledged.