What to do if you have decided to go to the hospital following your sexual assault

Hospital Advocacy

Hospital Advocates are available from the Cleveland Rape Crisis Center to respond to all emergency departments in Cuyahoga County and provide survivors and loved ones with support and information. An Advocate should be offered to the survivor in the emergency department; however, if the option is not presented, the survivor may also request an Advocate. Advocates are available 24 hours a day, and can be reached by hospital staff through the hotline at 216-619-6192.

SANE Units

Medical treatment and attention for sexual assault can be given at any emergency department. There are, however, several emergency departments in Cuyahoga County with units specialized in treating survivors of sexual assault. These units are referred to as SANE Units as they are staffed 24/7 by certified Sexual Assault Nurse Examiners. To locate the SANE Unit most convenient for you, please contact the Cleveland Rape Crisis Center’s 24-Hour Hotline at 216-619-6192.

What to Expect

Treatment in an emergency department within 96 hours of a sexual assault consists of both medical care and forensic evidence collection. The following is a brief overview of what a survivor may expect.  It is important to remember that a survivor can ask questions throughout the examination if information is unclear or the process becomes uncomfortable. Any part of the exam can be refused and the examination can be ended at any time.

Medical Examination

The medical examination performed on a survivor of sexual assault will include a medical history and a thorough physical exam for both external and internal injuries.

Prevention of Sexually Transmitted Infections

Survivors are often prescribed antibiotics to prevent STIs such as Gonorrhea, Chlamydia and Syphilis. These prophylactic treatments may come in liquid, pill, or injectable form. A follow-up medical evaluation three to four weeks after the assault is recommended to ensure that these prophylactic treatments were effective.

A survivor who is a minor may be tested for the following sexually transmitted infections (STIs) throughout the process of the examination: Syphilis, Gonorrhea, and Chlamydia. Hospitals are required by law to contact the survivor if any of these tests show positive results. The hospital may not call about negative results.

Adult survivors should not be tested for the presence of STIs during their emergency room visit. Tests done at that point will only reveal the presence of STIs that existed prior and not inform the survivor if anything was contracted as a result of the assault. If the survivor notices any sores or blisters in the pubic region they should consult their doctor.

Prevention of Pregnancy

Survivors should be offered prophylactic treatment to prevent a pregnancy from occurring from the assault. Commonly referred to as Plan B or “the morning after pill,” this prophylactic treatment is a high dose of the hormones found in birth control pills. Plan B is not an abortive agent.

Some forms of this treatment may cause nausea and should be accompanied with food and an anti-nausea drug.

The pregnancy prophylactic can be effective up to 96 hours after the assault but is more effective if taken early. If the survivor vomits and loses the pills, she should contact the doctor. The treatment is very effective, however, a urine pregnancy test is recommended 2 weeks following the assault to ensure its success.

If the survivor was not offered treatment to prevent pregnancy, resources for treatment are provided at the end of this guide and manual.  A survivor can also ask if a prescription for the prophylactic treatment is available.

Drug Facilitated Sexual Assault

Rape is considered drug facilitated when an individual supplies an intoxicant to another person, with or without that person’s permission, for the purpose of having sex. Almost any substance can be used to facilitate sexual assault but those most commonly seen may include illegal intoxicants, prescription medication, over the counter medication and alcohol.

If an individual suspects that s/he may be a victim of drug facilitated sexual assault, they should seek immediate medical attention to have potential evidence collected and to ensure physical safety.

HIV Testing

Testing for HIV is not recommended while being seen in the emergency department. It is recommended that testing be done at 3 months, 6 months and 12 months following the assault. This timeline will ensure accurate results as it may take time to detect the antibodies associated with HIV infection.

Evidence Collection

The part of the examination that involves the collection of evidence is commonly referred to as a rape kit. The rape kit is a box containing instructions for the medical professional collecting evidence and various envelopes and bags for the evidence collected.

The exam consists of numerous steps including, but not limited to, scraping underneath the survivor’s fingernails, cutting hair samples, photographic documentation, swabbing of the genitals and the survivor’s narrative account of the assault. The survivor will also be asked to provide any clothing worn that may be considered evidence.

The completed kit will go to the police and the items will be carefully inspected for DNA samples. Survivors should contact law enforcement for information regarding the findings of evidence.

The survivor should not be alarmed if the results of the kit come back inconclusive. Perpetrators do not always leave behind physical evidence. Furthermore, the kit may only show that sexual conduct took place and may not necessarily reflect force, threat of force, or coercion.

The survivor should not be billed for any costs related to evidence collection. If the survivor has an evidence collected and still receives a bill, the survivor may contact the Cleveland Rape Crisis Center for assistance in correcting this error with the hospital’s billing service. A survivor will be responsible for any services beyond those of collecting evidence such as laboratory tests, x-rays and prescription medication.

The Presence of Law Enforcement at the Hospital

The police may want to meet with a survivor while the survivor is at the hospital emergency department. If the survivor wishes to pursue legal action, the survivor may give a statement at that time. If the survivor is unsure about pressing charges, s/he may give a statement to the police at that time and later choose not to pursue legal action. If the individual does not wish to press charges or to speak with law enforcement, it is her/his right to refuse an interview.