The most fortunate of us learned everything we know about sexual assault from two sources: Hollywood, and scandalous news stories that usually focus on the accused (since it usually takes a celebrity perpetrator to make headlines). Shockingly, they do not always paint an accurate picture of reality.
We’re thus left with a series of misconceptions and biases that range from merely wrong to horrific. To set the record straight, we talked to “Amanda,” an RN and Sexual Assault Forensic Examiner (“SAFE”). Who are you going to believe, her, or a show in which the crime is being investigated by Ice-T?
According to Oscar-winning movies like Monster and Boys Don’t Cry, rape victims will always be bruised and bloody (after all, it was an assault, wasn’t it?). In a weird case of pop culture influencing itself, the villain of Gone Girl gets it into her head that in order to convincingly fake a sexual assault, she must go the extra mile and simulate the event with a goddamned wine bottle. Conclusion: If a woman has truly been assaulted, there’ll be damage, even if it takes a doctor and a special exam to find it.
This, however, is not true — an assault might not leave any injuries at all (we’re often talking about a part of the body designed to push out a baby, for Pete’s sake). That’s a good thing in theory, but it’s something Amanda constantly has to explain to people.
“This is a huge prosecutorial hurdle to overcome,” she says. “It’s one of those details that you walk into court expecting to have to testify to, and you tell the prosecutor to ask that question specifically, so I can tell the jury that no visible injury does not mean there was no trauma.” In fact, she points out, vaginal injury is just as likely to occur as a result of consensual sex, so even when there are injuries, they aren’t evidence of a crime.
Meanwhile, the injuries that victims should worry about are ones you almost never see on TV. “Interesting fact: If an assault, sexual or otherwise, involves strangulation, it is automatically deemed a felony offense,” Amanda says. That’s because even brief strangulation can lead to damage you don’t even notice until much later. “When a person loses consciousness from strangulation, this is often caused by micro strokes in the brain,” she explains. “These tiny strokes can often only be detected on CT or MRI, and can be deadly. Even if they don’t kill you today, the cumulative effect is that of a traumatic brain injury and can lead to lifelong deficits.”
That’s why Amanda and other specially trained medical professionals always check for strangulation, even if the victim is pretty sure they would remember that kind of thing. Often they don’t, Amanda says, and often the only sign is a thumbprint bruise behind the earlobe or broken blood vessels in the eyes, ears, or mouth. In other words, a lot of places you can’t see on yourself. This is one reason Amanda is adamant about victims going to the hospital afterward, even if they think they escaped the attack unharmed.
Wait, you didn’t know that many victims avoid going to the hospital afterward? They sure do, and it’s because a lot of them believe …
Myth: Getting Examined Afterward Is Almost As Bad As The Assault
This is the dreaded “rape kit” you’ve seen in a million shows, the exam a victim gets after a sexual assault. Here’s where popular culture tries to portray this in a way that drives home how unpleasant and invasive it is (to help us sympathize with victims, which is nice) but in the process, winds up scaring many victims away.
You can probably picture it at this point. “A bruised, weeping girl reclines on a cold exam table with her legs in stirrups,” Amanda guesses. “The doctor comes out from the sheet covering her genitals and tells the detective standing beside him about the evidence he found.” The fact that the detective may or may not be Ice-T doesn’t help. One marathon of crime dramas is enough to give anyone a phobia of both police and doctors.
To wit: In one episode of Law & Order, Officer Jayne-Mansfield’s-Daughter informs a rape victim at a hospital that she must have a rape kit whether she likes it or not, literally chases her down when she starts to run, then casually hurls a “don’t take a shower in case you change your mind” at her retreating figure. Meanwhile, the doctor seems more concerned with exactly how drunk the victim may or may not have been than the shards of glass he removed from her body.
No doubt, shitty cops and doctors do exist (we’ll get to that later), but people don’t tend to go into this specialty with the intention of torturing victims. Here’s how it goes where Amanda works: “The patient is taken immediately back to a room and the SAFE nurse is contacted to come in and take the case,” Amanda says. “I tell them that SAFE means I am specially trained to work with survivors of traumas and assaults like they have been through, and there is nothing that they can tell me that will shock me.”
What follows is a pretty routine check-up. “I ask about how she is doing now. Any discomfort? We talk about each body part, and pain in your head, neck, shoulders, all the way down. Then we check in. I ask how she is doing and if she’s ready to talk about what happened. When she is ready I start writing. Verbatim, everything she says gets written exactly. This report is what directs my care. Based on what they tell me, I know where to look for injuries as well as where to collect evidence. I also know how to make them more comfortable: For example if there was no contact with her mouth I can now get her something to eat or drink without risking losing evidence.”
“Depending on what she would like to do, we proceed,” Amanda continues. “I have her stand on a clean sheet and disrobe behind a curtain I hold up. Each article of clothing is separated to be boxed up for evidence. She changes into a gown and sits on the bed. Then I begin the head-to-toe exam … I ask the patient if there is any discomfort along the way, and if I see any injuries, I will ask what happened. We can take photos of injuries for later use, and will swab areas where evidence may be, based on the story.
“The final step of the exam is the dreaded genital exam. If she is not comfortable, we skip this, but most women are okay with it by this point because we have built a good rapport. She positions herself just like we are doing a pap smear, a speculum is inserted, I check the tissue for trauma while collecting samples — and we are done.”
Were you surprised that the victim had the right to decline parts of the procedure? “From the moment you walk into my ED, you are in charge,” Amanda says. “My job is to give you back control of your body and your choices. If you just want STD and pregnancy prevention medications, that’s all we have to do. If you want a head-to-toe exam to check for injuries, you got it. Evidence collection and police reporting? I will make it happen for you. You are in charge.”
The exam also doesn’t mean the victim is pressing charges — getting a rape kit doesn’t trigger an investigation. Police can be given the kit anonymously and will hold it for 90 days while the victim decides. So please, if this happens to you, go to the hospital.
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