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Sexual Assault and Examinations (Kentucky)

2 Contact Hours
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN), Registered Nurse Practitioner
This course will be updated or discontinued on or before Monday, September 22, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


≥ 92% of participants will know the importance of awareness of sexual assault, how to become certified as a nurse examiner, and better understand state-mandated requirements to care for sexual assault survivors.


After completing this course, the learner will be able to:

  1. Define terms associated with sexual assault and violence.
  2. Identify the importance of forensic nurses and examinations.
  3. Recognize the longstanding effects that can occur after a sexual assault or trauma.
  4. Recall important critical aspects of a forensic examination.
  5. Identify state-mandated requirements for hospitals' response to sexual assault survivors.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Sexual Assault and Examinations (Kentucky)
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Krystle Maynard (DNP, RN, SANE-A)


The following terms may be utilized to increase awareness and broaden the scope of forensic nursing: sexual assault forensic examiner (SAFE), sexual assault nurse examiner (SANE), sexual assault medical forensic examiner (SAMFE), and sexual assault examiner (SAE). While SANE is the most commonly recognized term, the alternate terms often include physicians, physician assistants, certified nurse midwives, etc. (Office on Violence Against Women [OVW], 2018).

Training, education, standards, and credentials may vary by state. However, the goal as a nation is that all cases of suspected or reported sexual abuse or assault will result in each person having access to a highly-skilled, forensically-trained provider (OVW, 2018).

Terms to Know

Adolescent: For forensics, the term adolescent is used to differentiate the age at which a victim would be subject to a pediatric examination. This could vary by state, as age and maturity level should be considered (OVW, 2013).

Disability: Someone with mental or physical impairments that may limit their ability to perform specific life activities or tasks (OVW, 2013).

Domestic Violence: A broad term to describe any violent, coercive, or abusive behavior that may be used to harm or intimidate a partner. Examples may include threats, physical violence, emotional or sexual abuse, isolation, manipulation, etc. (OVW, 2013).

Sexual assault: Any unwanted sexual contact without providing consent. It may also be called rape, sexual misconduct, sexual harassment, etc. (OVW, 2013).

Sexual assault examiner: A healthcare provider who has been trained in performing forensic medical examinations. The provider could be a nurse, nurse practitioner, physician, physician assistant, etc. (OVW, 2013).

Sexual assault response team (SART): A team of specially trained individuals who respond to sexual assault victims. Team members may include healthcare providers, law enforcement, and victim advocates. SARTs may vary from state to state, as not all states have a well-developed response team (OVW, 2013).

Suspected sex offender: This person has been accused and suspected of committing a sexual assault against someone (OVW, 2013).

Victim: Someone reporting being sexually assaulted (OVW, 2013).

Victim advocate: Often working for or with a local rape crisis center, victim advocates are called at each report of sexual assault. These individuals will offer their supportive resources and services and often remain with the victim throughout the forensic examination at the victim's request (OVW, 2013).

Vulnerable adults: Individuals with decreased mental capacity or impairments that prohibit them from being fully functioning, consenting adults (OVW, 2013).


According to the World Health Organization (WHO), sexual violence includes any form of sexual act, attempted sexual act, unwanted acts, or advances by any person, regardless of relationship status (WHO, 2013). Sexual violence is a worldwide problem and can include any of the following (International Association of Forensic Nurses [IAFN], 2018):

  • Sexual harassment
  • Rape
  • Sexual abuse/assault
  • Forced/coerced marriage
  • Genital mutilation
  • Forced prostitution
  • Trafficking


Sexual violence is a worldwide public health concern. Here are some statistics to ponder to shed some light on the magnitude of a known problem.

Kentucky statistics include the following (Kentucky Association of Sexual Assault Programs [KASAP], n.d.-a):

  • 39% of Kentucky women will be victims of sexual violence at some point in their life.
  • 18% of Kentucky men will be victims of sexual violence at some point in their life.
  • 23% of women will experience attempted (or completed) rape.
  • Almost 50% of Kentucky females were raped before the age of 18.

National statistics include the following (Centers for Disease Control and Prevention [CDC], 2022):

  • More than 50% of women will be a victim of sexual violence.
  • 1 in 3 men will be a victim of sexual violence.
  • 1 in 3 women experience sexual harassment in a public place.
  • 1 in 9 men will experience sexual harassment.
  • 4 out of 5 women report being raped before the age of 25.
  • Almost 50% report being raped before the age of 18.
  • 8 out of 10 males report being forced to penetrate before the age of 25.
  • Approximately 50% of non-Hispanic American Indian or Alaska Native and multiracial women report being raped in their lifetime.
  • A sexual assault occurs every 68 seconds.
  • ONLY 25 out of every 1,000 rapists end up in prison.

Consequences of Sexual Violence

Any form of sexual assault or violence is known to cause trauma to the survivor. When sexual violence occurs during childhood or adolescence, survivors have much higher risks to their health and mental well-being. Adults who experience sexual violence are said to have higher chances of sexually transmitted infections (STIs), unintended pregnancies, abortions, complications during pregnancy, mental health conditions, and suicide (IAFN, 2018).

Unfortunately, the risk factors do not end with the survivors; the children of survivors are also at risk. Research has shown that children of women who have experienced traumatic events as a result of sexual violence are at risk of having poor health and educational outcomes as they grow older. Emotional, behavioral, and mental health disturbances may also occur at higher rates (IAFN, 2018).

Forensic Nursing

Forensic nursing strives to bridge the gap between the science of nursing and the criminal justice system. Both nurses and nurse practitioners can specialize in forensics, as they are specially trained to manage the care of victims of sexual assault, neglect, physical assault, and intimate partner violence.

Forensic nurses can be found in any of the following (Foudoulian, 2023):

  • Emergency departments (ED)
  • Child advocacy centers
  • Coroner's offices
  • Police departments
  • Correctional facilities
  • Community-based clinics

Forensic nursing encompasses a wide range of specialized care for individuals who have experienced any or all of the following:

  • Sexual assault
  • Intimate partner violence (IPV)
  • Child abuse or neglect
  • Elder abuse
  • Incarceration


The original training standards for sexual assault forensic training were created by the OVW. They were later revised with the help of the IAFN (OVW, 2018).

Sexual Assault Nurse Examiner

SANEs are registered nurses who have gained additional specialized training to care for victims of sexual assault. The primary roles of a SANE include (Maynard, 2023):

  • Determining whether a victim can provide informed consent for a forensic examination.
  • Perform a thorough physical assessment, including obtaining a complete medical history.
  • Providing education to victims regarding the risk of contracting STIs, the need for testing, and the available prophylaxis measures.
  • Providing education regarding the risk of pregnancy as a result of the assault, as well as options and resources available.
  • Collect deoxyribonucleic acid (DNA) samples and take photos during the forensic examination, if indicated.
  • Document all details of the event history, medical history, injuries, samples taken, etc.
  • Be prepared to provide expert testimony with the assistance of the documentation should the case move forward to trial.

Annually, more than 400,000 individuals over 12 are sexually assaulted. The standard of care after a sexual assault is to present to a medical facility for assessment and treatment for those requiring immediate medical attention, followed by a forensic examination. Included in a forensic examination is the provision of an advocate, mental health services, prophylaxis for STIs, and other resources. SANE coverage is limited in many locations nationwide, leaving sexual assault survivors at risk for inadequate or zero sexual assault care (Thiede & Miyamoto, 2021).

Kentucky has 104 hospitals, and only 15 are designated SANE-ready, meaning they employ a SANE for 24/7 coverage (Michas, 2023).

Multiple studies have proven that patient outcomes improve for sexual assault survivors when a SANE coordinates their care. Since SANEs have specialized training, there are less likely to be gaps in evidence collection, the evidence collection kits will be handled appropriately and sealed, the chain of command is less likely to be broken, and trauma-informed care will be provided.

SANE Qualifications and Programs

The IAFN provides SANEs with the opportunity to become board-certified in both pediatric and adolescent/adult populations. Board certification may not be required, as all states can develop their credentialing process. Be sure to educate yourself on the specific requirements of the state you live and work in to remain compliant (OVW, 2018).

Should a nurse be interested in becoming certified in forensic nursing, the IAFN has developed a certification process with specific requirements that must be met. To sit for the forensic certification exam, nurses must (Maynard, 2023):

  • Carry a full, unrestricted nursing license in the state where they live (or compact license).
  • Have practiced as a registered nurse for at least two years (three years if sitting for the pediatric exam).
  • Have successfully completed the required 40-hour SANE course (must meet state-mandated educational requirements).
  • Participated in a forensic preceptorship.
  • Have at least 300 hours of sexual assault-related nursing practice in the past three years. Two hundred hours must have been performed in the population the nurse is seeking certification. For example, nurses cannot sit for the pediatric certification exam without experience caring for the pediatric population. 

Educational requirements and course offerings may vary by state, as some may encompass in-person, didactic training for sexual assault forensic providers.

As the leader in forensic nursing, the IAFN offers online forensic courses specializing in adult/adolescent and pediatric populations. The online IAFN training courses provide the didactic component that allows nurses and advanced practice nurses to become forensically trained. Specifically designed to meet all educational requirements, nurses receive 41 contact hours at completion (40 hours for the pediatric course). In addition to the didactic component, clinical components may also be required, depending on your state's regulations for certification.

For those who prefer in-person courses, consider contacting your state board of nursing for leads on your state's offerings. The IAFN also provides a list of their approved courses.

Kentucky Board of Nursing

To apply for an initial SANE credential in Kentucky, nurses must have each of the following (Kentucky Board of Nursing [KBN], n.d.):

  • A current Kentucky or multistate license
  • Complete a KBN-approved SANE course
  • Submit the SANE course certificate of completion
  • Pay a $120 application fee
  • Obtain a federal and state background check
  • If a nurse wishes to apply for SANE credentialing for both pediatric and adult populations, then the nurse must provide a certificate of completion and pay an application fee for both programs.

The Kentucky Revised Statute discusses the hospital's responsibilities for the care of victims of sexual assault. Despite the need for more SANEs, unfortunately, not every hospital in the state employs them on a full-time basis. As a result, victims may present to their local ED after a reported sexual assault to seek a forensic exam. If the specific hospital does not have a SANE present, they are still required, by law, to provide services to the victim. The law regarding forensic exams in Kentucky includes the following (KASAP, n.d.-b):

  • Each hospital with an ED is required to supply a trained provider 24/7 for sexual assault examinations.
  • Consent is required before the examination. Once that is done, providers are expected to perform a thorough history and physical, attend to all medical needs first, gather evidence, perform laboratory or other necessary diagnostics, and offer treatment.
  • Providers are also required to educate victims on the potential for STIs and the risk of pregnancy, as well as contact their local rape crisis resource office for the allowance of an advocate.
  • Minors can provide consent without a guardian present.
  • No victim shall be charged for a forensic exam, nor their insurance billed.
  • Each victim has the right to choose whether or not they wish to report the assault to law enforcement.
  • If the victim opts to report the assault, the hospital staff is to contact law enforcement within 24 hours.
  • The hospital will be responsible for safely storing and handling SAFE kits, samples, and evidence. If the assault is not reported to law enforcement, all kits must be stored for one year.
  • For victims under 18, hospital staff will have to determine if mandatory reporting is necessary.

Only 15 hospitals in Kentucky are designated as SANE-ready (Cabinet for Health and Family Services [CHFS], 2023). Kentucky has 13 sexual assault programs, and each program offers the following:

  • 24-hour rape crisis line
  • Counseling services
  • Advocacy in hospital, law enforcement, and legal settings
  • Mental health supportive services
  • Crime victims fund assistance
  • Community resource referrals

Forensic Examinations

Due to the traumatic nature of sexual assaults, each forensic-trained nurse should provide victim-centered care. The response time should be timely, and the nurse should demonstrate respect, professionalism, and compassion to minimize causing further trauma (OVW, 2013).

As a suggestion, sexual assault victims should be prioritized in ED settings. Victims should always be medically cleared by a provider and be allowed to wait in a private location (OVW, 2013).

Trauma-informed Care

With the hustle and bustle of most EDs, it can be challenging to remember the concept of trauma-informed care in sexual assault patients who come through the ED. Combine this with hospitals that do not employ trained SANEs, which can increase the survivor's trauma experience.

SANEs are trained to maintain a trauma-informed approach, leaving the survivor at the center. The survivor has a hand in their care throughout the forensic interview and examination process. The overall goal is to prevent the survivor from being re-traumatized. The six identified principles of trauma-informed care are (Brown et al., 2022):

  1. Safety
  2. Transparency & trust
  3. Collaboration
  4. Support
  5. Cultural and gender issues
  6. Empowerment

Developing rapport and providing individualized care helps create an environment built on trust and safety.

Benefits of Forensic Examinations

Sexual assault survivors may be scared to report their assault to law enforcement or may be afraid to go through with a forensic examination. From a trauma-informed approach, it is crucial to educate survivors on their rights to refuse an examination or to report their assault. Explaining what could happen if they proceed with reporting and an examination is also acceptable.

Collecting evidence during a forensic examination increases the likelihood of a perpetrator being caught and charged. Once a perpetrator gets convicted, then it is one step in the right direction of preventing future sexual assaults from occurring (RAINN, n.d.a).


Consent is key before beginning any part of the forensic examination. The examination may be delayed if a victim cannot consent (due to substance use, intoxication, etc.). Nurses and providers must remain culturally aware of any issues that may arise for specific populations and accommodate any request by the victim to allow a friend or family member to remain with them.

Before beginning any part of the exam, providers will need to be sure that they thoroughly explain each part of the examination process. It is also essential to educate the victim on their right to refuse any portion of the forensic examination.

Each facility may have its policies regarding consent, but in general, consent is needed for all of the following (OVW, 2013):

  • Medical care
  • Pregnancy testing and treatment
  • STI testing and treatment/prophylaxis (including human immunodeficiency virus [HIV])
  • Evidence collection using photography
  • Need for medical records release
  • The notification of law enforcement (if they are not already present)
  • Any form of evidence collection
  • Evidence release
  • Any necessary toxicology screening

Reporting to Law Enforcement

Unless the victim falls in the mandatory reporting category (minor, vulnerable adult, etc.), they can choose whether or not they want to report their assault. In this case, the examiner can explain to the victim what could happen if they do and do not report. It is crucial to remain unbiased and to provide a victim-centered response (OVW, 2018).

Payment of a Sexual Assault Examination

The Violence Against Women Act (VAWA) developed a grant program that provides funds to all states to ensure no victim will have to pay for sexual assault services (OVW, 2013).

Victim-Centered Care

When someone comes into a facility reporting a sexual assault, they have experienced a traumatic event. It is up to the healthcare providers and staff to familiarize themselves with providing a victim or patient-centered approach. Emergency department staff should reasonably attempt to prioritize sexual assault victims during their triage process. Providing victims with a private space for forensic examinations is also best practice.

Before beginning a forensic examination, providers should be aware that the exam process may need to be adapted at any point to address and respect certain circumstances or needs of the victim. Examples may include (OVW, 2013):

  • Gender identity
  • Disability
  • Language or communication needs
  • Cultural beliefs or practices
  • Immigration status
  • Sexual orientation


As with any form of medical examination, specific equipment may be necessary. Facilities should have up-to-date forensic examination protocols specific to the state, standard forensic exam equipment, supplies for the victim (change of clothes, etc.), a sexual assault evidence collection kit, swabs and drying station, and more (OVW, 2018).

photo of forensic exam equipment being used in a lab

Forensic Exam Equipment


Victims should be evaluated and medically treated upon arrival at a designated exam facility or local ED. Once the victim is medically cleared (or even before), healthcare providers should notify local law enforcement and victim advocates so they can offer their services. Every person who is a victim of sexual assault has the right to a victim advocate; it will be up to the victim to choose to accept offers for services and resources, as well as if they want the advocate to stay with them during the forensic exam (OVW, 2013).

Often, advocates can be helpful during the exam process by providing emotional support. Sexual assault examiners are responsible for remaining unbiased and focused on collecting evidence.

Forensic History

The proper protocol starts with the SAE introducing themselves to the victim and gaining consent before proceeding with an exam. Once consent is obtained, the examiner will start collecting a medical history from the victim. Necessary information to collect may include the following (IAFN, 2018):

  • Allergies
  • Past medical history
  • Past surgical history
  • Current medications
  • Recreational drug use
  • Immunization history
  • Last menstrual cycle
  • Pregnancy history
  • Contraception use
  • Last consensual sexual encounter

Once a health history foundation is obtained, the examiner will shift the interview toward the traumatic events surrounding the sexual assault. The information given during this time will help the SAE determine key areas to pay attention to when collecting evidence at the next examination stage. Information to discuss may include (IAFN, 2018):

  • Alleged sexual acts during the event
  • Time and date of the event
  • Event location
  • Any information about the assailant
  • Any use of threats, weapons, or restraints
  • Any use of electronic devices used during the event for recording purposes
  • Potential for drug-facilitated assault
  • Any contraception that may have been used
  • Ejaculation information (if it occurred, where, etc.)
  • Physical injuries associated with the assault
  • Pain or bleeding
  • Evidence destruction

It is important to note that the SAFE will identify critical pieces of the history and forensic interview to help guide their physical examination and evidence collection (IAFN, 2018).

Physical Examination

The examiner will begin the examination process with a comprehensive physical assessment, remembering to gain consent along the way (after explaining each step). Given the intrusive nature that can go along with a sexual assault exam, the examiner needs to begin their assessment with less invasive measures. For example, pay attention to their general appearance, mental status, and demeanor. Does the survivor appear clean, disheveled, scared, anxious, or cooperative? Regardless of what the examiner may observe, remember that no two people will react or respond the same way. So, be sure to abstain from allowing oneself to become biased or judgmental during this process (IAFN, 2018).

As the examiner proceeds with the physical examination, other factors to consider include:

  • Clothing (is the survivor wearing the same clothes from the event, or have they showered?)
  • Assess bodily structures for any sign of injury
  • Assess for sexual maturation

If the examiner learned of specific types or areas of injury during the history, assess each area, take photographs, and know that this will also be part of evidence collection and documentation. For documentation purposes, specific terminology is to be used for physical findings and may include the following (IAFN, 2018):

  • Laceration (tear)
  • Abrasion
  • Incision (cut)
  • Bruise/contusion
  • Hematoma
  • Edema (swelling)
  • Erythema (redness)
  • Petechiae

Anogenital Anatomy and Injury

During an approved forensic course, examiners will learn about normal anatomical variants and specific injuries commonly acquired during a sexual assault. Please note that having no apparent signs of injury does not mean an assault did not occur. Forensic courses will also go over specific methods used to identify and confirm physical findings during an examination, such as (IAFN, 2018):

  • Position
  • Labial examination and separation
  • Irrigation
  • Use of a colposcope for better visualization of internal structures
  • Anoscopic examinations may occur in some states if within a nurse's scope of practice
  • Hymen visualization
  • Toluidine blue dye use
  • Expert consultation

Evidence Collection

The goal of evidence collection is to gather as much evidence as possible. The SAE examiner will utilize the information provided during the health history, physical findings, and with the help of sexual assault kit instructions. DNA specimens and photography will most likely be utilized at this stage after first gaining consent. The examiner must pay close attention to exam findings, as each injury and potential evidence must be documented.

It is essential to continue to explain each step of the exam to the victim and collect consent before progressing. Take the survivor's lead, if necessary. For example, if the survivor is not ok with a vaginal examination, listen. It is acceptable to explain the potential for not gathering key evidence should they decide to report their assault to law enforcement. This is part of gaining consent; the victim gets to decide which parts of the exam they are comfortable with and which they are not (IAFN, 2018).

Types of evidence to collect may include any of the following:

  • DNA
  • Physical findings
  • Event History
  • Toxicology studies
  • Forensic photography
  • Foreign bodies, conception tools, tampons, etc. 

Adjunct methods and tools may be used during the evidence-collection phase to assist in visualization and collection. Alternate light sources can help with better visualization. Various swab collection techniques may be necessary depending on the type and location. A speculum is often used for vaginal examinations, and colposcopes can assist with magnification for photographic purposes (IAFN, 2018).

Evidence Specifics

Trace evidence may be collected in dirt, sand, leaves, grass, glass, etc. The evidence must be documented and photographed if any of these aspects are identified, then secured safely in envelopes or a paper bag (not plastic). Evidence collection bags and envelopes must all be sealed, initialed, dated, and timed (Kleypas & Badiye, 2023).

Swabs located within a forensic examination kit are often used to collect evidence in blood, saliva, semen, and urine. Biological evidence such as these may be collected with swabs (often moistened with a sterile solution) on the skin, under fingernails, on bitemarks, oral or buccal region, and in the perineal, vaginal, cervical, and rectal areas (Kleypas & Badiye, 2023).

Clothing worn at the time of the assault is considered evidence. Those who may come in contact with a survivor first (such as law enforcement and ED staff) should be aware of national protocols and instruct survivors not to change clothes, bathe, use the bathroom, or shower. If a survivor has changed their clothes, there may still be evidence on the clothes they were wearing at the time of the assault, so it is appropriate to request those items to be adequately secured in a paper bag as evidence (Kleypas & Badiye, 2023).

Forensic Photography

As with each process, consent for photography is required at each step of the examination process. Not each examination will require photography, as not each survivor will present a visual injury to be considered as evidence. As a general rule, only utilize photography as an evidence-collection method if it is relevant to the specific event and can be used as supporting evidence. It is important to note that examiners must familiarize themselves with legal considerations concerning their state. Personal cell phones are generally discouraged. Forensic organizations often have access to designated photography equipment (IAFN, 2018).

Sexual Assault Evidence Collection Kit

Also known as a "rape kit," sexual assault evidence collection kit contents may vary by state. Kits may include swabs for evidence collection, blood sample supplies, comb, bags, and paper sheets for clothing and other evidence collection, envelopes, document forms, and instructions. Unfortunately, many hospitals are not deemed "SANE-ready," necessitating the examinations be performed by someone not forensically trained (Rape, Abuse & Incest National Network [RAINN], n.d., b).

Whenever possible, it is essential to request that the survivor refrain from doing any of the following before their sexual assault examination:

  • Using the bathroom
  • Showering/bathing
  • Changing their clothes
  • Cleaning/freshening up
  • Brushing their hair

Naturally, individuals will want to do any of these, so if they happen to be performed, it does not eliminate the ability to have a forensic exam. Typically, DNA evidence will need to be collected within 72 hours of the assault occurring. If an examination is performed after 72 hours, there is a slight chance that some evidence may still be present (RAINN, n.d., b).


Documentation is vital in the forensic examination process, as it brings to the surface all components of the history, reported event findings, physical evidence, and more. Not to mention, there is always the potential that a SANE may be called to testify as an expert witness in cases that go to trial. Given that this could occur years after an examination, nurse examiners may only have their documentation to go by during that process. Adequate documentation is crucial (IAFN, 2018).

In addition to the history, each component of the physical examination, evidence collection, injury assessment, and verbal reports must be documented. When obtaining the survivor's recollection of the event, nurse examiners should document direct quotes as much as possible. Nurse examiners must utilize the recommended terminology when documenting each area of injury (IAFN, 2018).

Legal Considerations

Law Enforcement Reporting

It is ultimately the survivor's decision whether they wish to report the assault to local law enforcement. The examiner must explain the options available, though this will vary depending on age, cognitive ability, and circumstances surrounding the assault. For example, an adult can decide not to report, but if the examination is being done due to a report of sexual assault on a small child, reporting to law enforcement is necessary (IAFN, 2018).

SANEs must educate themselves and adhere to the rules surrounding the chain of custody for sexual assault evidence collection kits. The chain of custody documentation must include the patient's identifying information, date and time of collection, and law enforcement case number. It must remain safe until it is released to law enforcement. Each individual with access to evidence or evidence collection kit must also be documented on the chain of custody form (Kleypas & Badiye, 2023).

The length of time evidence will be stored may vary by state. In Kentucky, there is no statute of limitation for rape and sodomy offenses. There is a one-year statute of limitation for sexual abuse if the victim is over the age of eighteen. If under eighteen, the statute is five years (RAINN, 2023).

Drug or Alcohol-Facilitated Assault

Sexual assaults that occur when the perpetrator uses alcohol or drugs to alter someone's ability to give proper consent are termed drug or alcohol-facilitated sexual assaults; this can happen to anyone, with alcohol being the most common route perpetrators utilize. The use of drugs or alcohol does not make the assault any less real for anyone affected by it. A potential downside is that victims may be unable to consent to a forensic exam until they are no longer under the influence (Drug Enforcement Administration [DEA], 2017).

Sexually Transmitted Infections

There is always a risk of STIs during sexual assaults. Healthcare providers are thoroughly trained to explain necessary information in a way that the survivor will understand. Providers are expected to educate on specific risk factors (this can vary based on assault details) and offer STI testing and treatment. STI testing and treatment follow-up education are also key (OVW, 2013).

Survivors have the right to accept or deny treatment offerings once they have been educated on the most common STIs, symptoms to watch for, and the STIs that may not demonstrate symptoms immediately or mimic other things (IAFN, 2018).

Risk of Pregnancy

Pregnancy is a common fear as a result of sexual assault. Based on information gathered during the examination, healthcare providers can provide the victim with information regarding their risk of becoming pregnant due to their assault. Victims can be offered a pregnancy test (they must also provide consent for this) and potential treatment options. Victims of sexual assault have the right to be offered pregnancy prevention as it is consistent with state protocols and regulations. Contraception methods and follow-up options should also be discussed (OVW, 2018).

Emergency Contraception

After sexual assaults occur, victims are often concerned about unintended pregnancies. The risk of a pregnancy arising from a sexual assault can vary for many reasons, such as the last menstrual cycle, ovulation period, contraception used, and more. Emergency contraception is an option to offer victims following a sexual assault. These are often called the "morning-after pill." Levonelle is a pill that must be taken within 72 hours of the assault, and ellaOne can be taken up to five days following an assault (National Health Services [NHS] Inform, 2022). It is important to note that a victim's weight can affect the efficacy of these medications. It is also essential to educate victims that these do not protect against STIs, so that additional treatment options may be necessary.


As there are often multiple components in a sexual assault case, each individual may have specific tasks to complete before discharge. For example, suppose the victim reports their assault to law enforcement. In that case, it may be beneficial for the nurse examiner and law enforcement to be present during the history interview. In an already traumatic situation, making someone disclose details of their assault multiple times is not in their best interests (OVW, 2013).

Pediatric Forensics

Though this course is primarily specific to the adult population, it is vital to cover a few key principles related to abuse and reporting in the pediatric population (Children's Advocacy Centers of Kentucky, 2021).

  1. Forensic exams are needed for all pediatric reported or suspected sexual abuse situations.
  2. Mandatory reporting is required.
  3. When possible, obtain a history from the child without a parent or guardian present; also, seek history from the parent in a separate location.
  4. A child should not be held down, restrained, or forced into evidence collection.
  5. Acknowledge that history and evidence collection may be scattered due to the timing of reporting. Collaboration with the Department for Community Based Services (DCBS) and a local child advocacy center may be necessary.
  6. Parental consent is not necessary; the minor can provide consent.
  7. Familiarize yourself with your state and local laws and protocols related to pediatric forensics and abuse allegations.
  8. DCBS Hotline- 1-877-597-2331 or 1-877-KYSAFE1
  9. Only someone certified in pediatric forensic exams can perform the exam. If no one present is certified, then a qualified healthcare provider should perform the exam.

Case Study

Amanda is a 19-year-old looking forward to her first year away from home at college. She recently settled into her dorm room and has gotten her first week of classes out of the way. Making new friends is still a work in progress, but it is nothing she did not expect. A new city, school, and meeting new people will take time. The guy in Amanda's math class seems nice enough; he tells her good morning, picks up her pen when she drops it, and appears to enjoy making eye contact with her during class. Going into her second week of classes, this guy finally starts conversing with her; he asks her name and introduces himself as Jared. As they made small talk, Jared asked Amanda if she wanted to hang out on Friday night and stated that his fraternity was hosting a party. He assured her it would be very chill and nothing too crazy. Amanda was trying to broaden her horizons, and despite knowing she had never been fond of parties, she decided to try it and told him yes.

Friday arrives, and Amanda feels confident in her outfit, hair, and makeup and heads over to Jared's fraternity house. He spots her walk in, and they decide to grab a drink and find somewhere quiet to talk alone. Amanda seemed to like him, as they talked for hours! When she realized it was getting late and she had had a few drinks, Amanda decided to walk back to her dorm. Jared was genuinely sweet and insisted on walking her back so she would not roam campus alone at night.

When they arrived at Amanda's dorm room, they realized that none of her roommates were there, so Amanda invited Jared in for a few minutes. Jared decides to make the first move and kisses Amanda. Amanda was starting to like Jared, so she went with it. Things started getting increasingly heated, and Amanda tried to pump the breaks. In between making out, she tried to explain that they should slow down, that they did not know each other yet, and that she needed to sleep. Jared showed no interest in slowing down or stopping. Amanda continued to ask Jared to slow down, and he continued to say things to her like, "It's ok, just go with it," and "I like you, don't you like me?" Amanda realized he was much stronger than she was, and as he began to rip her clothes off, she asked him to stop, but he wasn't listening.

When he finished, Jared kissed Amanda on her forehead and left. Once he was gone, Amanda lay there in shock as she cried herself to sleep. She replayed the whole night in her head all weekend, questioned if she did something to cause what happened, and wondered what she should have done differently. Amanda felt embarrassed, ashamed, and broken. She didn't know who to talk to or when; she wanted to forget it ever happened to her.

However, Amanda had trouble focusing in class on Monday, especially when she saw Jared in class, and he acted like everything was fine. Amanda decided to speak to a school counselor about what happened. The counselor reassured Amanda that she did nothing wrong. The counselor also asked Amanda if she wanted to report the assault. At first, Amanda said no; she wanted to forget. But, the more she talked with the counselor, the more she realized that if this happened to her, how often might this happen to others? As Amanda changed her mind, the counselor helped her call the university police to report the incident. Per protocol, Amanda had to go to the university ED for a sexual assault examination. The counselor instructed Amanda to take her clothes with her from Friday night in case they could be used.

Since Amanda had no traumatic injuries or other medical problems, she was medically cleared and sent to a private exam room while waiting for a nurse. The nurse finally arrived, as did a victim's advocate, and they said so many things that Amanda felt like her head would explode.

Amanda went through the Friday night events the best she could while answering all the nurse's questions. The nurse asked her if she had showered, cleaned up, brushed her teeth, etc., since the incident, and Amanda told her she had. Amanda worried she had done something wrong or was too late to seek help. She did remember to bring her clothes that she hadn't yet washed, so she provided them to the nurse to collect in a brown paper bag.

As she went through the motions of answering the questions, allowing the nurse to perform a vaginal exam, and using swabs everywhere (so it felt like), Amanda couldn't help but get emotional, wondering how she let herself get there. The victim's advocate helped calm Amanda down and talked with her about resources, talking to a professional, and many other things as the nurse finished her examination. Upon discussing whether Amanda wished to report her assault to local law enforcement, Amanda asked the nurse what she should do. The nurse explained to Amanda her options and decided to pursue reporting the incident.


Sexual violence is an issue experienced by many around the globe. It is a common form of trauma, which can severely affect the quality of life of its victims. There is a need for increased awareness and research to provide trauma-informed and evidence-based care to patients.

Kentucky Resources

  1. Kentucky Association of Sexual Assault Programs, Inc.
  2. Kentucky Coalition Against Domestic Violence
  3. Child Advocacy Centers of Kentucky
  4. Kentucky Office of the Attorney General, Office of Victims Advocacy
  5. Kentucky's Regional Rape Crisis Centers
  6. Kentucky's Domestic Violence Shelters
  7. Crisis text line: Text "KY" to 741741

National Resources

  1. National Sexual Assault Hotline- (RAINN) 800-656-HOPE
  2. National Domestic Violence Hotline- 800-799-7233
  3. National Sexual Violence Resource Center
  4. National Alliance to End Sexual Violence
  5. National Center for Victims of Crime
  6. Coalition to Abolish Slavery &Trafficking (CAST)

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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