Sexual assault

'Sexual offence' is a term applied to many activities which are defined throughout the UK by the Sexual Offences Act (UK Parliament, 2003). The term includes rape and assault which are the focus of this section. Understandably, such experiences are traumatic for the person presenting to health care services, and difficult for non-specialist staff to manage. This learning will enable you to recognise the key points and find guidance for immediate management, and you can access more information in the 'Useful resources' and 'References' sections. Key messages are:

View the video of Keeley's story and think about how you might respond if you were the nursing staff member involved in this situation. To read a transcript of the audio in this video, select the link Keeley's story (Word 15KB).

Play this video

The patient/client's needs

The needs of a person who has been raped or sexually assaulted will vary depending upon the time of their presentation after the event, the nature of the assault and their circumstances and wishes. The British Association for Sexual Health and HIV (BASHH) support the following guidelines. You can find a link to 'BASHH' in the 'Useful resources' section.

Explore the next animation and as you do, take a few moments to think about how you would approach the care of someone presenting immediately after being sexually assaulted. What would you do and say? Who else might need to be involved? Make a note to find out the address and telephone number of your nearest Sexual Assault Referral Centre (SARC).

How you can help

How you manage the care of someone who presents immediately following a sexual assault will depend on the circumstances and severity of it, and of course their wishes. Not all people are obviously distressed or crying - some present as quiet and withdrawn, and to the untrained or inexperienced eye may appear to be coping with it all quite calmly. Often this group suffer more difficulties later.

One of the considerations will be whether a forensic medical examination is needed. A Forensic Medical Examiner (FME) collects DNA and other evidence to assist any future legal case, and the client should therefore be advised not to bath or clean their teeth until it is completed. Clothing and sanitary wear should be preserved. This sort of examination is a specialised skill which can be carried out with or without police involvement, for instance at a Sexual Assault Referral Centre (SARC).

To help the person understand what could happen next (if they consent), you need to be aware of the following actions which, if required, should be undertaken by a competent health professional:

  1. History-taking, similar to the elements described previously in 'Core knowledge'. This should include details about the perpetrator, what happened and where.
  2. A physical examination, e.g. for injuries, genitalia, vagina, rectum, peri-anal area, mouth, wherever relevant to the assault.
  3. Investigations for STIs and consider HIV post-exposure prophylaxis after sexual exposure (HIV PEPSE).
  4. Pregnancy prevention.
  5. Partner notification and contact tracing.
  6. Child or vulnerable person protection needs.
  7. Safety issues, e.g. is there a continuing risk of violence for this person?
  8. Psychological support, e.g. for post-traumatic stress disorder (PSTD).

You will need to know what specialist support services such as Rape Crisis are available.

Top tip

Make sure you and your colleagues document everything fully in the records - drawings sometimes help to locate the site of injuries, and measurements should be included. The records may be called upon in a court case. Let's return to Keeley's case and consider how you would handle the situation and select each stage to see how Keeley's situation unfolds.