The medical care of individuals presenting following sexual assault needs to be managed sensitively but with awareness of relevant time considerations. Most people who have been sexually assaulted do seek medical help at some stage, but the time taken to do so may range from hours to years. Management will vary depending on the time since the assault, whether the individual chooses to report the assault to the police and where she or he chooses to receive aftercare. Immediate care (see Chapter 18) should be followed up with longer-term medical and psychosocial support.

If there are ongoing potentially life-threatening problems, their management takes precedence and the patient should be transferred to an emergency department immediately.

The individual should be asked if they wish to report to the police. If they do then transfer to a sexual assault referral centre (SARC) should be facilitated. Even if they do not wish to report, a SARC provides the ideal environment for assessment and support. However, some patients may choose not to access these services.

Accurate and legible documentation in the notes is extremely important; records should be timed and dated (see Chapter 20). The notes may be used as evidence if the patient chooses to report the assault to the police at a later time. Detailed documentation can also be invaluable later for other reasons, such as an application to the Criminal Injuries Compensation Authority. In all departments where individuals commonly present following sexual assault, a pro forma can be useful in enabling inexperienced staff to collect all necessary information.

The history should be carried out in a private room where the patient can feel safe. They should be given time to talk and should never be pressured into giving information they do not wish to disclose. It is important to ask about details of the sexual assault if these have not already been given or are unavailable. This helps in determining risk, tailoring testing and treatment and providing appropriate support. Specific details concerning the assault and the perpetrator will help to identify the need for STI screening, pregnancy prevention, psychosocial support or a forensic medical examination. The patient should also be asked whether they have any injuries.

A sexual history should be taken, including current contraceptive use and date of last menstrual period, as well as last consensual intercourse. A full medical history is important and should include previous illnesses, including mental health. A full medication history should include use of asthma inhalers and alternative therapies, which are relevant if post-exposure prophylaxis for HIV is given. It is also important to determine to whom the victim has disclosed the assault. Information should not normally be passed on without their consent.

It is good practice to offer a full examination, but this may be a reminder of the assault. Self-taken or noninvasive tests for STIs may be offered as an alternative. Both men and women should be offered proctoscopy if there is a history of anal penetration.

There is a 5% risk of pregnancy in women of reproductive age following rape. Prevention of pregnancy must be a primary consideration when a woman presents following a sexual assault. Pregnancy testing should be considered prior to the offer of emergency contraception. Note that a negative pregnancy test does not reliably exclude pregnancy if there has been unprotected sexual intercourse in the preceding 3 weeks.