01Principles and purposeThe professional or clinical skill and the decisions it supports.
Immediate care should restore control after an experience in which control was taken away. Use the person’s language, minimise repetition and ask only what changes clinical or forensic care. A clear account for medical purposes can cover timing, sites of contact, condom or ejaculation information where relevant, pain, bleeding, memory gaps, strangulation, substances and pregnancy possibility. Detailed investigative questioning belongs to trained police and forensic processes.
Consent is granular. The patient can accept injury care and emergency contraception while declining police contact or forensic examination. They may agree to some samples and not others. Explain the purpose, discomfort, possible results, storage and information sharing for each step. Capacity is decision specific; intoxication, shock or age can affect it, but they do not justify automatic examination. Use applicable national law and specialist paediatric pathways.
Assess immediate medical danger with ABCDE. Look specifically for strangulation symptoms, head injury, loss of consciousness, chest or abdominal trauma, bleeding and severe genital or anal pain. Treat injuries according to urgency. The absence of visible injury neither proves nor disproves assault, and examination should never be framed as a test of credibility.
Time-sensitive prevention runs alongside forensic options. Assess emergency contraception using the current method-specific interval and pregnancy context. Evaluate HIV exposure for PEP as soon as possible and within 72 hours, using current BASHH guidance. Check hepatitis B vaccination and post-exposure needs. STI tests are chosen by contact site and timing; a baseline negative may require repeat because it does not exclude very recent acquisition.
A Sexual Assault Referral Centre can provide forensic medical examination, clinical care, advocacy and access to follow-up. Referral should be offered irrespective of police reporting, although commissioning and terminology vary. Contact the service early for forensic timing and evidence advice, including after washing or changing clothes, because useful options may remain.
Discharge planning is clinical care. Speak privately about the alleged perpetrator, safe transport, accommodation, children and phone monitoring. Give written information only if safe. Name who will review results, PEP toxicity and completion, pregnancy testing, vaccines and mental health. Offer advocacy and trauma support without requiring immediate counselling or a police statement.
Key points
- Believe the disclosure, thank the person for telling you, ask what they need now and avoid questions whose only purpose is investigating the allegation.
- Obtain explicit consent separately for history, examination, treatment, photographs, forensic samples, information sharing and police involvement; consent may be withdrawn.
- Treat life-threatening injury first, then address strangulation, head injury, genital or anal trauma, intoxication, pregnancy risk, HIV exposure and hepatitis B protection.
- Offer prompt SARC referral whether or not the person has reported to police; service names, access and self-referral routes vary across UK nations and localities.
- Explain options that may preserve evidence without making washing, eating, urinating or changing clothes a condition of receiving care.
- Assess immediate safety, suicidality, domestic abuse, exploitation and safeguarding privately, using professional interpreters rather than companions.
- Arrange confidential result ownership, STI testing at appropriate sites and windows, vaccination or prophylaxis review, pregnancy follow-up and psychological support.
02Situations and prioritiesThe context, relevant information and actions that matter most.
Voice change, dysphagia, dyspnoea, neck pain, neurological symptoms or loss of consciousness after neck compression requires urgent assessment.
Unexpected amnesia, disproportionate intoxication or suspected covert administration needs prompt clinical care and specialist toxicology advice.
A potentially qualifying exposure should be assessed for PEP immediately because initiation is not recommended beyond 72 hours.
Contact capable of causing pregnancy triggers emergency-contraception and baseline pregnancy assessment independent of reporting choice.
The person may choose medical care, forensic sampling, anonymous evidence storage or police reporting in different combinations where services allow.
Perpetrator access, stalking, controlled communications or dependent children can make ordinary discharge arrangements dangerous.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Immediate trauma and strangulation assessment - Why
- Identify airway, vascular, neurological, thoracoabdominal and genital injuries needing emergency treatment.
- Interpretation and limitations
- Normal external appearance does not exclude internal injury; symptoms and mechanism determine observation, imaging and referral.
- 02
Pregnancy assessment - Why
- Establish baseline status and select emergency contraception or follow-up after pregnancy-capable exposure.
- Interpretation and limitations
- A negative early test does not exclude conception from the assault and requires a timed repeat plan.
- 03
Site-specific STI and blood-borne-virus tests - Why
- Establish baseline infection status and diagnose infection at contacted anatomical sites.
- Interpretation and limitations
- Interpret against exposure time and assay window; repeat tests may be required and baseline positivity does not date acquisition.
- 04
Specialist forensic examination - Why
- Document findings and collect relevant trace, DNA and toxicology specimens with consent.
- Interpretation and limitations
- A normal examination neither excludes assault nor determines consent; specimen relevance and timing are case specific.
- 05
Mental-health and safeguarding assessment - Why
- Identify self-harm, exploitation, domestic abuse, child risk and practical barriers to safe discharge.
- Interpretation and limitations
- Share information according to consent and lawful safeguarding duties, limiting disclosure to what is necessary.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseRestore choice in the first consultationAn adult presents hours after an assault, has no major bleeding and is unsure about police involvement.+
- 1Check immediate safety, ABCDE, strangulation, head and abdominal injury, intoxication, suicidality and whether anyone accompanying them is safe.
- 2Explain medical, SARC, forensic and reporting options separately and obtain consent for each chosen part without pressing for a decision.
- 3Address emergency contraception, HIV PEP within the current window, hepatitis B and site-specific testing while contacting the SARC for forensic advice.
- 4Agree safe transport and contact methods, result ownership, repeat pregnancy and infection testing, PEP follow-up and advocacy support.
02Emergency branchTreat serious injury before evidence collectionThe patient has airway symptoms, major bleeding, collapse or severe head, chest or abdominal injury.+
- 1Resuscitate and activate the appropriate emergency specialty immediately.
- 2Preserve clothing or samples opportunistically only when this does not impede life-saving care and the patient consents.
- 3Document clinically necessary findings objectively and coordinate later forensic care with the specialist service.
03Child or young personUse the specialist paediatric pathwayA person under 18 discloses assault or abuse, or examination raises concern.+
- 1Ensure immediate safety and involve the designated safeguarding lead and paediatric sexual-assault service under local national arrangements.
- 2Assess consent or capacity and parental involvement individually; do not allow a possibly unsafe adult to control the consultation.
- 3Limit examination and questioning to urgent clinical need until specialist advice is obtained.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Confirm ownership and dates for repeat pregnancy, STI, HIV, hepatitis and vaccine follow-up.
- Review PEP adherence, renal or hepatic monitoring and adverse effects under the current regimen when PEP is started.
- Reassess injury, strangulation symptoms, sleep, intrusive memories, mood, self-harm and practical safety.
- Keep contact methods confidential and verify whether messages, letters or portal notifications are safe.
- Offer ongoing advocacy and trauma support while respecting the person’s pace and reporting decisions.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Consent is divisible
Agreement to medical examination does not imply agreement to photographs, forensic samples, police contact or every treatment.
No injury proves nothing
Many assaults leave no visible injury, so examination findings cannot determine whether consent was present.
Prevention has clocks
Emergency contraception, HIV PEP and toxicology each have different time constraints that should be assessed in parallel.
Washing does not end care
A person who has washed, eaten or changed clothes can still receive clinical support and may retain forensic options.
07Common pitfallsFrequent interpretation and management errors.
- 01
Delaying injury treatment or prophylaxis until a police decision is made.
- 02
Taking a detailed investigative statement instead of a focused clinical history.
- 03
Treating consent to one examination component as blanket consent.
- 04
Saying a normal examination excludes assault.
- 05
Discharging to an unsafe address or communication route without private assessment.