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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Male genital findings
Document all findings to the following (Figure 4)
1. Penis (Is patient circumcised?)
2. Urethral meatus (Is a discharge present?)
3. Glans
4. Shaft
5. Scrotum/testis
Figure 4
Photodocumentation
Document the use of colposcope, still photographs, or video for attainment of photodocumentation of findings.
Specify the body area of the pictures taken.
Examination Performed by Personnel
Document the names of persons completing the examination, license number (if applicable), signature, credentials,
and telephone number.
Evidence Submitted to The Forensic Laboratory
Female/male anus
Document all findings
Examination position (supine, knee-chest position, lateral recumbent)
Examination methods (define: traction, etc.)
Use of toluidine blue
Buttocks
Perianal skin
Anal folds
Anal dilatation (note if persistent or immediate; record actual time to dilation)
Document if stool is present in the ampulla; it may be helpful to have the patient defecate and reexamine the
patient
It is possible that further invasive procedures may be required such as anoscopy, vaginoscopy or a speculum
examination under anesthesia if it is suspected that injuries to deeper structures are present.
Summary of Findings
It is important to note that the absence of injury is a common finding in cases of sexual abuse. It is important that
your conclusions summarize and integrate the physical findings in light of the history of sexual abuse, and a normal
genital examination can neither confirm nor negate sexual abuse incidents. In cases with obvious physical findings,
one can state that the examination is consistent with the history of sexual abuse.
Medical Laboratory Tests Ordered
NOTE: Ideally, cultures should be deferred until after biological evidence is collected. If possible, actual cultures should
be taken whenever available as this is still considered the ‘gold standard’ in legal proceedings. Medical advancements
in nucleic acid amplificantion assays have lead to an increased use of screening and even a replacement of culture using
this technology. Gonorrhea or chlamydial detection through nucleic acid amplification confers and higher degree of
sensitivity although less specificity. The lack of specificity is compensated for by corroboration with culture results or repeat
amplification testing.
Document all laboratory tests ordered as indicated
Document when the following laboratory tests were obtained (if applicable):
Gonorrhea culture (document source of culture: oral, cervical, vaginal, anal, penile)[NOTE: GC culture remains the
gold standard although NAAT testing is done frequently for screening purposes)
Chlamydial culture (document source of sample as above)
Wet mount
Serology
Syphilis
HIV
Hepatitis
Pregnancy test (document whether blood or urine test was sent)
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Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Document all evidence sent to the forensic laboratory (Module—Adult/Adolescent Patient)
Strict documentation of chain of custody accounting for all personnel in possession of evidence
Document the following:
Clothing
Foreign body on material, including:
Blood
Dried secretion
Fiber/loose hairs
Vegetation soil/debris
Swab for suspected semen
Swab for suspected saliva
Swabs from areas denoted positive by alternative light source (alternate light source)
Control swabs (reference samples) of area adjacent to alternative light source
Fingernail scrapings
Matted hair cuttings
Pubic hair combing/brushing
Feminine hygiene products
Document oral/genital samples sent from the following regions:
Oral
Vaginal
Vulvar
Vestibule
Cervical
Anal
Penile
Document attainment of reference samples
Distribution of Evidence
Identify the agency, name of individual accepting the following evidence, and date and time
Clothing
Sexual assault kit (evidence kit)
Reference blood sample or buccal swab
Toxicology samples
Urine sample, if not officially part of the sexual assault kit
Signature of Officer Receiving Evidence
Signature of officer
Name
Agency ID number
Pediatric/Adolescent Patient Sexual Assault Examination
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