Sexual Abuse and Assault

Core Concepts

Consent is the dividing line

Consent is freely given, informed, and reversible. It cannot be given by someone who is asleep, unconscious, intoxicated to the point of incapacity, threatened, or below the age of consent. Silence is not consent, and consent to one act is not consent to another. The presence or absence of consent — not the presence or absence of resistance — is what makes an act assault. Many survivors do not physically fight back because of shock, fear, or the freeze response; the absence of a struggle is not consent.

Who experiences sexual violence

Survivors include people of every gender, age, and background, and perpetrators are most often known to the survivor. In the context of this chapter, note the overlap with other topics: sexual assault by an intimate partner is a form of IPV (Topic 2), and sexual exploitation is a common feature of human trafficking (Topic 4). Survivors frequently delay disclosure by months or years, which matters for evidence collection and for offering support whenever disclosure finally happens — there is no "too late" to be believed and supported.

The nurse's first response

When a survivor discloses — during triage, a prenatal visit, or postpartum — the priority is emotional and physical safety:

• Respond calmly; believe the person; say clearly, "This was not your fault. I'm glad you told me."
• Take them to a private space; do not interrogate or press for details of the assault; the story belongs to them.
• Offer care within your scope: assess and treat injuries per protocol, and follow the facility's sexual assault response plan (many hospitals use specially trained Sexual Assault Nurse Examiners, or SANEs).
• Explain each step before doing it and get consent for every examination — a survivor needs control over their body and choices.
• Offer, but do not pressure, a forensic examination (evidence collection, sometimes called a "rape kit"). The survivor decides; they can decline any part.
• Follow institutional policy on emergency care, including pregnancy testing, STI screening, and any preventive treatments — these are initiated per provider orders and facility protocol, and the nurse should not quote specific regimens.
• Connect the survivor with an advocate (rape crisis or hospital advocate) and provide resource information discreetly.

Forensic examination and evidence

A forensic exam is a structured process performed by trained personnel using a kit, and it is governed by strict rules:

• The survivor gives informed consent at each step and can stop at any time.
• Evidence is collected with attention to chain of custody — every transfer of evidence is documented so it can be used in court.
• Timing matters: evidence may be collected soon after the assault; but survivors who come later should still receive medical care and support regardless of whether a forensic exam is possible.
• The exam is offered, not required, and a decision to decline it never changes the quality of medical care the survivor receives.

Pregnancy-related considerations

• Assault during pregnancy: a pregnant person may be sexually assaulted by a partner or others; care includes injury assessment, fetal assessment per obstetric protocol, emotional support, and the same reporting and advocacy considerations as any assault.
• Pregnancy after assault: the survivor needs pregnancy testing and, if pregnant, compassionate options counseling within the scope of the provider and facility — the nurse's role is to support, inform, and refer, not to steer a decision.
• Prenatal care as a safe space: for many survivors, maternity visits are the only place they are asked and believed; routine, private screening for sexual violence and IPV is expected practice (see Topic 2).

Reporting and advocacy

Mandatory reporting rules differ by state: reports are typically required for abuse of minors and older or dependent adults, and some states have additional duties in other situations. For competent adult survivors, the decision to involve police usually belongs to the survivor — the nurse supports autonomy while following the law. When in doubt about a reporting duty, consult the facility's social worker, risk management, or policy rather than deciding alone. Advocacy resources (rape crisis centers, hotlines, hospital advocates) should be offered to every survivor.

Common Confusions