What Is a SANE Exam?

If you or a loved one has been sexually assaulted, you may have heard of a sexual assault nurse examiner (SANE) exam. Sexual assault nurse examiners are registered nurses who have also undergone additional training for how to both care for the victims of sexual assault and collect evidence that can be used for future prosecution. This evidence collection is sometimes also referred to as a rape kit.

When someone has been sexually assaulted, they can choose to undergo a SANE exam even if they do not know if they want to prosecute their attacker. Undergoing such an exam preserves evidence that could be helpful, should the attacker be brought to trial.

If You Need Help After Sexual Assault

Call the National Sexual Assault Hotline (800-656-HOPE (4673))

After a Sexual Assault

When someone is sexually assaulted, they are not always automatically offered a sexual assault forensic exam. If you or someone you know has been sexually assaulted, call the National Sexual Assault Hotline (800-656-HOPE (4673)) or your local sexual assault service provider. They can help you find a location near you that provides sexual assault forensic exams. They may also be able to assign you a victim's advocate who will go to the hospital with you and provide emotional and practical support throughout the process.

In most cases, a victim's advocate cannot be called as a witness should you choose to report the crime. But that is not true if you invite anyone else to be with you for the exam. If there is a third person in the room who is not necessary to facilitate communication (i.e. an interpreter) or counseling, communication between the victim and the advocate is no longer privileged/protected. Specific rules about privilege vary from state to state.

If you choose to undergo a SANE exam, you do not need to report the assault to the police. However, if you choose to report to the police, having undergone a SANE exam can potentially provide helpful evidence. It may also help you access needed medical care, including treatments to reduce the risk of sexually transmitted diseases. For example, you may be offered post-exposure prophylaxis for human immunodeficiency virus (HIV). If relevant, you may also be offered emergency contraception.

Preparing for a SANE Exam

If you have been sexually assaulted, try to avoid doing any of the following before seeking help:

  • Taking a bath or shower
  • Using the toilet
  • Changing clothes
  • Combing your hair
  • Cleaning up the area where you were assaulted

It is normal to want to wash away the experience. However, it's important to recognize that doing so may reduce the likelihood that evidence will be usable, if it can still be collected. Having done any of these things does not mean a SANE exam can't be performed. It may just collect less evidence.

If you have to change your clothes before seeking care, put them and any other items you had on you in a paper bag in order to protect any evidence on them. You can, and should, bring a change of clothes to the hospital for after the exam if that will make you feel better.

Ideally, a SANE exam would be performed within 72 hours of the assault. This increases the likelihood that any DNA evidence will be preserved. However, if it is been longer than that, you can still request an exam. There are types of evidence that can still be useful even after 72 hours.

If you have an exam, it will likely take at least a few hours. The exam itself takes a significant amount of time. In addition, they may need to call an examiner and/or an advocate who is not on site.

What Happens During a SANE Exam?

A SANE exam normally has a number of steps. You can always ask the nurse to stop the exam, pause for a break, or even skip a step. It is important to remember that the exam is your choice, and that therefore you can choose to stop or skip any part of it that you don't want or don't feel that you can handle.

The first thing that will happen during a SANE exam is that any injuries you have that need to be treated quickly will be treated. After that, you'll be asked a number of questions, including about:

  • Any medications you are taking
  • Health problems you have
  • Any recent, consensual sexual activity
  • What happened during the sexual assault

The questions about recent sexual activity are not to stigmatize you for your sexual activity. They're to determine if evidence might be found on your body unrelated to the assault. Questions about what happened during the assault are to make certain that the nurse or other examiner can find any areas where you might be injured or where there might be evidence.

At this point, you will undergo a physical examination. Depending on what happened during the assault this may include internal examination of your mouth, vagina, or anus. The nurse may also comb your hair and pubic hair to collect samples and take blood or urine samples. If you allow it, the examiner may also take pieces of your clothing, including your underwear. With your permission, the examiner may also take photos of your body to document your injuries and the process of the examination.

Finally, after the evidence is collected, you'll receive any non-urgent medical care. This may include treatments to reduce your risk of sexually transmitted infections and, if relevant, pregnancy. A follow-up visit may be scheduled or you may be referred for help to an agency in your community.

If you are under 18 and have been sexually assaulted, it is important to know that the person performing the exam may be a mandated reporter. This means they could be required by law to report the assault to the state child welfare agency or local law enforcement.

Who Can Perform a Sexual Assault Forensic Exam?

In addition to nurses, other health professionals can be trained to become a sexual assault forensic examiner (SAFE) or sexual assault examiner (SAE). Specific regulations for becoming a SANE, SAFE, or SAE vary by state. However, in general, professionals must have significant experience with physical assessment. They must also undergo specific training in forensic examination, which usually takes place over 40 hours or more.

Core elements of SANE or SAFE training include:

  • Provide victim-centered care, which can be different from patient-centered care
  • Informed consent, and any local regulations that affect it
  • Confidentiality, and its limits
  • Reporting to law enforcement
  • Working as a team with local agencies that respond to sexual assault
  • Requirements for the examination to be paid for under the Violence Against Women Act

Unfortunately, a substantial fraction of training programs for emergency room (ER) physicians do not provide training in sexual assault exams. This is another reason why it may be helpful to call the National Sexual Assault Hotline to find where you can get a SANE exam before choosing an ER. For individuals who live in areas without SANEs or SAFEs, local physicians may be able to access these services using telehealth.

In most states, sexual assault forensic exams are fully paid for by the government, under the Violence Against Women Act. In some circumstances, victim compensation funds can be used to pay for, or reimburse a person for, associated medical care

A Word From Verywell

You may notice that this article doesn't use gendered words to refer to the victims of sexual assault. This is because individuals of any gender can be victims of assault. No matter what your gender, if you have been assaulted, you are deserving of affirming, humanizing care. Men who have been assaulted may have a particularly difficult time reporting, due to fears of stigma. They may benefit from reaching out to supports specific for male victims, such as the 1 in 6 hotline (1in6.org). LGBT individuals who have been sexually assaulted may also want to see if there is a local sexual assault advocacy group that specifically works with their community.

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Article Sources
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