Forensic implications in the management of sexual violence in hospitals

Sexual assault involves a broad spectrum of nonconsensual sexual activity, including events with and without vaginal and/or anal penetration and/or oral sex and events characterized by the use of physical force or psychological coercion. Given the acute nature of sexual assault, emergency medicine providers are often the first clinicians to take care of the victim, and care of such patients differs from care of those presenting other kind of trauma or injuries. The sexual assault examination poses many problems to health personnel that have a dual responsibility regarding the management of the victims of sexual assault. The first is to provide the victim with the required medical and psychological treatment, while the second is to assist the victims in their medico-legal proceedings by collecting evidence and performing good quality and thorough forensic medical examination and documentation. Healthcare professionals treating victims of sexual assault admitted to Emergency Departments (ED) need a high level of professionalism, and the personnel involved in this process must perform their role in a scientific manner to effectively aid the administration of justice. They must listen and gather useful information for treatment as well as not just focusing on clinical intervention, but also on taking legal and forensic implications into account. Despite the fact that indicators have been published in the literature, even today there is still a lack of consistency in how they are applied in some hospital settings. Sometimes the case histories collected from the victim in the ED are still inadequate or incomplete in determining how the case event should be reconstructed. To avoid discrepancies between the medical reporting and the reconstruction of sex crimes, it is crucial to use strategies, which focus not only on technical aspects of evidence collection, but also on the way the victim's story will be recorded. Such efforts could lead to better management of sexual assault victims, and to securing their legal rights. Within this setting, the involvement of healthcare professionals specialized in the forensic field is paramount both for conducting accurate clinical examination for collecting a detailed documentation of physical injuries and for sampling biological evidence for forensic purposes.