The Basics of a Sexual Assault Nurse Exam (SANE Exam)
The SANE Exam is a way to collect evidence that may be on a victim's body after a sexual assault or an incident of domestic violence.
A SANE Exam is done at a hospital by a specialty trained nurse, called a SANE Nurse. A SANE Nurse is educated in how to care for someone who has been assaulted. Feel free to call our office if you would like a confidential advocate to accompany you to your exam (719-275-2429).
A SANE Exam is also called an evidence collection exam. Evidence that is sometimes collected is spit (saliva), bodily fluids such as semen, blood, vaginal fluid, or other physical evidence like body hair, dirt, or skin.
Please note that you can go in for a SANE exam for either an attempted or completed sexual assault.
You have a right to
- Consent to have a sexual assault exam.
- Healthcare providers should not conduct a SANE exam or collect physical evidence without your permission.
- You do not have to report to law enforcement to have a SANE exam conducted or evidence collected.
- You have the right to have a sexual assault advocate present during the SANE exam if you so choose. Services are confidential and free of charge.
- You have the right to decline to do any part of the examination and the right to ask any questions you may have.
- You have the right to withdraw your consent at any time.
- You have the right to receive care without judgment or bias.
Basic components of a SANE exam
- Your history: consists of questions related to the assault, as well as your medical history. It is intended to help identify injuries related to the assault and to guide the evidence collection.
- Physical Assessment of your body: the purpose is to identify injuries and document physical findings, such as bruises, marks, cuts, etc.
- Evidence Collection: This process includes 13 steps, and the exam is conducted in a sensitive and respectful manner. Any step in the exam can be declined. The evidence collection kit includes retrieving a variety of samples including debris (soil, fibers, grass, etc.), body liquids, blood, hair, urine, oral swabs, and genital swabs.
- Preventive care: medications are given to prevent STIs if necessary, and emergency contraception is offered to prevent pregnancy.
- Discharge, follow-up, and referrals: instructions are given regarding follow-up care for medical and counseling purposes with advocates.
The sexual assault exam takes an average of 3-4 hours. This may be less or more, depending on the circumstances and extent of needed care. The evidence collection kit may be collected right after the assault and up to 120 hours after an assault. Because each case is unique, evidence collection outside the defined time frames may be considered on a case by-case basis.
Collection steps
Try your best to remain in the clothes the assault happened in, or bring them with you to the hospital. Clothing frequently contains the most important evidence in a case of sexual assault. The most common items of clothing collected from patients and submitted to crime laboratories for analysis are underwear, hosiery, blouses, shirts, and slacks. There are also instances when coats and even shoes must be collected.
There may be material or fibers that are found related to the assault. This is identified as trace evidence. These materials can help to provide evidence beyond DNA swabs. It is collection of any hairs, fibers, or other materials.
In cases where the patient was orally penetrated, the oral swabs and smear can be as important as the vaginal or anal samples. The purpose of this procedure is to recover seminal fluid from recesses in the oral cavity where traces of semen could survive.
Semen is the most common fluid deposited on the patient by the offender. There are also other fluids, such as saliva, which can be analyzed by laboratories to aid in the identification of the perpetrator. It is important that the provider ask the patient about any possible foreign material left behind and examine the patient's body for evidence of foreign matter.
If the circumstances of the assault suggest there has been contact between the victim’s genitalia and the offender’s mouth or penis WITHIN 5 DAYS of the examination, there exists the possibility that saliva or seminal fluid may be found on the patient’s external genitalia. In this instance, the entire pubic area should be swabbed. When the patient is prepubescent, external genital swabs should be collected instead of vaginal and cervical swabs.
Pubic hair can retain trace evidence from a sexual assault. For this reason, collection of pubic hair combings may be beneficial. If the patient is prepubescent or has shaved her/his pubic hair, external genital swabs would be more appropriate.
After fully explaining the procedure to the patient, put the patient in either supine or prone knee-chest position, there will be approximately 2 minutes for anal dilation to occur, then nurse will swab the anal cavity using the two swabs provided.
Vaginal swabs should only be obtained in the adolescent (pubertal) and adult population of female patients. Prepubescent patients would have external genital swabbing only. When collecting the vaginal specimens, it is important not to aspirate the vaginal orifice or to dilute the fluids in any way. Utilizing a speculum in the patient who has reached the onset of menses, swab the vaginal vault using the two swabs provided.
Collection of tampons as evidence. The sexual assault examiner may find that the patient has inserted a tampon in response to menstruation or bleeding post assault, or the patient may have a tampon in from the time of the assault. The tampon may have absorbed residual semen from the offender. It will therefore be necessary to collect the tampon as evidence. For the male patient, both adult and child: the presence of saliva on the penis could indicate that oral-genital contact was made; the presence of vaginal fluids could help corroborate that the penis was introduced into a vaginal orifice; and feces or lubricants might be found if rectal penetration occurred.
As with vaginal samples, cervical samples are only collected in patients who are past onset of menses. The cervix provides an excellent source for sperm and DNA collection. The cervix serves as a reservoir for sperm as the flow of cervical mucus creates strands.
Fingernail clippings are commonly collected on patients which may have been in a physical altercation during an assault. They may contain skin cells of the suspect and are simple to collect. Use clippers from kit and the nurse or patient may cut the fingernails onto the enclosed bindle. Nails from both hands should be included.
In some instances of sexual assault, dried deposits of blood, semen, or saliva may be found at the crime scene or on the body or clothing of either the patient or suspect. The purpose of collecting DNA Sample/Buccal Swabs is to determine the patient's DNA profile for comparison with such deposits.
This will vary based on the patient, history and circumstances of the assault. For example, it may be appropriate to swab a female's abdomen when she says the suspect ejaculated on her.
