The Sexual Assault Nurse Examiner (SANE) exam is a specialized medical-forensic procedure for individuals who have experienced sexual assault. Its purpose is twofold: to deliver comprehensive, trauma-informed medical care and to meticulously collect and preserve potential forensic evidence related to the assault. The exam ensures a patient-centered response focused on physical health and emotional safety. Seeking a SANE exam is entirely voluntary, and the patient maintains the right to consent to or refuse any part of the process, including evidence collection. This procedure provides care and preserves options, regardless of whether a patient is ready to involve law enforcement immediately.
The Specialized Role of the SANE Nurse and Setting
The examination is performed by a Sexual Assault Nurse Examiner, who is a Registered Nurse or Advanced Practice Nurse with advanced training in forensic nursing. This specialized education, often involving 40 or more hours of instruction, focuses on the specific medical and psychological needs of sexual assault survivors. SANE nurses are skilled in providing compassionate, trauma-informed care while maintaining the rigorous standards required for collecting legal evidence.
These exams are typically conducted in secure, private settings, most often within hospital emergency departments, but also at dedicated Sexual Assault Response Centers (SARCs) or specific clinics. The environment is set up to minimize stress and maximize patient comfort, often with the support of a victim advocate present throughout the process. The SANE nurse works in coordination with a multidisciplinary team to ensure the patient receives seamless medical and emotional support.
Components of the Forensic Examination
The SANE exam begins with a medical screening to address any immediate or life-threatening injuries, which takes precedence over all other steps. Following this, the SANE nurse obtains a detailed medical-forensic history, using non-leading questions to document the patient’s account of the assault and identify areas for evidence collection. This history guides the subsequent physical assessment and evidence gathering process.
The physical assessment is a thorough, head-to-toe examination to identify, document, and treat any visible or non-visible injuries. This is followed by the collection of trace evidence, which includes swabbing various body sites, such as the mouth, anus, and genitalia, to collect potential biological fluids. The nurse also collects items like clothing worn during the assault, hair samples, and fingernail clippings, which are preserved in a Sexual Assault Evidence Collection Kit.
Forensic photography is used to document any injuries, including bruises, cuts, or signs of defensive wounds. Photographs are taken only with the patient’s specific consent and are focused exclusively on the areas of injury or evidence. Throughout the examination, a strict chain of custody is maintained for all collected evidence to ensure its integrity should the patient decide to pursue legal action.
A patient may be offered prophylactic medications to prevent potential health consequences of the assault. This commonly includes emergency contraception and medications for Post-Exposure Prophylaxis (PEP) against sexually transmitted infections (STIs), including HIV. While medical care can be sought at any time, the optimal window for collecting biological evidence that maximizes the chance of finding viable DNA is within 72 to 96 hours of the assault.
Understanding Reporting Options and Consent
The SANE exam separates medical care and evidence collection from the decision to report the crime to law enforcement. The patient has complete autonomy in deciding whether to file a police report at the time of the exam, or at all. The SANE nurse informs the patient of their reporting options, which include a reported exam or an anonymous option.
The anonymous option, often referred to as an “unreported” exam or “Kit Held,” allows the patient to have forensic evidence collected and preserved without immediately involving the police. The evidence kit is assigned a unique identifier and stored securely by law enforcement or a designated crime lab for an extended period, which varies by state but can range up to ten years or more. This choice gives the patient time to consider their legal options and decide to have the kit tested later, should they choose to report the assault.
Informed consent is constant throughout the process; the patient must agree to each step, from the medical history to the collection of specific swabs. The patient can revoke consent, pause the procedure, or refuse any component of the exam at any time without compromising their right to medical treatment. This emphasis on patient control is central to the trauma-informed approach used by SANE nurses.
Immediate and Long-Term Post-Exam Care
Once the physical examination and evidence collection are complete, the SANE nurse provides the patient with comprehensive discharge instructions. These instructions cover the use of prophylactic medications, such as the schedule for completing the full course of HIV PEP, and information on potential side effects. Patients are advised on follow-up appointments, including re-testing for STIs and HIV several weeks after the assault to ensure accurate results.
Post-exam care includes connection to community resources and support services. The SANE nurse or a present victim advocate provides referrals for crisis counseling and long-term mental health services. Information about local support groups and national hotlines, such as the National Sexual Assault Hotline, is provided to ensure immediate and ongoing emotional support.
The patient also receives information regarding victim compensation programs, which can help cover expenses like follow-up medical care, counseling, and lost wages. These resources are available regardless of the decision to report the crime, underscoring the commitment to the patient’s holistic recovery. The goal is to ensure the patient is safely discharged with a network of resources to support their healing.