Sexual Assault & Hospital Advocacy

In-Hospital Sexual Assault Advocacy

Onslow Victims Center's (OVC) Hospital Advocacy responds to Onslow Memorial Hospital for adult sexual assault survivors who present initially after an assault.

The Hospital Advocate's primary role during the sexual assault case is to emotionally support the survivor so they are not alone while navigating the medical-legal process. Advocates are specially trained to provided crisis intervention, psychoeducation with a broad focus on potential elements of victimization, exploration of coping with symptoms, information about options, and linkage to community resources. The advocate will support the survivor by providing general information about the medical/legal evidence collection and legal system and help answer questions they may have about next steps.

All advocacy is survivor-centered and provided in a trauma informed approach





Stage 1:

From the first 24 hours to about a week or so after the assault, you may experience a feeling of acute distress and anxiety. This is the first aftershock of the attack and is the first stage of recovery. Having trouble believing that the rape even happened is very common. Women have reported a sudden need to turn to others for guidance as they come to question their capabilities.

You may encounter emotional and/or physical problems such as recurrent headaches and nightmares, nausea, confusion, paralysis, sleeplessness, loss of appetite, and fatigue. Feeling like you are in an emotional void, or being numb, may also be experienced. Dwelling on the rape and feeling dirty or being fearful that it might happen again are also very common during the first stage of recovery.

Steps for make recovery easier:

  1. Remember that you are most important. It does not matter what others are saying, thinking, or feeling, your well-being and health are the top priority. Try to have people around you who care about you and who support whatever decisions you make.
  2. Attend to the physical side of the rape. See your doctor. Medication may be needed to treat any injuries you obtained during the attack. Do not think that constant headaches, dizziness, and nausea are normal. There could also be a possibility of pregnancy and Sexually Transmitted Infections.
  3. As soon as possible try to resume your regular routine. This will help show you that life can and will go on.
  4. Make some decisions to regain some control over you life. It is okay for you to not be comfortable making decisions immediately after the attack, but make sure to take back control and be in charge of your life.


Stage 2:

This stage begins within the first few weeks of the rape. During this time you may feel calmer overall but may still experience underlying stress. You may feel more defensive, emotionally and physically. You make see yourself as somewhat helpless and confused. Mood swings and anger are common during this stage.

You may or may not be able to feel anger toward the rapists, however if may also trouble you that you can feel anger towards your family and friends. This completely normal and does not mean in any way that you enjoyed that attack. There are many theories, which explain why some women initially have trouble feeling anger toward the rapist. It may be that the lack of anger was necessary for survival on your part. You may think that if you are not angry at your rapist that he/she will not have a reason to rape you again. Others believe that rape results in a great deal of blame and self-punishment. As such, it is hard to be angry with the rapist when you are blaming yourself.

Giving over control of your life to others may be a response to the attack as well- a sort of self imposed isolation. This can be good as it gives some time to reorder you thoughts and priorities but it can also result in loss of privacy and independence. It can make it difficult to resume your normal life and to regain the responsibility for your own thoughts, feelings, and behaviors.

Steps to make recovery easier:

  1. The erratic behavior you may be experiencing during this time does not mean that you have because neurotic or crazy. It is a part of the normal recovery process. Your mind is trying to make sense of the attack that has just happened.
  2. You can use many of the suggestions given to you during Stage 1. It is most important for you to regain control of your life as soon as possible.

Stage 3:

In a few weeks you may start to feel fine. You may go through the day without a thought of the rape. To yourself and to others it might appear that you have recovered fully. This is called apparent readjustment. This may last a few weeks or months. During this time your mind is processing or making sense of the events of the rape, how you feel about others, and how you feel about yourself. This is a protective mechanism that lets you return to a somewhat normal lifestyle while the subconscious does the difficult work of trying to straighten out feelings and memories. This is when you may want to reestablish your previous lifestyle. You may wish to maintain your support system with friends and family and keep in touch with those you found most supportive. You can let them know that you still need their help and support.

Final Stage:

This stage may make it feel like you have not recovered at all. It is very common to have a relapse in depression, anxiety, fear, insomnia, headaches, mood swing, distrust of men, feelings of guilt, and sexual disturbances may start to manifest themselves. This stage is called reorganization/integration and may no begin until several weeks or months after the rape. These feelings have been buried for the last several weeks in your mind and now they are resurfacing because you are in a better place to start to deal with them. It is a huge step in recovery, even though it feels like you are going backwards.

This may be the first time you feel any real anger toward your rapist. This is a completely health reaction and it will finally allow you the ability to vent this emotion. It also shows the you are putting the responsibility for the rape where it belongs; on the rapist and not on yourself. You may decide during this phase that a change in lifestyle is in order. Such decisions usually result from a need to feel safe and secure. Try to avoid extreme changes.

Begin to look into rational methods of improving you safety. Getting a dog, upgrading you locks and windows are all good, healthy reactions that are helping you regain your power and control. Your recovery will be complete when you can again enjoy those activities that were important to you before the rape. Recovery is absolutely possible, it may just take some time. However, you may also carry some aspects with you.

Click here to learn more about the recovery process

Post Traumatic Stress Disorder- Survivors of sexual assault may experience severe feelings of anxiety, stress or fear, known as PTSD, as a direct result of the assault.

Substance Abuse- Survivors of rape and sexual assault may turn to drugs and alcohol in an attempt to relieve their emotional suffering.

Stockholm Syndrome- Survivors may develop Stockholm Syndrome, which means that they subconsciously bonded emotionally with their attacker. They involuntarily feel very close to their abuser as a way to ensure their survival. Survivors suffering from Stockholm Syndrome may say things like "I know what he's done to me but I still love him" or "I know it sounds crazy, but I just miss her."

Depression- This is one of the most common emotionally reactions that survivors often have.

Sexually Transmitted Infections: HIV/AIDS, Hepatitis, HPV, Gonorrhea, Chlamydia, Pubic Lice, Genital Warts, and Herpes are only a few of the STIs that a survivors could contract after a rape.

Sleep Disorders- Many survivors suffer from sleep disturbances and disorders including insomnia.

Eating Disorders- Survivors can develop eating disorders after a sexual assault because they are trying to regain some control in their life and food is definitely something they can control.

Body Memories- Body memories are when the stress of the memories of abuse experienced by a survivor take the form of physical problems that cannot be explained by usual means.

Dissociative Identity Disorder: This disorder normally occurs after a traumatic event in a person's life. It is characterized by two or more distinct identities control an individual's behavior at different times.

Self-Harm/Self-Injury- Deliberate self-harm is when a person inflicts physical harm on him/herself as a means to feel something or control their life again.

Suicide: Survivors of sexual abuse or rape may experience suicidal thoughts.

Anxiety- Survivors can manifest anxiety in different forms. Sometimes is shows itself in panic attacks, agoraphobia, and irrational feelings of fear and distrust for a specific type of person.

Attachment Issues- After a violent attack, such as rape, survivors can have trouble forming meaningful relationships.

  • Support his/her ability to make decisions for his/herself
  • Believe his/her stories and accept their experiences are real to him/her. Let them know that they can speak family, friends, or the Sexual Assault Adovcate at Onslow Women's Center.
  • Practice nonjudgmental listening and support. Respect this person's right to hold his/her own beliefs about this topic.
  • Remind him/her that the victim is never to blame. No matter what she/he was wearing, where she/he was, how late it was, if she/he was drinking, if she/he was on drugs, or if the rape began with consensual activity. Rape is never justified and it is never the victims fault
  • Encourage the survivor to contact the police or the District Attorney's office with any legal concerns.
  • You can provide physical comfort and support (hug, hand holding, shoulder patting, etc) if the survivor initiates with you.
  • Encourage the survivor to go visit their doctor or a hospital to get a Rape Kit done. If they do not want a Rape Kit done, encourage them to at least visit the doctor to make sure there are no internal injuries, STIs, or pregnancy.
  • If the survivor decides to get a Rape Kit, let them know that you will go with them if they want you too.

The term rape kit actually refers to the kit itself—a container that includes a checklist, materials, and instructions, along with envelopes and containers to package any specimens collected during the exam. A rape kit may also be referred to as a Sexual Assault Evidence Kit (SAEK). The contents of the kit vary by state and jurisdiction and may include:

  • Bags and paper sheets for evidence collection
  • Comb
  • Documentation forms
  • Envelopes
  • Instructions
  • Materials for blood samples
  • Swabs

Preparing for a sexual assault forensic exam

If you are able to, try to avoid activities that could potentially damage evidence such as:

  • Bathing
  • Showering
  • Using the restroom
  • Changing clothes
  • Combing hair
  • Cleaning up the area

It’s natural to want to go through these motions after a traumatic experience. If you have done any of these activities, you can still have an exam performed. You may want to bring a spare change of clothes with you to the hospital or health facility where you’re going to have the exam.

In most cases, DNA evidence needs to be collected within 72 hours in order to be analyzed by a crime lab—but a sexual assault forensic exam can reveal other forms of evidence beyond this time frame that can be useful if you decide to report. Place your belongings, including the clothes you were wearing, in a paper bag to safely preserve evidence.

How long is the exam?

The length of the exam may take a few hours, but the actual time will vary based on several different factors. It may be helpful to have someone to support you during this time. If you call Onslow Victims Center (910-347-4000) you will be connected with an advocate who can talk to you about the examination and offer support. The advocate may also be able to accompany you during the actual exam. Be aware that if you invite someone other than an advocate into the exam room, they could be called as a witness if you decide to report the crime.

What happens during a sexual assault forensic exam?

The steps below outline the general process for the exam. Remember, you can stop, pause, or skip a step at any time during the exam. It is entirely your choice.

  • Immediate care. If you have injuries that need immediate attention, those will be taken care of first.
  • History. You will be asked about your current medications, pre-existing conditions, and other questions pertaining to your health history. Some of the questions, such as those about recent consensual sexual activity, may seem very personal, but these questions are designed to ensure that DNA and other evidence collected from the exam can be connected to the perpetrator. You will also be asked about the details of what has happened to you to help identify all potential areas of injury as well as places on your body or clothes where evidence may be located.
  • Head-to-toe examination. This part of the exam may be based on your specific experience, which is why it is important to give an accurate history. It may include a full body examination, including internal examinations of the mouth, vagina, and/or anus. It may also include taking samples of blood, urine, swabs of body surface areas, and sometimes hair samples. The trained professional performing the exam may take pictures of your body to document injuries and the examination. With your permission, they may also collect items of clothing, including undergarments. Any other forms of physical evidence that are identified during the examination may be collected and packaged for analysis, such as a torn piece of the perpetrator’s clothing, a stray hair, or debris.
  • Possible mandatory reporting. If you are a minor, the person performing the exam may be obligated to report it to law enforcement.
  • Follow up care. You may be offered prevention treatment for STIs and other forms of medical care that require a follow up appointment with a medical professional. Depending on the circumstances and where you live, the exam site may schedule a follow up appointment, or you can ask about resources in your community that offer follow up care for survivors of sexual assault. Someone from the exam site may also be able to provide information or resources about reporting options.

Who can perform the exam?

Not every hospital or health facility has someone on staff that is specially trained to perform a sexual assault forensic exam and interact with recent survivors of sexual assault. When you call the National Sexual Assault Hotline at 800.656.HOPE (4673) you will be directed to a facility that is prepared to give you the care you need.

  • Sexual Assault Nurse Examiners (SANEs) — registered nurses who receive specialized education and fulfill clinical requirements to perform the exam
  • Sexual Assault Forensic Examiners (SAFEs) and Sexual Assault Examiners (SAEs) — other healthcare professionals who have been instructed and trained to complete the exam

Why should you consider having a sexual assault medical forensic exam?

  • It won’t cost you. You should not be charged for the exam. The Violence Against Women Act requires states to provide sexual assault forensic exams free of charge if they wish to remain eligible for critical anti-crime grant funding. If you are charged for the exam, immediately contact Onslow Women's Center .
  • You can have time to decide if you want to report. The decision to report the crime is entirely yours. It may take some time to decide what to do. Having a sexual assault forensic exam ensures that the forensic evidence will be safely preserved if you decide to report at a later time.
  • It increases the likelihood of prosecution. The importance of DNA evidence in sexual assault cases cannot be overstated. Not only does DNA evidence carry weight in court, but it may prevent future sexual assaults from occurring. Even if the perpetrator is not prosecuted, their DNA may be added to the national database, making it easier to connect the perpetrator to a future crime.
  • Your health matters. Sexual assault can affect your physical health. You may have injuries and trauma related to the assaults that aren’t immediately visible. During an exam you may be able to access treatment for these injuries, receive preventative treatment for STIs, and obtain emergency contraception to prevent pregnancy

If you would like to press charge against your rapist, be sure to have a Rape Kit done at your local hospital to obtain as much evidence as possible. After that call your local police and file a report against your rapist. If you are unsure if you want to press charges, in some states you can file a "blind report", which is an anonymous complaint in which the police record your account of what happened, but do not pursue an investigation. If you ever change your mind later and want to officially report you can make "blind report" an official report.

What does it mean to press charges?

After the initial report is made to law enforcement, a survivor can decide whether or not they would like to move forward with the investigation, a process referred to as pressing charges. Ultimately, the decision to press criminal charges is up to the state. It’s possible, though uncommon, that a prosecutor may move forward with charges based solely on the available evidence, even if the survivor chooses not to be involved.

Why would the state decide not to move ahead with the case?

If law enforcement or the prosecution team feel that they are not able to prove guilt, they may decide not to press charges. They may have encountered challenges proving the case due to a lack of evidence, an inability to identify the perpetrator, or other factors. It can be tough to hear, but this is not meant to diminish your experience. Out of every 1000 instances of rape, only 13 cases get referred to a prosecutor, and only 7 cases will lead to a felony conviction.1 No matter the final outcome, reporting increases the likelihood that the perpetrator will face consequences.

There are opportunities to explore your pursuit for justice beyond the criminal justice system. You may choose to file a civil suit, which is a lawsuit in civil court in order to receive monetary compensation.

Charges have been pressed. What happens now?

Many sexual assault cases are resolved through a plea bargain. A plea bargain an agreement between the prosecutor and perpetrator’s representative, in which the perpetrator agrees to plead guilty to a crime in return for a reduction in penalty, such as a lighter sentence. This course of action does not involve or require the survivor to testify.

If the case does go to trial it will be tried in criminal court, and the survivor will generally be asked to testify. Some aspects of state and federal law are designed to protect the interests of survivors who participate in a trial. One example is a rape shield law, which limits what the defense can ask the victim about prior sexual history. The prosecutor can also file legal motions to try to protect the victim from having to disclose other personal information. All states have their own rules and resources for protecting participants in a trial.

What should I know about testifying?

It can be nerve-racking to speak in public, as well as in a courtroom. It’s important to discuss concerns you might have with the legal professionals who are representing you and supporting your interests. Onslow Victims Center can provide you with an advocate to support you during the trial or resources to make the process less intimidating. You may also have the right to a support person or special accommodations depending on your state’s Victim Bill of Rights.

Learn more about what to expect at a criminal trial.

Tips for taking the stand

The following tips can help you stay focused and calm throughout your testimony.

  • Allow yourself to take brief pauses. If at any time you're feeling overwhelmed, ask the judge or prosecutor for a short break.
  • Stay hydrated; bring a water bottle and take sips of water throughout.
  • If you feel yourself getting angry or frustrated, take a moment to pause.
  • Keep your eyes focused on the person asking you questions, rather than looking at the perpetrator or their supporters.
  • Always tell the truth. If you don’t remember something exactly, it’s important to say so. If you say something you didn’t mean to, or you think something came across in a way you didn’t intend, you can clarify your statement. Ask the judge, “May I go back to something I previously said?”
  • Answer the questions – and nothing more. Don’t volunteer additional information unless you are asked.
  • If you don’t understand a question, say so. You can always ask the attorneys to repeat or rephrase a question so you can better understand it.
  • Every trial is different. If you have specific questions about testifying, check in with a victim advocate or the prosecuting attorney.