What Does This Mean for the Patient Who Presents to the ED?

If law enforcement authorization is required for medical forensic examination (MFE) to be performed or paid for, it most likely will be denied. This does not mean that a physical evidence kit (PEK) should not be collected. Studies have shown just the act of undergoing an MFE and PEK collection can validate and address sexual assault patients’ concerns, minimize the trauma they may experience, and promote their healing.^10-12 Additionally, if the patient decides to file a civil lawsuit, they can have the kit analyzed in a private laboratory. The presence of semen or DNA evidence is further proof stealthing occurred. Most importantly, patients should be provided pregnancy, sexually transmitted infection, and HIV prophylaxis, as would be done for any sexual violence survivor.¹³

Case Resolution

The SANE nurse arrived and explained to staff and the patient about stealthing and reviewed the options available to the patient. The rape crisis advocate was consulted and came to the ED to support the patient. An MFE was performed and a PEK was collected. The kit was stored as per the hospital’s anonymous kit storage policy. The patient received appropriate prophylaxis.

Dr. Rozzi is medical director of the forensic examiner team at WellSpan Health, and the secretary of ACEP’s Forensic Section.

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Dr. Riviello is chair and professor of emergency medicine at the University of Texas Health Science Center at San Antonio.

References

1. National Domestic Violence Hotline. Stealthing. NDVH website. https://www.thehotline.org/resources/stealthing/. Accessed December 13, 2023.
2. Rape Crisis England and Wales. What is stealthing? RCEW website. Accessed December 13, 2023.
3. Shah S. What is stealthing? The sexual misconduct gaining legal attention around the world. Time website. Published Mar 15, 2023. Accessed December 13, 2023.
4. Du Mont J, White D, McGregor MJ. Investigating the medical forensic examination from the perspectives of sexually assaulted women. Soc Sci Med. 2009;68(4):774-780.
5. Latimer RL, Vodstrcil LA, Fairley CK, et al. Nonconsensual condom removal, reported by patients at a sexual health clinic in Melbourne, Australia [published correction appears in: PLoS One. 2019;14(2):e0213316]. PLoS One. 2018;13(12):e0209779.
6. Davis KC. “Stealthing”: Factors associated with young men‘s nonconsensual condom removal. Health Psychol. 2019;38(11):997-1000.
7. Hernandez J. California is the 1st state to ban ‘stealthing’, nonconsensual condom removal. NPR website. Published Oct 7, 2021. Accessed December 13, 2023.
8. California AB-453. California Legislative Information website. Published Oct 08, 2021. Accessed December 13, 2023.
9. Chadha, K. Conditional Consent. Law and Philos. 2021;40:335–359.
10. Campbell R. The psychological impact of rape victims. Am Psychol. 2008;63(8):702-717.
11. Fehler-Cabral G, Campbell R, Patterson D. Adult sexual assault survivors’ experiences with sexual assault nurse examiners (SANEs). J Interpers Violence. 2011;26(18):3618-3639.
12. Buchbinder M, Brassfield ER, Tungate AS, et al. “I still feel so lost”: experiences of women receiving SANE care during the year after sexual assault. J Am Coll Emerg Physicians Open. 2021;2(4):e12464.
13. Centers for Disease Control and Prevention. Sexual assault and abuse and STIs-adolescents and adults. CDC website. Last reviewed July 22, 2021. Accessed December 13, 2023.