Scope and Purpose

This guidance has adapted the the BASHH National guideline for the management of individuals disclosing sexual violence in sexual health services (2022) for disclosure taking place Sexual Health Services within the West of Scotland Managed Clinical Network. 

Many individuals do not disclose sexual assault or rape. The guidance aims to provide guidance to support appropriate management when they do.

Sexual Violence can take on many different forms; it is not limited to acts of non-consensual penetration nor does it require the use of physical force. It involves a wide range of behaviours, including attempts to obtain a sexual act, sexual harassment, coercion, trafficking for sexual exploitation and Female Genital Mutilation.  Sexual assault is an act motivated by power and control and although presents more frequently in females, affects all genders.

The role of sexual health clinics

Sexual Health Services are a key area where first disclosures about a sexual violence may be made.  Disclosures can be complex in nature and part of wider organised crime. There are also strong links between sexual abuse and other forms of gender based violence including domestic abuse and forced marriage.

Clinicians working within sexual health services should be able to identify concerns about sexual violence, have an understanding of the relevant medico-legal aspects and be familiar with local support services in order to respond to disclosures of sexual assault appropriately.

Disclosure of rape & sexual abuse is always difficult and patients should be assisted as much as possible with this process. The structure of the service both in terms of clinic environment and administrative processes should be considerate to the needs of patients disclosing sexual violence. Staff should be confident in informing patients of the choices available to them.

Reference to the current updated guidance on clinical and forensic issues by the British Association of Sexual Health and HIV (BASHH), The Faculty of Sexual and Reproductive Healthcare (FSRH) and The Faculty of Forensic and Legal Medicine (FFLM) is recommended.

 All sexual health clinicians should:

• Take sexual health histories that allow recognition of gender based/intimate partner violence.
• When a disclosure is made, ascertain and acknowledge the patient’s priorities in the provision of care.
• Embed Trauma Informed Principles of Safety, Choice, Collaboration, Empowerment and Trust into management.
• Be aware of the impact and potential consequences of sexual violence and avoid potential physical or emotional triggers.
• Identify and appropriately respond to any safeguarding issues.
• Explain the options available regarding police involvement and referral for forensic medical examination for the collection of potential DNA and other evidence if within the window of opportunity for forensic capture. Remember, if a patient has chosen to be referred to a SARC for a forensic medical examination, as a self-referral or with police engagement, a genital examination is generally unnecessary in a sexual health setting and prior examination may compromise the forensic evidence.
• Undertake pregnancy and infection risk assessments and offer testing depending on details of the assault, the time since the incident and incubation periods. If attending a SARC, this will be within 7 days of the assault and still within incubation periods.
• Assess psychological state and onward safety risk, and enquire about the use of harmful coping strategies and any pre-existing or ongoing domestic abuse. Acknowledge and encourage positive coping mechanisms.
• Acknowledge the risk of re-traumatisation when disclosures are made. Minimise the number of times the patient has to do this by offering to share appropriate information on their behalf with other health care staff or agencies involved in their aftercare and recovery for example sharing a summary letter of their care with their GP.

General Approach

• Listen
• Be Sensitive
• Accept their account in a non-judgemental way. It is not within your role to decide if a crime has been committed.

Acknowledge how they are feeling, this may sometimes include misplaced self blame. Reassure them that they are in a safe place and re-enforce the patient’s courage in speaking out.

• Try to empower the patient by supporting them to make choices about reporting.
• Provide risk assessments for STIs and pregnancy as appropriate and facilitate access to support services
• Try to avoid typing and looking at computer monitor while patient  is speaking; if you do please reassure the patient that you are still listening
• Offer information on available options, resources and appropriately supported onward referrals

Take into account the impact sexual violence may have had on the patient and offer a dynamic different to the one experienced during the assault. Ensure that their experience is not repeated or triggered in the consultation. Offering choices avoids inadvertently taking away control.

• Take into account the impact this may have on you and seek appropriate onward support for yourself if adversely affected by managing the situation.
• Every interaction provides an opportunity to support recovery.
• Maintain the trust that has been established when someone has felt safe enough to make a disclosure by explaining confidentiality limitations early to avoid any perceptions of false promises.
• Explain clearly the options available to the patient in response to the recognition of their priorities and your clinical assessment. Provide realistic expectations to avoid loss of trust.
• Provide an environment that allows adequate time and avoids interruptions during the consultation to promote feelings of safety.
• Enquire about pre-existing harmful coping strategies or domestic abuse to ensure about onward safety when leaving the clinic.
• Collaborate to make a management plan that acknowledges their priorities and concerns.
• Involve and collaborate with the patient in the management plan, empowering them to make informed choices and acknowledging their priorities and concerns. Enquire about what they are expecting from the consultation and perhaps more importantly, what they don’t want to happen, including any proposed multi-agency involvement.

A useful, short animation on understanding how victims of sexual assault may respond is available at: https://mediaco-op.net/projects/nhs-lanarkshires-eva-serviceanimation/