Sexual Assault Nurse Examiner (SANE) Exam Components and Process
A Sexual Assault Nurse Examiner (SANE) exam is a comprehensive forensic medical examination performed by specially trained nurses to collect evidence, provide medical care, and offer crisis intervention to sexual assault victims, ensuring proper documentation and preservation of evidence for potential legal proceedings.
Key Components of a SANE Examination
Initial Patient Care and Preparation
- Before any examination, the healthcare professional addresses immediate health concerns including STI risk, pregnancy possibility, and worries about physical injury 1
- The exam should be conducted in a manner that minimizes trauma to the patient, particularly for adolescent victims 1
- Informed consent must be obtained from the patient before proceeding with any examination or treatment 1
Forensic Evidence Collection
- Evidence collection can be useful for up to 4 days after assault and possibly longer; local authorities should be consulted for cases between 4-7 days post-assault 1
- The forensic examination must maintain an unbroken chain of evidence with accurate documentation of findings 1
- Colposcopic procedures are used to detect and document genital trauma, including microtrauma that may not be visible to the naked eye 1
- Documentation must be exact, avoiding value judgments or interpretations of the patient's body language or facial expressions 1
Physical Examination Components
- Visual inspection of genital, perianal, and oral areas for injuries, warts, and ulcerative lesions 1
- Collection of specimens from sites of penetration or attempted penetration 1
- Speculum examination using appropriate technique to minimize discomfort, especially important for adolescents who may not have had previous examinations 2
- Video colposcopy may be offered to patients, with some adolescents reporting benefit from watching their own examination 1
STI Testing and Prophylaxis
- Cultures for N. gonorrhoeae from pharynx, anus, vagina (in females), and urethra (in males) 1
- Cultures for C. trachomatis from anus and vagina in females; urethral specimens in males only if discharge is present 1
- Wet mount and culture of vaginal swab for T. vaginalis infection 1
- Collection of blood samples for HIV, hepatitis B, and syphilis testing 1
- Prophylactic treatment is often recommended and includes:
Follow-up Care Planning
- Follow-up examination recommended 2 weeks after assault to detect new infections 1
- Serologic tests for syphilis and HIV should be repeated at 6,12, and 24 weeks after assault if initial results were negative 1
- Hepatitis B vaccine follow-up doses should be administered 1-2 and 4-6 months after the first dose 1
Special Considerations
Adolescent Victims
- Examinations should be performed by personnel experienced with adolescent assault victims 1
- Speculum examinations in adolescents should only be performed when medically necessary, not routinely 2
- The psychological impact of sexual trauma in adolescents includes increased risk of depression, suicidal ideation, self-harm behaviors, and eating disorders 3
Documentation Requirements
- Clinical records from both referring physician and assault center may be subpoenaed if there is prosecution 1
- For legal purposes, cultures are preferable over nucleic acid amplification tests (NAATs) for gonorrhea and chlamydia 1
- All presumptive isolates of N. gonorrhoeae should be confirmed by at least two tests using different principles 1
Benefits of SANE Programs
- SANE programs provide 24-hour first-response medical care and crisis intervention to sexual assault survivors 4
- Evidence suggests SANE programs are effective in promoting psychological recovery, providing comprehensive medical care, documenting forensic evidence accurately, improving prosecution of cases, and creating community change 4
- SANE-trained emergency nurses demonstrate significantly better attitudes toward sexual assault victims compared to those without training 5
Common Pitfalls to Avoid
- Forcing speculum insertion when resistance is encountered can cause trauma and negative experiences 2
- Using terms such as "hymen not intact" should be avoided in documentation 1
- Assuming an intact hymen means speculum examination is impossible is incorrect in most cases 2
- Failing to maintain proper chain of evidence can compromise legal proceedings 1