Sexual Assault Examination and Medicolegal Care
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Direct answer
Sexual assault examination combines medical care with medicolegal documentation, and it proceeds promptly without waiting for police formalities. The examining doctor takes informed consent, records history and injuries, collects forensic samples with a chain of custody, and offers emergency contraception, STI prophylaxis, HIV post-exposure prophylaxis and hepatitis B protection where indicated. Reporting follows the POCSO Act 2012 for children and the criminal law applicable to adults.
What you must remember
- Consent: informed and voluntary; guardian consent for minors, with the child's assent sought as far as possible.
- Emergency contraception: levonorgestrel 1.5 mg within 72 hours; copper IUD within five days, the most effective option.
- STI prophylaxis: single-dose ceftriaxone with azithromycin or doxycycline, per national STI guidance.
- HIV post-exposure prophylaxis: started as early as possible, ideally within 72 hours, per national guidance.
- Evidence: swabs, clothing, combings and nail scrapings, collected within the recommended window and sealed with a chain of custody.
- Reporting: mandatory under the POCSO Act for child survivors; adults are covered by the Bharatiya Nyaya Sanhita 2023.
A stepwise medicolegal pathway
The medical and legal tasks run in parallel, and the doctor's documentation must cover both. The steps below set out the order that examiners expect.
- Stabilise and consent: treat life-threatening injuries first, then obtain informed consent or guardian consent and explain the procedure.
- Take the history: record the time of assault and whether the woman has bathed, washed or voided, since these define the evidence window.
- Examine and document: examine the body and genitalia, record injuries in the survivor's words with diagrams, and avoid the two-finger test.
- Collect forensic samples: take swabs, clothing, combings and nail scrapings, sealed and labelled with a chain of custody.
- Provide prophylaxis: offer emergency contraception, STI treatment, HIV post-exposure prophylaxis, hepatitis B vaccination and a pregnancy test.
- Report and refer: complete the medicolegal certificate, intimate the police as required, and arrange counselling and follow-up.
Care is never withheld pending the police, and the documentation is written to stand up in court.
Where the exam tries to catch you
Sexual assault questions test the time windows, the banned examination and the reporting duties.
- Trap: Delaying the examination until the police arrive. Correct: Medical care and evidence collection proceed promptly, without waiting for police formalities.
- Trap: Performing the two-finger test to assess sexual history. Correct: The test has no scientific validity and is discouraged.
- Trap: Assuming emergency contraception works only within 72 hours. Correct: Levonorgestrel is effective within 72 hours, while the copper IUD or ulipristal extends the window.
Frequently asked questions
What is the time window for emergency contraception after sexual assault?
Levonorgestrel 1.5 mg is effective when started within 72 hours of the assault. A copper IUD can be inserted within five days and is the most effective option. Ulipristal extends the window in some settings.
Which STI prophylaxis is given after sexual assault?
Single-dose ceftriaxone with azithromycin or doxycycline is commonly given as STI prophylaxis. Hepatitis B vaccination and HIV post-exposure prophylaxis are given per national guidance. Sexual assault STI prophylaxis is started at the first visit, not deferred.
Does the medicolegal examination need police presence?
Medical examination should proceed without waiting for police formalities. Police intimation and the medicolegal certificate are completed in parallel. Sexual assault medicolegal care protects both the survivor's health and the evidence.
Which law mandates reporting of sexual assault against children?
The POCSO Act 2012 mandates reporting of sexual offences against children, and doctors who examine child survivors must report to the police or the Special Juvenile Police Unit as required. Adult survivors are covered by the Bharatiya Nyaya Sanhita 2023, which replaced the Indian Penal Code from July 2024.