Medical Support and Examinations
Disclaimer: This guide is not intended to replace professional support, guidance, advice, or diagnosis.
Trigger warning: A trigger is a word or an event that can cause an action to take place. In this toolkit certain words can be triggering for survivors. Which means that reading those words or sentences can cause a survivor to either feel uncomfortable or anxious and might even take them back to an unpleasant memory. If while reading someone does experience this, it is best to do a quick grounding exercise.
Frequently Asked Questions
Where can I access medical help?
You can access medical help at any government or private hospital. All government hospitals are required to treat survivors free of charge. However, the private hospital may recommend you to go to a public hospital that is better equipped to assist you. You can, however, insist that they conduct the examination. If the hospital refuses to conduct a medical examination or provide treatment to you they can be punished by the law.
Why is a medical examination important? How will it help me?
Some important reasons to undergo a medical examination are:
Do I need to get a medical examination done if I want to report the crime?
Although it is not mandatory to get a medical examination done in order to report a crime, the exam will help preserve any possible DNA evidence or any physical evidence from your body, clothes, or personal belongings. Such an examination can also detect the possibility of an unwanted pregnancy or any other infection, so you can get treatment or take emergency contraception to end the pregnancy if needed.
If I get a medical examination done, do I have to report the crime? What if I only want to seek treatment?
If you are above 18, you do not have to report the crime if you do not want to.
Keeping evidence: Having an examination done is beneficial as, with your consent, the doctor will safely store any evidence. This evidence, such as DNA, can be used if you choose to report the crime to the police at a later time. Most health facilities store the evidence samples for a specific number of days. If you are an adult, you could let the doctor know whether or not you want to report the crime to the police. If you have not made up your mind about it at the time of the examination, please ask the doctor how many days they will keep the samples. Then you can let the health facility know of your decision.
No one can force you to report a crime without your consent. Even if you choose not to pursue a legal case, you have the right to get treatment. If the hospital authorities contact the police, you can inform the police that you do not wish to file a complaint.
For under-18s: If you are under 18 years old, the doctor is legally required to report the crime to the police under POCSO. But in the absence of the police, the doctor cannot deny treatment. Treatment may start, and the police could be informed at the same time.
While getting a medical examination is advisable, if the examination is done 72 hours (3 days) after the assault, the genital (private parts) evidence, such as bodily fluids, is lost. Similarly, if the medical examination is done after a gap since the incident (more than 72 hours), physical evidence may be lost.
Are there any steps that I should take to preserve evidence before I get a medical examination?
The DNA evidence will need to be collected within 72 hours (3 days) of the sexual assault in order to be effectively analysed. However, you can get an examination done after 72 hours too; the examination can help document any other physical evidence that can be collected from you.
Some activities to avoid before getting an examination done are:
- Bathing or showering
- Using the washroom
- Changing your clothes (If you do change your clothes, keep the clothes you were wearing safely in a bag to preserve evidence)
- Brushing or combing your hair
- Cleaning up any genitals areas (private parts) where there might be evidence present
However, if you have done any of the above activities after the incident, before going for a medical examination, it is important to tell the doctor about it.
I have already had a shower, and it has been more than 72 hours. Can I still get an examination done?
Yes, you can. It is completely understandable that you may not have been in a position to get an examination done within 72 hours. You can go for an examination after 72 hours or after performing any of the activities listed above. A medical examination will help doctors provide you with the treatment you might need.
I have my period. Will this affect the examination?
If you are menstruating (on your period) at the time of the examination, a second examination will be required on a later date when your period is over in order to record the injuries clearly. Some amount of evidence may be lost because of menstrual blood. It is important to inform the doctor if you were menstruating at the time of the assault or the examination.
What do I need for a medical examination?
You do not need anything to get an examination done. It would be useful to bring a spare change of clothes in case it is required to collect the clothes you are wearing as evidence. While you can go for a medical examination on your own, we recommend going to the hospital with someone you trust. Sometimes having a trusted friend might make you feel comfortable and help you go through the hospital procedures.
How long is the examination?
Please remember that sexual violence of any kind is a medico-legal emergency and so a doctor must immediately attend to you. The procedure involves seeking consent, history taking (related to the incident(s) of sexual violence), physical examination, collection of samples and documentation by the doctor. The procedure may take about 1.5 hours, but if additional tests are required, it may take more time. You should tell a doctor if you need a short break during the course of the entire procedure. It is OK for you to take a break if you need one.
Do I have to be alone during the examination?
If you request, a relative may be present while the examination is done (preferably of the same sex as the survivor). If you are 12 years and above, you can decide if you want a parent or a guardian inside the examination room. However, the police personnel must not be allowed in the examination room during the examination.
|There are three ways that you can get an examination done:
Neither the court nor the police can force you to undergo a medical examination. It has to be with your informed consent (if you are an adult) or your parents’ or guardian's consent (if you are less than 18 years of age).
* If the person brought for the medical examination is less than 18 years old, then the medical practitioner is legally obliged to report the case.
- As per the law, the doctor is bound to inform the police about the incident. If you are an adult, you have the right to refuse to file an FIR. The informed refusal is documented in this case.
- If you wish to lodge a police complaint later or have come with a police requisition (after filing a police complaint), the details about the Medico-Legal Case (MLC) number and the concerned police station will be recorded by the examiner.
If you are less than 18 years old, it is legally mandated (compulsory) for the doctor to report the incident. However, the doctor cannot ask that a police complaint be filed before the medical examination and treatment are provided.
I do not identify with the binary gender, can I still get a medical examination done?
If you are transgender or gender noncomforming, you have a choice whether you want to be examined by a female doctor or a male doctor. In case a female doctor is not available, a male doctor may conduct the examination in the presence of a female nurse.
Will the doctor ask about my sexual history?
A doctor should ask about your consensual sexual history within the past 72 hours only. This is to make sure that they can correctly interpret observations regarding the detection of sperm or semen during the exam. Your sexual history is also important to carry out the medical examination scientifically. In case of non-penetrative assault, the examiner must document any injuries and collect relevant swabs. The doctor should explain to you the purpose of each step during the examination, and you can always ask the doctor questions about what is being done.
Who will be conducting the exam?
The medical examination will be conducted by a registered doctor at a government hospital, but you can also approach a registered private doctor if you do not have access to a government hospital/doctor. Any registered medical practitioner from a government or private hospital can conduct the examination, and it is not mandatory for a gynaecologist (women’s health doctor) to examine you. If you are female, the hospital must make every possible effort to assign a female doctor to the examination. In case a female doctor is not available, a male doctor may conduct the examination in the presence of a female nurse.
Do I need to sign any papers or make any statements in order to get an examination done?
Before the examination, you will need to sign a consent form stating that you have agreed to the examination. The consent form has to be signed:
- By you, the survivor (if over 12 years of age)
- By a guardian or parent if the survivor is under the age of 12 years or if the survivor is unable to give consent by reason of mental disability
The consent form must be signed by the survivor (if able), a witness (e.g. a nurse or a hospital employee), as well as the examining doctor (the police or a relative cannot be considered a witness). You will also get a copy of the medico-legal examination report free of cost. It is your right.
Can I ask the doctor to stop the examination or not conduct some tests?
Yes, you (or a guardian) can refuse to give consent for any part of the examination at any stage. The doctor may explain the importance of that particular test so that you understand how it is used to collect evidence (which may be useful if you intend to file a report with the police). It may also be useful for your treatment. However, if you refuse a test, you will still be treated at the hospital.
Do I need to pay for this medical examination?
No, you do not need to pay at a government or private hospital. As per the law, treatment for survivors of sexual assault is to be free of cost at all health facilities.
Do I need to take anything to verify my identity for the medical examination?
No, you do not. As long as you are an adult, the hospital will provide care to you. If you are under 18 or look younger, it would be wise to carry some government identity (PAN card, AADHAAR card), as the hospital staff may need the identity proof to verify your age to be put in the proforma or medical examination report.
Will I receive an acknowledgement or proof that the medical examination has been conducted?
Yes, you will receive a copy of a document called the “proforma”. This is the entire medical report documenting the examination and the observations made by the doctor. This document will be signed by the examining doctor and a witness.
What are some consequences of sexual assault that I should be aware of?
Health consequences of sexual assault are different for everyone. As per the guidelines for medico-legal care for victims of sexual violence survivors of sexual assault may suffer from the following:
|Non Genital Injuries||Psychological Health Consequences||Long-term Consequences|
This section helps you understand the different parts of a medical examination.
- Collection of general information, informed consent for examination, evidence collection and police procedures
- The doctor will start by recording the date, time, place, name, age, sex (male, female, or transgender), address and contact number.
- The doctor may ask for information about the police case registered and about who you have brought with you and your relationship with them.
- The doctor will also identify any marks of identification (two in number), such as moles, scars, tattoos. These are preferably marks that can be seen from the exposed parts of the body, like your hands or face.
- Only in life threatening situations, the doctor may initiate treatment without consent as per section 92 of IPC.4 In case you have refused to consent to police intimation, it is documented by the examiner while sending the Medico-Legal Case report to the police with a note stating “informed refusal for police intimation”.
- The doctor will ensure that you are given first aid care. Under Section 357(C), all hospitals (private or public) operated by the central or state government have to provide medical treatment or first aid.
- Medical history is noted down.
- Depending on your gender, the doctor will then record your obstetric (women’s health) history including menstruation (periods), past history of pregnancy, abortions, etc. This information is not relevant from an evidence point of view, so the doctor will only ask this if it is required for the purpose of treatment.
- The doctor will also ask about relevant medical history in relation to STIs (gonorrhoea, HIV, HBV, etc.). The doctor will also ask if you have had an surgeries/operations at the affected areas, in addition to vaccinations received.
This is important in order to understand whether you will have any health problems related to the assault. The doctor will refer you to further medical care if this is the case. This information should also be kept in mind during the examination and interpretation of findings.
If you are a minor (less than 18 years of age) or a young adult and look younger than your age, and do not have a proof of age, then the doctors may carry out a test for estimation of age. This is necessary as legal provisions for sexual offenses against minor and adult persons are different. For guidelines on age estimation, please refer to the manual provided in the Endnotes section.
- Collection of incident details
- The doctor may ask about the history of the incident. This will be held as evidence in a court of law as it is “recorded by a neutral and unbiased doctor.”
- You must try to be as specific as possible about the details of the place of the assault, time, nature of force used, and areas of contact on your body.
- If you are able to, you should tell the doctor about any activities you may have carried out - like bathing, washing genitals (in all cases), rinsing mouth, drinking, and eating (in oral sexual assault) as this will affect the evidence collected. The details will be used for your testimony in case you choose to pursue legal action.
- If at any point you feel uncomfortable or unsure, ask the doctor for the reason behind the questions asked. The doctor must explain it to you.
- Evidence collection and examination of injuries
- Based on the description of the incident you give, the doctor will only examine whatever is required and relevant.
- At any time if you are uncomfortable with the examination, you can ask the doctor to stop.
- The evidence on the body surface and materials like clothing can be (in certain circumstances) collected even after 96 hours.
- While collecting the evidence, the doctor may ask you to stand on a large sheet of paper so as to collect any foreign materials that may be left on you.
- Genetic evidence from the body cavities (oral, vaginal, anal) can be collected within 72 hours of the incident.
- The doctor will examine all physical injuries and collect the clothes you were wearing at the time of the incident.
- Documentation - The doctor then documents the examination, and makes four copies of the examination proforma. These copies are kept with the hospital and police and with you. If you choose to report the incident, then this proforma is sent for evidence processing.
Whether you want to proceed with a case or not, it is important to keep the copy handed over to you safely. This will help if in the future you wish to take legal action against the abuser.
- Specialised treatment - Specialised treatment is given after the examination has taken place. This can include treatment for STIs, HIV, Hepatitis B, and pregnancy, in addition to any other psychological support, like therapy or counselling, that you may need.
2. Model Guidelines under Section 39 of The Protection of Children from Sexual Offences Act, 2012 | Guide to mandatory reporting
3. Guidelines for medico-legal care for victims of sexual violence. World Health Organization Geneva, ISBN 924154628 X
4. Indian Penal Code 1860
5. Manual for Medical Examination of Sexual Assault