This story was originally published on March 19, 2015.
Graphic discussion of sexual assault evidence-collection process ahead. Sexual assault is one of the least-reported crimes; RAINN estimates that 68% of sexual assaults go unreported. There are many reasons — including fear and misunderstanding of the reporting process — why a survivor might choose to keep quiet about an assault. Christine Amendola, MS, a New York City-based physician assistant and Sexual Assault Forensic Examiner (SAFE), is working to change that. Amendola spoke with us to demystify the lynchpin of the reporting process: the rape kit, or "Sexual Offense Evidence Collection" (SOEC) kit. "Sometimes, I find that patients are really scared about what’s in that box," she shares. "When I start explaining the process to them, everything gets a little easier for them to understand. They're not as intimidated when they realize it's a bunch of envelopes. There’s some swabs, there’s some slides, and that’s really it." Amendola has worked as a SAFE for 11 years. Even though Amendola's team cares for one assault case per day on average — and "that’s just in three hospitals and just in the Bronx," she adds — she knows they see only a fraction of the borough's sexual assault survivors. "It’s definitely underreported and under-recognized," she tells us. "But, we are here, and the process is patient-driven. We give them all the support and follow-up they need."
Graphic discussion of sexual assault evidence-collection process ahead. Sexual assault is one of the least-reported crimes; RAINN estimates that 68% of sexual assaults go unreported. There are many reasons — including fear and misunderstanding of the reporting process — why a survivor might choose to keep quiet about an assault. Christine Amendola, MS, a New York City-based physician assistant and Sexual Assault Forensic Examiner (SAFE), is working to change that. Amendola spoke with us to demystify the lynchpin of the reporting process: the rape kit, or "Sexual Offense Evidence Collection" (SOEC) kit. "Sometimes, I find that patients are really scared about what’s in that box," she shares. "When I start explaining the process to them, everything gets a little easier for them to understand. They're not as intimidated when they realize it's a bunch of envelopes. There’s some swabs, there’s some slides, and that’s really it." Amendola has worked as a SAFE for 11 years. Even though Amendola's team cares for one assault case per day on average — and "that’s just in three hospitals and just in the Bronx," she adds — she knows they see only a fraction of the borough's sexual assault survivors. "It’s definitely underreported and under-recognized," she tells us. "But, we are here, and the process is patient-driven. We give them all the support and follow-up they need."
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Perhaps the most destructive misconception about the evidence-collection process, Amendola says, is that agreeing to this process is the same as agreeing to press charges. Evidence collection is just evidence collection, and patients can elect to use that evidence or not. "No one is going to make the choices for them," Amendola stresses. "Their choice was taken away when [their assault] happened, but now, they're in charge." Patients are in no way obligated to go through every step of evidence collection: They can do one step, or all 15. "Whatever DNA is on them right now, it’s going to get washed away or deteriorate," Amendola says. "So, if [they] do this part of the exam now, and [they] don’t want to make a report or deal with police, that’s totally fine... What we can’t do is go back and get the evidence [later on]." The exam can only be performed up to four days after assault, and is immeasurably more effective if performed directly after.
And, the support that survivors receive extends beyond what many imagine: Most facilities that offer sexual-assault forensic exams also give survivors clothing (so they aren't going home in hospital gowns) and provide social workers or other advocates who accompany survivors during the exam. Finally, "We give them almost all the medication that they need, right there in the hospital," Amendola explains, "to prevent infection and...because the HIV prophylaxis is for a whole month, we give them the first week, so they don’t have to go to CVS right after." With these basics established, read on for Amendola's breakdown of the steps of an SOEC kit.
Step 1: Oral Swabs
"[We] take those two swabs and...just go around the mouth, around the gums, in between the cheeks, under the tongue...in case there is some evidence there. We’ll swab it on the slide; then, we let it dry and...put it in the box.”
Step 1: Oral Swabs
"[We] take those two swabs and...just go around the mouth, around the gums, in between the cheeks, under the tongue...in case there is some evidence there. We’ll swab it on the slide; then, we let it dry and...put it in the box.”
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Steps 2-7: Buccal Specimen, Trace Evidence, Clothing, Underwear, Debris Collection, Dried Secretions, & Bite Marks
"[The buccal specimen is collected by what] almost looks like a little brush... We’ll swab on the inside of the cheeks; that takes the victim’s DNA... So [the examiner] can prove that [the perpetrator's] DNA doesn’t match the victim’s DNA. "Step three is for trace evidence. What we do is we have the patient undress over a towel, one of those little, white sheets [of paper], and once they undress, maybe some evidence will fall off of them — a piece of grass from a park, some dirt...just so that no piece of evidence is lost...we wrap up that piece of paper, and we stick it into the envelope, and that’s put into the kit... We try to treat the whole body as a crime scene; we make sure to collect everything. "Step four is we take their clothing, if possible... If they have their pants and they think maybe somebody ejaculated on their pants, or there’s something they don’t recognize on their shirt, we’ll take that and it’ll go in a separate, brown-paper bag and [we] give it to the police as well. Sometimes, patients come a couple days later, and they’re not wearing the clothes...they can bring [them in] at another time as long as they package [the items] in paper, because plastic and moisture really cause the DNA to get destroyed. "We don’t strip them naked... I’ll let them wear two gowns, I’ll undress their backs. I try to keep it as modest and un-intimidating as possible. Step five is when we take the underwear and put it into the kit. "Step six is if we do see anything on them when we are examining them, like sand in between their toes, or something else, that kind of puts the puzzle together. We’ll take that. If we find something sticking in their hair, we’ll take that. "Step seven...that’s the dried-secretion and bite-mark swab [pictured]. What we’ll do is have a patient stand there, partially undressed, and we’ll look at them with a black light — a UV light — and sometimes, if there’s a substance on them, particularly semen, it’s fluorescent under the light. We’ll take one of the swabs, wet, and swab the secretion off of them and put it into the evidence collection. And, if there's a bite mark on them, we may be able to pick up the perpetrator’s saliva by taking that swab as well.”
"[The buccal specimen is collected by what] almost looks like a little brush... We’ll swab on the inside of the cheeks; that takes the victim’s DNA... So [the examiner] can prove that [the perpetrator's] DNA doesn’t match the victim’s DNA. "Step three is for trace evidence. What we do is we have the patient undress over a towel, one of those little, white sheets [of paper], and once they undress, maybe some evidence will fall off of them — a piece of grass from a park, some dirt...just so that no piece of evidence is lost...we wrap up that piece of paper, and we stick it into the envelope, and that’s put into the kit... We try to treat the whole body as a crime scene; we make sure to collect everything. "Step four is we take their clothing, if possible... If they have their pants and they think maybe somebody ejaculated on their pants, or there’s something they don’t recognize on their shirt, we’ll take that and it’ll go in a separate, brown-paper bag and [we] give it to the police as well. Sometimes, patients come a couple days later, and they’re not wearing the clothes...they can bring [them in] at another time as long as they package [the items] in paper, because plastic and moisture really cause the DNA to get destroyed. "We don’t strip them naked... I’ll let them wear two gowns, I’ll undress their backs. I try to keep it as modest and un-intimidating as possible. Step five is when we take the underwear and put it into the kit. "Step six is if we do see anything on them when we are examining them, like sand in between their toes, or something else, that kind of puts the puzzle together. We’ll take that. If we find something sticking in their hair, we’ll take that. "Step seven...that’s the dried-secretion and bite-mark swab [pictured]. What we’ll do is have a patient stand there, partially undressed, and we’ll look at them with a black light — a UV light — and sometimes, if there’s a substance on them, particularly semen, it’s fluorescent under the light. We’ll take one of the swabs, wet, and swab the secretion off of them and put it into the evidence collection. And, if there's a bite mark on them, we may be able to pick up the perpetrator’s saliva by taking that swab as well.”
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Steps 8-12: Fingernail Scrapings, Pulled Head Hairs, Pubic-Hair Combings, Pulled Pubic Hair, Perianal & Anal Swabs
"[We] kind of scrape under the patient's nails, to see if we can get any DNA they may have gotten during the struggle. I tell patients it’s almost like getting a manicure. I’m not doing anything to hurt you. I try to make it a little less intimidating, if at all possible... Each hand gets scraped over a piece of paper. We keep the stick and the paper and wrap it up and put it into the collection. "[For] steps nine and 11, we used to pull head hair and pubic hair — we don’t [anymore]. Pulling hair from a patient is painful, and they’ve already been through so much... Step 10 is the combing. Usually, when you comb the pubic hair, a couple of them fall out anyway... We’ll let [the patient] comb it; we won’t do it for them... Sometimes, we’ll find other hair that doesn't belong there. "We only do the anal swabs if there has been anal contact. But, the perianal, sometimes we’ll do [that one] just because of gravity. Fluids can seep down and we may be able to collect something... We can do these swabs pretty quickly, one right after the other.”
"[We] kind of scrape under the patient's nails, to see if we can get any DNA they may have gotten during the struggle. I tell patients it’s almost like getting a manicure. I’m not doing anything to hurt you. I try to make it a little less intimidating, if at all possible... Each hand gets scraped over a piece of paper. We keep the stick and the paper and wrap it up and put it into the collection. "[For] steps nine and 11, we used to pull head hair and pubic hair — we don’t [anymore]. Pulling hair from a patient is painful, and they’ve already been through so much... Step 10 is the combing. Usually, when you comb the pubic hair, a couple of them fall out anyway... We’ll let [the patient] comb it; we won’t do it for them... Sometimes, we’ll find other hair that doesn't belong there. "We only do the anal swabs if there has been anal contact. But, the perianal, sometimes we’ll do [that one] just because of gravity. Fluids can seep down and we may be able to collect something... We can do these swabs pretty quickly, one right after the other.”
Step 13-15: Vulvar/Penile Swabs, Vaginal Swabs, Cervical Swabs
"The vaginal swabs are steps 13, 14 and 15; 13 is the outside, 14 is the inside, and 15 is the deeper one, the cervix, which is the entrance to the uterus. We can actually do 13 and 14 without a speculum...we [insert] a Q-tip inside [instead]. This is less painful than in a [regular pelvic] exam; in an exam, it’s a little more of a scraping, and this is just a swab. For 14, I usually [use a speculum], just because I can get along the walls of the vagina; for 15, you absolutely need it, so you can do the cervix. "For a male...we’ll just swab around the penis, around the testicles... They used to do the gonorrhea and chlamydia samples by putting the Q-tip inside the penis. Now, they are able to collect [STI information] through the urine. We don't even do testing during the rape exam; we just treat and [provide] prophylaxis."
"The vaginal swabs are steps 13, 14 and 15; 13 is the outside, 14 is the inside, and 15 is the deeper one, the cervix, which is the entrance to the uterus. We can actually do 13 and 14 without a speculum...we [insert] a Q-tip inside [instead]. This is less painful than in a [regular pelvic] exam; in an exam, it’s a little more of a scraping, and this is just a swab. For 14, I usually [use a speculum], just because I can get along the walls of the vagina; for 15, you absolutely need it, so you can do the cervix. "For a male...we’ll just swab around the penis, around the testicles... They used to do the gonorrhea and chlamydia samples by putting the Q-tip inside the penis. Now, they are able to collect [STI information] through the urine. We don't even do testing during the rape exam; we just treat and [provide] prophylaxis."
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Contents Of The Drug-Facilitated Sexual Assault (DFSA) Kit
"We only do the drug-facilitated [kit]…when we think a patient may have been drugged prior to the assault. If they are incapacitated, if they have zero recollection of the events that happened, if they wake up someplace different and never remember getting there, if they are vomiting, urinating on themselves, more drunk than they would be…we’ll take two tubes of blood, and possibly their first urine sample, and send that off to the lab to get processed. They’ll test for a lot of drugs that could have been used during the assault. "If [the survivor] happens to have been drinking or doing drugs on their own, as long as they are honest about it and it’s documented, they will never be prosecuted for that. That’ll never be held against them... They really just need to be honest about it... If they were doing something they weren’t 'supposed' to, that’s okay; they still shouldn’t have been raped... It’s always a crime. "A sexual assault in and of itself could be vaginal, oral, anal intercourse — it doesn’t even have to be with a body part. Those are all considered sexual assaults. Some people think, Okay, it wasn’t vaginal rape, so it wasn’t rape. It was; this is still something you need to be treated for.
"We only do the drug-facilitated [kit]…when we think a patient may have been drugged prior to the assault. If they are incapacitated, if they have zero recollection of the events that happened, if they wake up someplace different and never remember getting there, if they are vomiting, urinating on themselves, more drunk than they would be…we’ll take two tubes of blood, and possibly their first urine sample, and send that off to the lab to get processed. They’ll test for a lot of drugs that could have been used during the assault. "If [the survivor] happens to have been drinking or doing drugs on their own, as long as they are honest about it and it’s documented, they will never be prosecuted for that. That’ll never be held against them... They really just need to be honest about it... If they were doing something they weren’t 'supposed' to, that’s okay; they still shouldn’t have been raped... It’s always a crime. "A sexual assault in and of itself could be vaginal, oral, anal intercourse — it doesn’t even have to be with a body part. Those are all considered sexual assaults. Some people think, Okay, it wasn’t vaginal rape, so it wasn’t rape. It was; this is still something you need to be treated for.
"The red and the white stickers go with the drug-facilitated kit, which is a different kit [than the general SOEC kit]. The yellow sticker goes with the SOEC kit... Once we tape it closed, the examiner who...takes the evidence signs across it, so that it ensures no one’s tampered with the evidence.
"Usually, we say [the process] is about two hours, because we’re taking verbal history [and] doing the exam. We’re also taking pictures, if they’ll allow us — [that requires] a separate consent."
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