Sexual Assault

Working with people who have experienced sexual assault is a unique opportunity to provide care and support, no matter a patient’s gender or history, and there are specific barriers that trans people face that are important for clinicians to understand.

Sexual assault affects the lives of many trans people, and yet we know that less than half of trans people sampled ever tell anyone or seek support following a sexual assault (Callander et al., 2018). Making sure your service is affirming will help make sure trans patients feel safe, supported and respected, and more likely to return.

Australian research has found that over 50% of trans respondents said they had been sexually assaulted at least once, compared to around 14% of the general population (Callander et al., 2018). This reflects similar findings in international research (Callander et al., 2018). Research by Ussher and colleagues at the Australia’s National Research Organisation for Women’s Safety (ANROWS, 2020) found that trans women of colour, living in Australia, were more likely than cis women to report having been sexually assaulted by a stranger.

This report also found that trans women of colour were subject to regular verbal violence and assault across both public and private life. This suggests that there are few places trans women of colour are safe from violence (ANROWS, 2020). Applying an intersectional lens, it becomes clear that trans women of colour are considerably more likely to have trouble accessing health and support services due to barriers related to their trans experience, gender and cultural background.

There are many reasons why trans people of all genders might experience higher rates of sexual violence, and our clinicians play an important role in protecting trans people by providing trans-affirming mental health support, access to gender affirming healthcare, and links to support services.

A trans person who has been sexually assaulted has several options when seeking healthcare and support. It can be helpful for a trans person to know they can bring a support person with them.

In NSW, options that are available include a specialist Sexual Assault Service, a trusted GP or health professional, or the Emergency Department at a hospital. If patients want a forensic medical exam, this has to take place in a SAS.

Sexual Assault Services

Sexual Assault Services (SAS) can provide specialist care that is both knowledgeable about the specifics of sexual assault aftercare and affirming to trans patients, with a number of NSW sexual assault services having undergone trans awareness training.

SASs are staffed by counsellors, who provide support throughout and after an appointment with the patient, and trained nurses and doctors who are able to offer health check ups or medical forensic examinations to gather evidence of a sexual assault.

SASs not only provide care to people who visit their services, but can be contacted before attending to discuss options, receive support, make an appointment, or be met in the Emergency Department if the assault happened recently. It can be good to suggest a patient calls their local SAS, even if they’re unsure about attending or aren’t sure if what occurred was sexual assault. You are able to help the patient make a call and stay with them while they speak to the SAS over the phone.

The following practice points will strengthen your practice with all trans patients accessing your service, including those who have experienced sexual assault. 

Environment

Your clinical environment will be the first thing your patient interacts with, so it’s essential that it is welcoming.  

Making your space actively trans affirming doesn’t have to be complex or expensive. Little things like posters, brochures, stickers, flags, and affirming intake forms can make a big difference to practice. See our page about Creating Welcoming Environments for more information.

Self-determination

Supporting your patient to self-determine how they access support after a sexual assault means providing them with the information they need, and empowering them to make the decisions that are best for them. 

Sometimes this means helping them to make the decisions that work best for them by taking extra time to talk them through their options and respecting their autonomy when it comes to decision making.

Affirmation-first care

If working with trans patients is new, it can sometimes be difficult to train yourself out of habits, such as referring to body parts with certain language, or assuming the genders of patients, partners or perpetrators. Taking a moment to check these, and note them down, practise can make a big difference.

Taking small steps to be affirming in your entire practice often means the difference between someone feeling safe or unsafe in a service.

Knowing your patient’s rights

After experiencing sexual assault, a patient may be traumatised, disoriented, distracted, or have a range of other feelings and emotions. Even in cases where your patient seems okay, they may not have a good understanding of what their rights are in the situation. Being able to inform a patient of where they can choose to go from here can help take that load off their shoulders.

Your patient has a right to:

• Make decisions about what services they want to attend, and what they want to happen there

• Not consent or withdraw consent to any procedures or testing after a sexual assault

Visit our Rights & Justice page for more information about understanding your patient’s rights

When to work with the Police

When it comes to working with the Police, trans people who have experienced sexual violence may have very different needs and preferences.

Trans communities can have a complex history and relationship with Police. Trans people, particularly Sistergirls, Brotherboys, and trans People of Colour, might distrust both police and police processes. There may be many different reasons a trans person is hesitant or uninterested in engaging with police even after being the victim of a crime, and respecting these feelings and decisions is important.

When working with trans people who have experienced sexual assault, it can be helpful to outline exactly what going to the police could mean, what their rights are, and what support is available for them.

This can include, but is not limited to:

• No one over 16 is required to report their sexual assault unless they want to, including if they access healthcare after their assault such as attending a SAS, or if they undergo a medical forensic exam

• Counsellors are available through the local SAS who can support them through going to the police

• Making sure your patient knows that they don’t need to make a decision immediately, and that once they have had an exam, a SAS can keep forensic testing for 3 months, or even longer at the patient’s request.

For more information about how trans people can work with the police after a sexual assault, visit reporting sexual assault to police.