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Melanie Cole (Host): Thanks for tuning in to Back To Health, the podcast that brings you up to the minute information on the latest trends and breakthroughs in health, wellness, and medical care.

Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And on this Women's Health Wednesday, we're discussing Sexual Assault Awareness Month and the Sexual Assault Forensic Examiner Program at Weill Cornell Medicine. Joining me is Dr. Rama Rao. She's the Chief in the Division of Medical Toxicology in the Department of Emergency Medicine at New York Presbyterian Hospital, Weill Cornell Medical Center. She's an Associate Professor of Clinical Emergency Medicine at Weill Cornell Medical College Cornell University. And she's the Medical Director of the Safe Sexual Assault Forensic Examiner Program at Weill Cornell Medicine. Dr. Rao, it's a pleasure to have you join us today and what a great topic. It's so important to discuss this and certainly with an expert such as yourself. First of all, can we discuss what is sexual assault? What constitutes sexual assault?

Dr Rama Rao: Well, good morning and thank you for having me today. Sexual assault is an act that is really about power and control. It refers to a behavior or contact without consent of the victim, that could be fondling or unwanted sexual touching, penetration of a victim's body, forcing someone to perform sexual acts such as oral sex or forced kissing or other degrading or humiliating nonconsensual sexual acts.

And when we think about our bodies, we really have a lot of agency about who touches us under what context and what parts of our body they can have access to. That's a very private thing. And once that is taken out of the control of an individual, we use the term sexual assault.

Melanie Cole (Host): Thank you for that comprehensive definition. So why is the word survivor often used for victims of sexual assault?

Dr Rama Rao: The term survivor is used to really indicate that these are acts of violence, of power and control over another person's body. And as such, we use the term survivor in addition to or in lieu of the term victim to indicate the person that's experienced the assault.

Melanie Cole (Host): Well then, can you tell us what we know about survivors and perpetrators?

Dr Rama Rao: Yes. What's most important to recognize is that it is a very, very underreported crime for many reasons. And while it is described that one in three or one in four women will experience this in their lifetime and maybe a different ratio for men, men are generally left out of the conversation when it comes to being survivors and they really need to be invited into that discussion. Similarly, people that are non-binary or transgender also may underreport their experiences with sexual assault because they may perceive that the systems of care and the criminal justice system do not serve them the same way that it may for other people.

Melanie Cole (Host): I would certainly imagine that in the entire LGBTQ community, this is underreported as a result of just exactly what you just said. So if someone has been assaulted, what are their options? What are survivors of sexual assault entitled to in terms of medical care in New York state or really anywhere in terms of their dignity and their rights?

Dr Rama Rao: That is a wonderful question. And I'm so glad you asked that question. First of all, the laws in different states have really moved forward in helping survivors of sexual assault have certain rights. For example, in New York state, you are entitled by law to get care after a sexual assault, free of charge in an emergency department. And that is a very progressive and helpful thing to allow survivors to come forward.

Now, once they present to an emergency department, whether they're in New York state or anywhere, there are many options for care for them. The first is giving them support and making sure that they're medically okay. If what they experienced puts them at risk for sexually transmitted infections or, in the case of women of childbearing-age, pregnancy, there are medications in certain timeframes that can be offered to those survivors. Similarly, they can get a full examination and make sure that any other additional physical concerns they may have are properly addressed.

The next is that we can offer a forensic examination and there are certain sexual assault forensic examiner-designated hospitals in New York state and other states may have similar programs and there is a national sexual assault hotline number called RAINN, R-A-I-N-N, that people can call if they're either in crisis or want to get information perhaps for a friend or someone they care about. And that number is 1-800-656-4673 or they can go to rainn.org, R-A-I-N-N.

Now, let's say they go to the emergency department and they have their medical concerns addressed, the next thing that may be offered to them, depending on the time after the assault that they present, there is a timeframe in which evidence can be collected and that may vary from state to state what that timeframe is. But generally speaking, that falls within between five and seven days of the assault. There may be DNA evidence on a person's body, even if they've bathed or brush their teeth or changed their clothes that may be present. And a person can opt to have their narrative recorded and full forensic examination with evidence collection, which is done with a series of cotton swabs on their body. It's not painful, and they can determine what steps of the evidence they do and do not want to have performed. After that, that evidence, which is collected in something called a chain of custody, meaning how that evidence is handled and whether or not it's sealed and who it gets passed to and the conditions under which it's stored is all recorded.

And in New York state, we will hang on to that evidence for up to 20 years and different states have different durations that they'll hang on to that evidence. It can be much shorter than that on the period of months or about a month, depending on the state. And that gives the survivor time to determine whether or not they want to report to law enforcement. At which point, that evidence can be turned over to the criminal justice system for analysis,

Melanie Cole (Host): So they're not required to report this to the police if a person gets care in the emergency department?

Dr Rama Rao: That is correct. If they are an adult, they are not required. There are very rare exceptions to that, but by and large, you have the determination of what you want done when you arrive in the emergency department and when you get that evidence collected if you choose to, whether or not you choose to report.

Melanie Cole (Host): Well, can you tell us about the Sexual Assault Forensic Examiner Program, the SAFE Program, at Weill Cornell Medicine? Please tell us a little bit about this and really what you do, how you begin to assess this level of trauma. Tell us about the program.

Dr Rama Rao: Yes, we're very fortunate. We are a SAFE-designated center. The New York State Department of Health designates hospitals that meet certain requirements for care of survivors of sexual assault. They create a designation, a SAFE-designated center. So we're lucky to be one of those.

Now, there are many different terms that you may hear nationally for similar programs to ours. One may be the SANE program, Sexual Assault Nurse Examiner, or SART, Sexual Assault Response Team, or, in our case, sexual assault forensic examiners. And this is made up of a team of individuals who have undergone specialized training in the unique needs of survivors of sexual assault. They get trained not only in the impact of that assault and how to provide emotional support, but also in how to collect and handle the evidence and document a narrative and then work with the criminal justice system if they are asked to testify in a court of law, assuming the survivor reports this to law enforcement.

Melanie Cole (Host): What is the victim intervention program? What does that offer? And are there other programs like it in the city and around the country?

Dr Rama Rao: Yes. I'm very proud to work with a team of licensed social workers at the Victim Intervention Program at Weill Cornell New York Presbyterian. There are many similar programs across the city and across the country that work to supporting survivors of crime. And I use that term broadly because if you are a victim of any crime and you reach out to the Victim Intervention Program, you can be offered free confidential support and counseling services, legal advocacy, and support, or connected to people that can support you if you choose to move in the criminal justice system and you will really be very well informed of your rights. In New York state, there is a sexual assault survivors victim bill of rights, which you are entitled to learn about. And other states have similar laws.

And so programs like the Victim Intervention Program at New York Presbyterian Weill Cornell will provide that information to you. And also they are there to help secondary victims, meaning if you are a partner to someone who has been sexually assaulted, you may be experiencing some indirect trauma of your own and the victim intervention program can help those individuals also get through this very difficult time.

Melanie Cole (Host): Is there a hotline number? I mean, we hear about the suicide hotline numbers. You mentioned rainn.org, but is there a number that's available 24/7 if somebody needs that help right then and there to direct them because it's so traumatic and they don't know where to turn?

Dr Rama Rao: Yes. I think the rainn.org hotline, which is 1-800-656-HOPE or 1-800-656-4673 can offer 24/7 direct chat or counseling, and they can direct an individual to services local to their area. So if you're listening to this podcast and you're remote to New York and you have a question or a concern, or you've experienced this, you can call that hotline and they can give you some immediate support and then direct you to resources in your local area.

Melanie Cole (Host): That's 1-800-656-HOPE or 1-800-656-4673, rainn.org, R-A-I-N-N dot org. As we get ready to wrap up this unbelievable episode, that's been so informative, Dr. Rao, and I could hear how sweet and compassionate you are. And I imagine you are just so good at your job. Can you give some advice, a little bit of an overview for people that have been survivors of sexual abuse or people that love someone who is a survivor and what you really want them to take away from this podcast today?

Dr Rama Rao: Yeah, thank you for that. I think that the most important thing for survivors and people close to survivors to know is you're really not alone. There are many people that have experienced the same thing, and it's very difficult for people to be open about something that is often so very private. So there are resources for you and you can either approach those resources if you need them directly for yourself or someone you care about or, if you're interested in getting involved and becoming an advocate or a supporter of these organizations, there are many opportunities out there across the country to get engaged.

Melanie Cole (Host): Thank you so much, Dr. Rao, for joining us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and fast growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health. Please download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, please visit weillcornell.org and search podcasts. Parents, remember to check out our Kids Health Cast, too. I'm Melanie Cole

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