I’ve Treated Sexual Assault Survivors. Being Heard Is Not Enough.

Content warning: discussion of sexual assault. If you are in crisis, text or call 988.

“Perhaps most important, we need to keep saying to anyone out there who has ever been assaulted: you are not alone. We have your back. I’ve got your back.” — President Barack Obama, January 24, 2014

I took care of a 24-year-old last week who was unable to tolerate a vaginal exam. She could not even bear a conversation about it. I have countless patients who prefer online platforms for sexually transmitted infection screening because they do not have to answer painful questions in person. The way in which our healthcare system asks about lifetime partners and types of intercourse defaults to assuming sex is consensual in a manner that does not serve many of our patients. And the institutions we trained at and often revere are complicit in the silencing of sexual assault survivors.

The alleged gang rape of “Jane Doe” in the Cornell 7 case reminds us not only of the immediate complexities survivors face in navigating the healthcare system after an assault, but also, of the long-term physical and mental health effects, and the compounding effect of institutional silencing. I wish I had more optimism about the potential change the attention on Cornell may bring, but this arc is long, and perhaps even flat.

Access to Healthcare

Sexual assault survivors can face barriers to healthcare access. Depending on where the survivor lives, the closest sexual assault forensic exam (SAFE) location may be hours away. And, while the majority of assault survivors choose not to involve law enforcement, receiving care from a qualified sexual assault examiner influences whether the results can be used in a criminal case. It also impacts access to wraparound services, including mental health services, and the diagnosis, treatment, and prophylaxis of related medical conditions.

Even when access is available, it does not guarantee high-quality care. According to her attorney, Jane Doe went to Cornell Health 2 days after her assault in October 2024 and disclosed that she contracted a urinary tract infection “in a traumatic way.” Yet, she said her doctor “didn’t really follow up on that.“

In addition to referrals and warm handoffs for counseling, support, and resources, there is a clear medical checklist that should always be followed: A SAFE for documentation, screening and empiric treatment for sexually transmitted infections, assessment of hepatitis B and C status, and HIV post-exposure prophylaxis. Yet, countless survivors do not receive this comprehensive care.

Physical and Mental Health Outcomes after Sexual Assault

There are decades of research on the health consequences of sexual assault. In addition to physical injuries, infections, and undesired pregnancies, the odds of experiencing neurologic, pulmonary, gastrointestinal, and cardiovascular disease are higher, as are rates of chronic pain. Routine gynecologic care after assault can re-traumatize survivors, as can pregnancy and childbirth. Some studies suggest that rates of cervical cancer screening declination are higher among patients with a history of sexual trauma.

Post-traumatic stress disorder (PTSD) is common. And Rape Trauma Syndrome, which has multiple stages, includes an acute stage presenting as dulled memory function, disorganized thoughts, and confusion about daily life. Understanding how these symptoms manifest in the first hours to days after a sexual assault, combined with recognizing the complex effects of trauma on memory, could contribute to a trauma-informed approach to survivors who piece a timeline together over days to months after an event. Instead, as we have seen with the Cornell 7 case, narratives around reliability and believability often emerge, influence public beliefs, and create doubt.

Institutional Silencing

Institutional betrayal refers to “the role of institutions in traumatic experiences and psychological distress following these experiences.” This concept, built on the framework of betrayal trauma theory, describes situations whereby a person experiences harm at the hands of the entity on which they also depend. Jennifer Freyd, PhD, a professor of psychology at the University of Oregon and an expert on this topic, notes that institutional betrayal exacerbates trauma symptoms, including anxiety and dissociation, and is linked to higher rates of PTSD and higher scores on physical distress scales.

The concept of institutional courage as a counterpoint to institutional betrayal is appearing in the literature, but it is still more concept than reality. Unfortunately, our institutions continue to be impervious to permanent and long term financial or reputational consequences that would meaningfully change their approach to sexual assault.

Meanwhile, the current administration is making things worse. In early 2014, President Obama established the White House Task Force to Protect Students from Sexual Assault and launched NotAlone.gov. But in 2020, President Trump rescinded some of the Obama-era sexual assault protections, and as recently as last week, the administration rolled out more Title IX changes that diminish sexual harassment investigation requirements. Despite the fact that 13% of undergraduate students experience rape or sexual assault after enrolling in college (26% of undergrad women and 7% of undergrad men), the federal government is failing to incentivize or support schools in protecting survivors.

Bearing Witness

Many of us see patients startle, recoil, gasp, or shudder when we move unexpectedly in their presence. For those who eventually share their story with us, being heard and believed is powerful, though not enough.

What would real institutional accountability look like? The Cornell 7 case highlights the need for systems that are well funded and independent enough to truly protect and advocate for survivors. University administrators — including presidents, provosts, and boards — must face significant enough consequences for institutional failures of this degree to create meaningful change. They would need to have at least as much courage as Jane Doe has shown.

Love should not hurt. Everyone deserves relationships free from abuse. The National Domestic Violence Hotline is available 24/7 at 1-800-799-SAFE (7233). If you or someone you love are in immediate danger, please call 911. If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”