The Use of Medical Lubricant in Forensic Sexual Assault Exams: A Review of Clinical Best Practice
Following the allegation of rape or sexual assault, it is common practice to have a rape-kit collected to aid in the prosecution of the perpetrator. Over the last few decades, accepted best practice has changed quite a bit. And, to help providers keep up with the changes, in today’s post, we will take the time to discuss the role of sterile lubricants in the process. It is important to note that this post is to discuss the effects of using medical lubricants during the process and should in no way be interpreted as a standard operating procedure for performing a forensic exam — please refer to your local policy and protocols.
What is a Forensic Medical Exam?
Before diving into the role of lubricants in evidence collection, let’s briefly discuss what a rape kit is. A sexual assault forensic examination (SAFE), or more commonly known as a “rape kit,” is an exam that is completed by trained forensic medical personnel following the complaint of a sexual assault. Historically, these exams were conducted by law enforcement officers for the sole purpose of evidence collection. Now, the common practice is an exam by a sexual assault provider in the medical setting. These trained professionals including sexual assault nurse examiners (SANE) or a medical provider who is trained in sexual assault forensics. The medical community has taken the reins on performing SAFE for a number of reasons including:
- Humanizing the patient and offering support and crisis intervention
- A full exam and medical assessment
- Coordination of the treatment of injuries or infections
- Coordination of care for pregnancy, sexually-transmitted disease, and mental health
A forensic exam is a hybrid between a regular medical exam and evidence collection. Care of the patient is the primary focus while evidence collection and maintain a chain of custody is almost as important.
The Role of Medical Lubricant in the Forensic Exam
Historically, lubricants have been avoided to prevent contamination of evidence. However, research has concluded that it may not be as damaging as once thought. Prior to any invasive exam, a thorough external exam will be completed in accordance with the National Protocol for Sexual Assault Medical Forensic Examinations. During this phase of the exam, swabs will be taken of orifices and submitted for testing to look for DNA, body fluids, lubricants, and presence of foreign substances including spermicides (common on condoms). Prior to and during the swabbing, it is important that the areas are not cleaned, nothing is applied, and the medical provider collecting the evidence is wearing non-powdered examination gloves.
Once these swabs are taken, the use of sterile water or sterile water-based medical lubricant is indicated for proctoscopes, specula, or gloved digits prior to the exam to prevent further trauma. The 2011 edition of the Clinical Forensic Medicine: A Physician’s Guide states “lubricant from a single-use sachet or tube or sterile water can be used to lubricate the speculum. (Rogers & McBride, 2011, p. 118)” If medical lubricant is used at any point in the exam, it should be thoroughly documented and reported to the forensic lab. The use of medical lubricant during invasive exams helps to put patients at ease, decreases discomfort and additional trauma, and can allow providers to get a better look at internal structures.
Why Surgilube® Surgical Lubricant?
In one study, more than 5,500 vaginal samples were tested. With the use of water-based gel lubricants, the cytology error rates caused by the use of lubricant was 1.1% as opposed to the 1.5% of samples with the same erroneous using sterile water as a lubricant. The difference in the results is not statistically significant enough to draw conclusions or make the claim that the use of sterile water-based lubricants will compromise a forensic sample. Surgilube has been the go-to medical lubricant for gynecologists for more than 80 years and comes with the mark of quality assurance. Surgilube is water-based, bacteriostatic, and sterile. It does not alter DNA or have an effect on sperm or other cells. Our lubricant is available in sterile single-use packets, making them as effective in a forensic exam as they are in the operating room. To make your sexual assault patients more comfortable, trust the lubricant that obstetricians trust most, Surgilube.