Rationale:

• Patients who have been sexually assaulted may not possess the capacity to consent because of developmental disability, young age, or intoxication with drugs or alcohol.
• Most often sexual assault patients who lack consenting capacity due to developmental disability will have previous sufficient documentation of the condition.
• In the rare instance when an examiner suspects previously undocumented developmental disability, formal examination of the patient's mental status can be planned for a later date.

Evidence:

• One comparative study of 120 conveniently selected subjects (50% were adults with learning disabilities) showed that those with learning disabilities know much less about sex and understand much less about sexual abuse than nondisabled young people aged 16 years (18).
• A pre-exam informational video about the exam process and potential psychological sequela may attentuate subsequent development of depression and PTSD in some victims, as shown by a recent randomized controlled trial of 140 female sexual assault victims (19).

Comments:

• In rare cases, law enforcement may provide a court order to proceed with forensic evidence collection when a victim cannot give consent due to altered mental status from a severe head injury or other critical condition in order to preserve potential evidence.