Written by: Emily MacLeod (she/her) MN, PhD(c), RN
Edited by: Nadra Musse (she/her)
Sexual violence is a form of gender-based violence, a violation of fundamental human rights, and an ongoing public health crisis in Canada (1,2). Yet, individuals who have experienced sexual violence continue to face systemic barriers when seeking care. Emergency rooms often lack the necessary trauma-informed resources and environments, law enforcement processes can be intimidating, and the legal system remains fraught with delays. For many people, the experience of reporting an assault or seeking medical attention can be equally as traumatizing or retraumatizing as the assault itself (3).
Enter Sexual Assault Nurse Examiners [SANEs]—specialized forensic nurses who provide trauma-sensitive medical care and forensic examinations for individuals who have experienced sexual violence. SANEs are trained to collect evidence, offer emotional support, and guide individuals through medical and legal pathways. Despite this, the role of SANEs remains largely invisible in mainstream healthcare discussions and education. Individuals who experience sexual violence deserve better, and
it is time to dismantle the barriers that limit their access to comprehensive, compassionate, safe, and effective care.
What do SANEs do?
I would argue that SANEs are more than just nurses.
We are advocates, investigators, educators, and witnesses
to some of the most distressing experiences a person can endure. When an individual who has experienced sexual violence presents at a hospital or clinic, a SANE may be the first point of contact and is responsible for conducting thorough medical assessments to address immediate physical health concerns. This includes treating injuries, preventing sexually transmitted infections [STIs] and unintended pregnancy, and providing emotional support that leads with belief, validates their experience, normalizes their response, and acknowledges the profound impact of trauma.
Beyond medical care, SANEs significantly contribute to the forensic process by collecting evidence with meticulous precision. We document injuries, obtain forensic swabs, and ensure the integrity of the chain of custody for potential legal proceedings. The stakes are high; the way evidence is gathered and events are documented can largely impact whether or not a case proceeds to trial. However, SANEs do not simply act as an extension of the criminal justice system.
Our work is fundamentally client-centred and trauma-informed,
meaning every decision is made with the individual’s consent, ensuring they retain autonomy over their body during a time when that choice has been violently taken away.
SANEs also educate individuals about their rights and the medical and legal options available to them. Some individuals may choose to report to the authorities immediately, while others may opt for delayed reporting or decide against reporting altogether. Regardless of the choice, we provide guidance without judgment. The goal is not solely to collect evidence, but to
facilitate and empower individuals to reclaim control of their healing journey.
A Systemic Failure to Meet Demand
Despite the essential role of SANEs, access to our services remains highly inconsistent throughout Canada (4). Many hospitals and healthcare facilities lack trained nurses, leaving individuals who have experienced sexual violence to seek care in emergency rooms or clinics staffed by professionals who may not have the competency or trauma-informed approach required to meet their unique needs. In rural or remote communities, individuals are often forced to travel long distances to receive an exam or, worse, forego forensic medical attention entirely (5). The lack of accessibility disproportionately impacts marginalized groups, including Indigenous Peoples and gender-diverse individuals, who already experience higher rates of sexual violence (6,7). Individuals who have experienced sexual violence often leave healthcare settings feeling dismissed or retraumatized, reinforcing distrust in the system meant to care for them.
Funding constraints and the undervaluing of forensic nursing further contribute to these disparities. Many SANE programs operate on fragile funding models, relying on grants or community-based partnerships and organizations that are highly vulnerable to political climates and financial fluctuations (8). This lack of investment reflects a much broader problem within the healthcare system: sexual violence remains a low-priority issue, regardless of the devastating, widespread, and long-lasting consequences (9). Individuals who have experienced sexual violence
are left with inadequate resources, while healthcare providers are expected to fill gaps they have neither the training nor institutional support to address.
What Needs to Change?
- All healthcare providers, no matter their specialty, must recognize their role in responding to sexual violence. The lack of awareness about forensic nursing and SANEs limits the ability of physicians, nurses, and other medical professionals to provide appropriate referrals and support.
- Integrating forensic medical training and educational content about sexual violence and the role of SANEs into nursing and medical education is one solution. Medical and nursing schools should include forensic medical care as a core learning objective, ensuring all future healthcare providers understand the basics of trauma-informed care and evidence collection.
- Provincial governments, health institutions, and authorities must prioritize funding for SANE programs by recognizing them as essential services rather than optional add-ons.
It is clear that a shift is needed—not just in policy but in mindset.
The healthcare system cannot continue to treat sexual violence as an isolated issue, addressed only in moments of crisis, but instead needs to acknowledge the prevalence of sexual violence in our society and its significant impact on individuals’ health and well-being.
Sexual violence remains one of the most underreported crimes in Canada, in part because individuals fear not being believed or receiving inadequate care (10). SANEs are essential to the solution, but their impact is limited by system-level barriers preventing widespread access to their services. It’s time to change that. More funding, better integration into healthcare systems, intentional learning opportunities related to trauma-informed care and the forensic medical process incorporated into health discipline curricula, and more awareness of the role of SANEs can ensure that every individual, no matter where they live, has access to compassionate, competent, and survivor-centered care.
References:
1. World Health Organization. Violence against women prevalence estimates, 2018: Global, regional and national prevalence estimates for intimate partner violence against women and regional prevalence estimates for non-partner sexual violence against women [Internet]. Geneva: WHO; 2021 [cited 2025 Mar 12]. Available from: https://www.who.int/publications/i/item/9789240022256
2. Cotter A, Savage L. Gender-based violence and unwanted sexual behaviour in Canada, 2018: Initial findings from the survey of safety in public and private spaces [Internet]. Ottawa: Statistics Canada; 2019 [cited 2025 Mar 12]. Available from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00017-eng.pdf
3. Reeves E. A synthesis of the literature on trauma-informed care. Issues in Mental Health Nursing. 2015;36(9):698-709. doi:10.3109/01612840.205.1025319
4. Aziz S. ‘Serious gaps’: Forensic nurse shortage impacting sexual assault victims, advocates say. Global News [Internet]. 2023 Feb 4 [cited 2025 Mar 12]. Available from: https://globalnews.ca/news/9457517/sexual-assault-victims-nurse-shortage-canada/
5. Kemp C. New sexual assault strategy will provide much needed services in northern, rural Manitoba, advocates say. CBC News [Internet]. 2024 Apr 28 [cited 2025 Mar 12]. Available from: https://www.cbc.ca/news/canada/manitoba/sexual-assault-provincial-strategy-1.7187329
6. Heidinger L. Violent victimization and perceptions of safety: Experiences of First Nations, Métis and Inuit women in Canada [Internet]. Ottawa: Statistics Canada; 2022 [cited 2025 Mar 12]. Available from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2022001/article/00004-eng.htm
7. Jaffray B. Experiences of violent victimization and unwanted sexual behaviours among gay, lesbian, bisexual and other sexual minority people, and the transgender population, in Canada, 2018 [Internet]. Ottawa: Statistics Canada; 2020 [cited 2025 Mar 12]. Available from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2020001/article/00009-eng.htm
8. Chang A. Program helping sexual assault survivors in rural Manitoba under threat as feds nix funding. CBC News [Internet]. 2024 Apr 12 [cited 2025 Mar 12]. Available from: https://www.cbc.ca/news/canada/manitoba/sexual-assault-program-rural-manitoba-federal-funded-discontinued-1.7171261
9. Haskell L, Randall M. Impact of trauma on adult sexual assault victims: What the criminal justice system needs to know [Internet]. Ottawa: Department of Justice
10. Cotter A. Criminal victimization in Canada, 2019 [Internet]. Ottawa: Statistics Canada; 2021 [cited 2025 Mar 12]. Available from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2021001/article/00014-eng.htm
