Recommendations for the Care and Support of Women Affected by Sexual Violence. Guideline of the DGGG (S1-Level, AWMF Registry No. 015/097, December 2025, Version 1.0)

Abstract

Objective This guideline aims to improve and standardize medical care, support, and evidence collection for female victims of sexual violence in Germany.

Method In accordance with the requirements for S1 guidelines, the contents were formally discussed and agreed upon in numerous online meetings by a representative interdisciplinary group of experts well versed in the guideline topic. The German Society for Gynecology and Obstetrics (DGGG) led the discussion.

Recommendations Empathy, experience, and expertise, as well as respect and objectivity on the part of the medical personnel involved, are crucial for the care of women after sexual violence. The guideline provides 130 recommendations for the care and examination of women affected by sexual violence, including requirements for examination, the collection of evidence and documentation of injuries, testing for sexually transmitted infections, post-exposure prophylaxis and infectious disease follow-up examinations, as well as aspects of psychological and psychosocial care and psychological aftercare.

Keywords

guideline - sexual violence - rape - sexual assault - medical care and treatment - evidence - forensic examination

I  Guideline Information

Guidelines program of the DGGG, OEGGG and SGGG

More information on the program is available at the end of the guideline.

Citation format

Recommendations for the Care and Support of Women Affected by Sexual Violence. Guideline of the DGGG (S1-Level, AWMF Registry No. 015/097, December 2025, Version 1.0). Geburtsh Frauenheilk 2026. DOI: 10.1055/a-2797-1610

Guideline documents

The complete long version in German and a list of the conflicts of interest of all the authors is available on the homepage of the AWMF: http://www.awmf.org/leitlinien/detail/ll/015-097.html

Guideline authors

See [Tables 1] and [2].

Table 1 Lead authors/coordinating guideline author and deputy coordinator.

Author	AWMF medical society
Prof. Dr. med. Matthias David	German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e. V., DGGG)
Nicole Balint	German Society for Psychosomatic Gynecology and Obstetrics (Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe, DGPFG)

Table 2 Contributing guideline authors.

Author, mandate holder	DGGG working group/AWMF/non-AWMF medical society/organization/association
Nicole Balint	German Society for Psychosomatic Gynecology and Obstetrics (DGPFG)
Prof. Dr. med. Matthias David	German Society for Gynecology and Obstetrics (DGGG)
Dr. med. Lina Fryszer	German Society for Psychosomatic Gynecology and Obstetrics (DGPFG)
Univ.-Prof. Dr. med. Tanja Germerott	German Society of Forensic Medicine (Deutsche Gesellschaft für Rechtsmedizin, DGRM)
Dr. med. Christine Hirchenhain	German Society for Gynecology and Obstetrics (DGGG)
Paulo Roberto Sokoll, MPH	German STI Society – Society for the Promotion of Sexual Health (Deutsche STI-Gesellschaft – Gesellschaft zur Förderung der Sexuellen Gesundheit, DSTIG)
Dr. med. Anne Tank	German Society of Forensic Medicine (DGRM)
Dr. med. Axel Valet	German Professional Association of Gynecologists (Berufsverband der Frauenärzte, BVF)
Angela Wagner	Federal Association of Womenʼs Advice Centers and Womenʼs Emergency Hotline (Bundesverband der Frauenberatungsstellen und Frauennotrufe e.V., bff)
Dr. med. Cleo Walz	German Society of Forensic Medicine (DGRM)
Dr. med. Nadine Wilke-Schalhorst	German Society of Forensic Medicine (DGRM)

The following medical societies/working groups/organizations/associations wanted to contribute to the guideline text and nominated representatives to attend the conferences ([Table 2]).

Abbreviations

AWMF: Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften)

CT: computed tomography

DNA: deoxyribonucleic acid

HbsAg vaccine: hepatitis B surface antigen vaccine

HbsAb titer: hepatitis B surface antibody titer

ENT: ear–nose–throat

HIV: human immunodeficiency virus

HIV PEP: HIV post-exposure prophylaxis

I. U.: international units

IV: intravenous

IM: intramuscular

MRI: magnetic resonance imaging

PEP: post-exposure prophylaxis

PTSD: post-traumatic stress disorder

SGB: German Social Welfare Code (Sozialgesetzbuch)

StGB: German Penal Code (Strafgesetzbuch)

STI: sexually transmitted infections

TEARS: tear, ecchymosis, abrasion, redness, swelling

VSS: confidential securing of evidence (vertrauliche Spurensicherung)

WHO: World Health Organization
 

II  Guideline Application

Purpose and objectives

The guideline describes the current knowledge and status of research and, like every guideline, provides doctors with pathways for decision-making and action.

The guideline is focused on the support and care of women and persons with female sexual characteristics.

This group of persons affected by sexualized violence will be referred to in the subsequent guideline as female.

Target areas of care

• Primary medical care

• Specialized care

Target user groups/target audience

This guideline is aimed at the following groups of people:

• Gynecologists in private practice

• Hospital-based gynecologists

• Specialists in forensic medicine

Adoption and period of validity

The validity of this guideline was confirmed by the executive boards/representatives of the participating medical societies, working groups, organizations, and associations as well as the boards of the DGGG and the DGGG Guidelines Commission in December 2025 and was thereby approved in its entirety. This guideline is valid from 1 January 2026 through to 31 December 2028. Because of the contents of this guideline, this period of validity is only an estimate. The guideline can be reviewed and updated earlier if urgently required. Similarly, if the guideline still reflects the current state of knowledge, its period of validity can be extended.

III  Method

Basic principles

The method used to prepare this guideline was determined by the class to which this guideline was assigned. The AWMF Guidance Manual (version 1.0) has set out the respective rules and requirements for different classes of guidelines. Guidelines are differentiated into lowest (S1), intermediate (S2), and highest (S3) class. The lowest class is defined as consisting of a set of recommendations for action compiled by a non-representative group of experts. In 2004, the S2 class was divided into two subclasses: a systematic evidence-based subclass (S2e) and a structural consensus-based subclass (S2k). The highest S3 class combines both approaches.

This guideline was classified as: S1

Grading of recommendations

The grading of evidence based on the systematic search, selection, evaluation, and synthesis of an evidence base which is then used to grade the recommendations of the guideline is not envisaged for S1 guidelines. The individual statements and recommendations are only differentiated by syntax, not by symbols (see [Table 3]):

Table 3 Grading of recommendations (based on Lomotan et al., Qual Saf Health Care 2010).

Description of binding character	Expression
Strong recommendation with highly binding character	must/must not
Regular recommendation with moderately binding character	should/should not
Open recommendation with limited binding character	may/may not

Statements

Expositions or explanations of specific facts, circumstances, or problems without any direct recommendations for action included in this guideline are referred to as “statements.”

Achieving consensus and level of consensus

At online or consensus conferences (S2k/S3 level), the mandate holders vote on previously formulated draft statements and recommendations. The process is as follows. A recommendation is presented, its contents are discussed, proposed changes are put forward, and all proposed changes are voted on. If a consensus (> 75% of votes) is not achieved, there is another round of discussions, followed by a repeat vote. Finally, the level of consensus is determined, based on the number of participants (see [Table 4]).

Table 4 Level of consensus based on extent of agreement.

Symbol	Level of consensus	Extent of agreement in percent
+++	Strong consensus	> 95% of participants agree
++	Consensus	> 75 – 95% of participants agree
+	Majority agreement	> 50 – 75% of participants agree
–	No consensus	< 51% of participants agree

Expert consensus

As the term already indicates, this refers to consensus decisions relating specifically to recommendations/statements issued without a prior systematic search of the literature (S2k) or where evidence is lacking (S2e/S3). The term “expert consensus” (EC) used here is synonymous with terms used in other guidelines such as “good clinical practice” (GCP) or “clinical consensus point” (CCP). The strength of the recommendation is graded as previously described in the chapter Grading of recommendations but without the use of symbols; it is only expressed semantically (“must”/“must not” or “should”/“should not” or “may”/“may not”).

IV  Guideline

1  Preamble

This guideline focuses on the medical forensic and psychosocial care provided by doctors to women affected by sexualized violence.

In the following, this guideline uses the term “sexualized violence” (and not “sexual violence”) to make it clear that sexual desire is usually not the motivation for using violence. The underlying motivation for sexualized violence is predominantly the need to demonstrate power. Sexual actions are functionalized as a means; they are not the purpose of the use of force.

It is important that the medical staff involved in caring for women after sexualized violence have empathy, experience, expertise, respect, and objectivity.

The aim must be a victim-centered, trauma-informed approach.

A safe and supportive environment must be created when caring for affected women.

It is not the job of the medical staff involved in the care of affected women and the securing of evidence to assess the veracity of statements provided by persons involved about how the events, etc. unfolded; that must be the responsibility of any subsequent preliminary investigation and court proceedings. The credibility of the affected woman/women must not be questioned.

When documenting the evidence, an objective and neutral presentation of the events described is of great importance for subsequent legal proceedings.

Legally affected persons should be referred to as “alleged victims” and offenders as “suspects.” As from a medical perspective, a person reporting sexualized violence is always considered to be “affected”, this guideline uses the term “affected person(s)/affected woman(women).”

International publications have stated that the incidence of wrongful reports of being affected by sexualized violence is less than 10%; this incidence is not higher than the incidence of wrongful reports for any other comparable criminal offence [1].

The guideline describes the current state of knowledge and research and therefore, like every guideline, should provide physicians with a scope for decision-making and action.

The guideline authors are well aware of the structural heterogeneity of the Federal Republic of Germany when caring for and examining affected women after sexualized violence.

This guideline focuses on the care and support of women and of persons with female sex characteristics. In the following text, the feminine form is used to describe all persons subjected to sexualized violence.

1.1  Introduction and guideline aim

Rape is the most severe form of sexualized violence. It constitutes a serious violation of human rights and may be associated with profound somatic, psychological, and social consequences for the affected person.

According to the Istanbul Convention, rape is defined as “… non-consensual oral, vaginal or anal penetration of a sexual nature of the body of another person with any bodily part or object …” [2]. According to prevalence studies, 5 – 6% of all women in Europe will experience rape at least once in their lifetime [3], [4]. In Germany, the lifetime prevalence of attempted/completed sexual intercourse against the will of the affected person is reported to be 14.9% among women [5].

In the majority of cases, the perpetrator or suspect is known to the affected person and between 97% and 99% of perpetrators are male [3], [4], [6], [7].

The underlying motivation for sexualized violence is predominantly not sexual desire but the need to demonstrate power and control [8], [9]. Sexualized violence serves as a means of demonstrating aggression and asserting dominance [8], [9]. According to a representative survey of the German population by the Federal Criminal Police Office, charges against perpetrators are only pressed in 9.5% of cases of sexualized abuse and rape [10]. The experience of serious sexualized violence has both short-term and long-term effects on the physical and psychosocial health of the affected person.

Immediate physical consequences include acute injuries and the risk of contracting a sexually transmissible infection (STI) [11], [12], [13]. Unwanted pregnancy is also a possible consequence of sexualized violence [11], [12], [13].

Over the longer term, the physical consequences can be diverse and long-lasting. Affected women may suffer from psychosomatic disorders such as chronic lower abdominal pain, headaches, and sleep disorders [14], [15], [16], [17]. Other consequences can include dysmenorrhea, dyspareunia, and sexual dysfunction, which affect both physical and psychological health [13], [18], [19]. Moreover, it has been found that after experiencing sexualized violence, women may be at higher risk of alcohol, tobacco, and drug use [4], [9], [20].

The psychosocial consequences are also serious. On a psychological level, depression and post-traumatic stress disorders (PTSD) are very common among person affected by sexualized violence [3], [4], [5], [11], [17], [21], [22]. The affected women often experience a severely limited quality of life as the trauma impairs their functioning in everyday life [5], [15], [18]. Significant difficulties can also arise in interpersonal relationships, both within the family and in other social contexts. The affected women often feel socially isolated, which further complicates how they can process the experienced trauma [3], [4], [9], [18].

The World Health Organisation (WHO) has emphasized the crucial role of medical care after sexualized violence as a form of early intervention and to help affected persons cope with the experience [9], [23]. Medical care encompasses (depending on the wishes of the persons affected) somatic and psychosocial care as well as the securing of evidence for (possible subsequent) criminal proceedings. Clinically competent and trauma-informed care is experienced by affected persons as supportive and has a positive influence on their individual healing process and the processing of the event [12].

In Germany, there is currently room for improvement with regards to the financing and, in part, also the standardization and establishment of medical forensic care after sexualized violence [24], [25]. With the coming into effect of the Measles Protection Act in 2020, the financing of confidential securing of evidence (vertrauliche Spurensicherung, VVS) in Germany by statutory health insurance companies was agreed upon for the first time, which should encourage the establishment of nationwide structures for medical forensic care after sexualized violence [26]. However, the financing of medical care after sexualized violence is currently still not uniformly regulated across Germany.

2  General recommendations on initial care

2.1  Facilities

Recommendation E2.1
Level of consensus: strong consensus
Protected rooms which are separate from other hospital operations and are as quiet as possible should be available to care for women after sexualized violence.

2.2  Training/trauma-informed doctor-patient communication

Recommendation E2.2
Level of consensus: strong consensus
The physicians involved in providing care must be trained in the care of women after sexualized violence.

Recommendation E2.3
Level of consensus: strong consensus
The physicians involved in providing care can be especially trained in trauma-informed doctor-patient communication.

2.3  Specialist medical standards

Recommendation E2.4
Level of consensus: strong consensus
The medical forensic examination must be carried out by qualified forensic pathologists and/or gynecological medical staff in accordance with specialist medical standards.

2.4  Four-eyes principle

Recommendation E2.5
Level of consensus: strong consensus
The examination can be carried out by two people.

2.5  Language mediation, interpretation

Recommendation E2.6
Level of consensus: strong consensus
Female interpreters must be available if there is a language barrier.

Recommendation E2.7
Level of consensus: strong consensus
Friends or family members should not act as interpreters.

2.6  Female staff

Recommendation E2.8
Level of consensus: strong consensus
The request of the affected person for their care to be provided by female or male staff should be taken into account where possible.

2.7  Female third person

Recommendation E2.9
Level of consensus: strong consensus
The examination must always be carried out in the presence of a female third party (nurse/female doctor).

Recommendation E2.10
Level of consensus: strong consensus
The affected person must be enabled to have a trusted person of her choice present when receiving care.

2.8  Medical emergency

Recommendation E2.11
Level of consensus: strong consensus
If the affected person is experiencing an acute medical emergency (e.g., serious injuries, panic attacks, dissociation, intoxication), treatment of the emergency must take priority.

3  Dealing with affected persons

3.1  Explanation of the care options after sexualized violence

Recommendation E3.1
Level of consensus: strong consensus
The different care options (police report, confidential securing of evidence, purely medical care) after sexualized violence must be explained to the affected person.

Recommendation E3.2
Level of consensus: strong consensus
The affected woman must be able to freely choose which type of care she wishes to receive; she must not be pressured to opt for a specific type of care.

3.2  Control over the care process

Recommendation E3.3
Level of consensus: strong consensus
The affected person must be enabled to exert the greatest possible level of control over all stages of her medical care.

Recommendation E3.4
Level of consensus: strong consensus
Any (partial) rejection, interruption or early termination when taking the affected personʼs medical history must be recorded.

3.3  Trauma-informed/trauma-sensitive doctor-patient communication

Recommendation E3.5
Level of consensus: strong consensus
The concept of trauma-informed doctor-patient communication and care can be used when caring for affected persons.

3.4  Companions

Recommendation E3.6
Level of consensus: strong consensus
The presence of unnecessary persons when taking the womanʼs medical history and/or during examinations must only be permitted after consulting with the affected person.

Recommendation E3.7
Level of consensus: strong consensus
The names of all persons present when taking the womanʼs medical history and/or during the examinations must be recorded on the investigation form, and both the affected person and her companion(s) must be informed that all persons present may be called as witnesses in the event of any court proceedings.

Recommendation E3.8
Level of consensus: consensus
It is essential to ensure that the companion is not the suspect.

Recommendation E3.9
Level of consensus: strong consensus
If it becomes apparent when taking the affected womanʼs medical history or during the examination that her companion is a witness to the crime, this must be documented.

3.5  First contact

Recommendation E3.10
Level of consensus: strong consensus
The affected woman should be treated objectively, impartially and with empathy and it should be made clear that she is being listened to.

3.6  Explanation of the steps of the investigation

Recommendation E3.11
Level of consensus: strong consensus
All steps of the investigation must be explained and must only be carried out with the consent of the affected person.

3.7  Communication/active listening

Recommendation E3.12
Level of consensus: strong consensus
When talking to the affected person, it may be helpful for doctors to apply the concept of active listening.

4  Forms of care and legal constellations

When caring for persons affected by sexualized violence, various obligations are placed on the investigating doctors which arise from different courses of action.

In addition to providing basic medical care, documenting injuries in a manner that will stand up in court and the securing of evidence are particularly important.

4.1  Reporting a crime without requiring the investigative authorities to carry out an investigation

Recommendation E4.1
Level of consensus: strong consensus
The affected person must be informed that the medical staff are bound by confidentiality. Any waiver of confidentiality must be made in writing.

4.2  Investigation on behalf of law enforcement/investigative authorities (police, public prosecutorʼs office) or the courts (after prior reporting of a crime)

If an investigation is carried out on behalf of the investigative authorities/the court, then two scenarios are conceivable:

4.2.1  The affected person agrees to the investigation.

Recommendation E4.2
Level of consensus: strong consensus
To track the chain of evidence, the documents and/or evidence which were handed over to the police/the forensic medicine department must be recorded.

4.2.2  The affected person refuses an investigation.

Statement S4.1
Level of consensus: strong consensus
The investigative authority must instruct the affected person(s) about an investigation in accordance with Art. 81c StPO [Strafprozessordnung = German Code of Criminal Procedure].

Recommendation E4.3
Level of consensus: strong consensus
The affected person must be made aware that she can refuse an investigation in accordance with Art. 81c StPO.

4.2.3  The investigative authorities have commissioned the investigation

Recommendation E4.4
Level of consensus: strong consensus
If the investigation has been commissioned by the investigative authorities, all secured evidence (scrapings, smears, blood/urine samples) must be handed over to the police. Additional findings documented in writing must be handed over after obtaining a waiver of confidentiality.

Recommendation E4.5
Level of consensus: strong consensus
If there are doubts whether further documentation/reports of findings should be handed to the investigative authorities, the investigating doctors must first invoke their duty of confidentiality. It can then be clarified legally whether and how the investigative authorities should receive these documents/the documented findings.

Recommendation E4.6
Level of consensus: strong consensus
To ensure that the documentated information can be used at later stage for an investigation/in criminal proceedings, care must be taken to ensure that documentation is of a quality that will stand up in court.

4.3  Confidential securing of evidence

Recommendation E4.7
Level of consensus: strong consensus
The offer by the department responsible for the confidential securing of evidence (vertrauliche Spurensicherung, VSS) to store the evidence locally must be recommended to the affected person to ensure an unbroken chain of evidence.

Recommendation E4.8
Level of consensus: strong consensus
Doctors must find out about the status and regulations relating to the confidential securing of evidence (vertrauliche Spurensicherung, VSS) in their federal state. If there are, as yet, no regulations pursuant to Art. 132 Book V of the SGB [Sozialgesetzbuch = German Social Security Code], the doctors must inquire into the opportunities for cooperation with the nearest institute for forensic medicine.

4.4  Only medical care

Recommendation E4.9
Level of consensus: strong consensus
If no police report has been filed, the affected person should be offered the confidential securing of evidence (vertrauliche Spurensicherung, VSS) or she should be referred on to an appropriate institution.

Recommendation E4.10
Level of consensus: strong consensus
Doctors must inform the affected woman in such a manner that she is aware of the relevance of court-admissable documentation/collection of evidence should she later decide to file a police report.

Recommendation E4.11
Level of consensus: strong consensus
If the affected person does not wish to have any confidential securing of evidence (VSS), the measures carried out must at least be documented conscientiously and thoroughly.

4.5  Affected persons incapable of giving consent

Recommendation E4.12
Level of consensus: strong consensus
In cases when persons are affected by alcohol/drugs/medication it must be verified whether the person is capable of giving consent.

Recommendation E4.13
Level of consensus: strong consensus
Measures to collect evidence/investigations must only be carried out with the consent of the affected person.

Recommendation E4.14
Level of consensus: strong consensus
In the event of a long-term impairment of the personʼs capacity to consent, a decision for or against the securing of evidence and the extent of the collection of evidence must be made on a case-by-case basis in accordance with the presumed will of the affected person.

4.6  Cognitive and psychological impairments

Recommendation E4.15
Level of consensus: strong consensus
When the affected person has recognizable cognitive and/or psychological impairments, a decision must be taken whether the affected woman is capable of giving consent. The reasons for this assumption must be documented; the same applies to the assumption that she is incapable of giving consent.

Statement S4.2
Statement: strong consensus
Determining whether and to what extent the affected person is capable of consenting to medical measures and the securing of evidence herself is subject to medical assessment and must always relate to the specific treatment situation and the specifically intended measure(s).

Statement S4.3
Statement: strong consensus
Even persons under care may, as part of their right to self-determination, decide on medical measures by themselves and without their legal guardians. If the affected person is able to consent it is therefore irrelevant whether she has a legal guardian dealing with her medical care or not.

Recommendation E4.16
Level of consensus: strong consensus
If the affected person cannot (can no longer) consent herself and has a legal guardian to support her healthcare, this guardian must be contacted and involved in the decision about consenting to medical measures. This also applies to the securing of evidence after rape if the affected person is incapable of consenting and has an existing legal guardian for matters relating to public authorities.

Statement S4.4
Statement: strong consensus
Even if the affected person has a legal guardian and is incapable of giving her consent, the affected person remains the person towards whom the medical information is directed; legal guardianship does not mean that information and questions should only be directed at the legal guardian and that only the legal guardian may make the decisions.

Recommendation E4.17
Level of consensus: strong consensus
If, based on a medical assessment, the affected person is incapable of consenting or the medical doubts about her ability to consent are so strong that the affected personʼs wish for an investigation would otherwise have to be refused, an application for legal guardianship to cover healthcare matters (and possibly administrative matters) should be lodged at the competent local court (guardianship court) if the affected person does not already have a legal guardian and this is required for the specific measures to be taken.

5  Medical history

5.1  General medical history

Recommendation E5.1
Level of consensus: strong consensus
The affected personʼs general medical history must be taken and must include information about: height and weight, prior disorders, operations, medications.

Recommendation E5.2
Level of consensus: strong consensus
The affected personʼs mental state (orientation, consciousness, condition, and emotions) must be recorded and documented as part of the medical history.

5.2  Gynecological history

Recommendation E5.3
Level of consensus: strong consensus
The womanʼs general gynecological history must be taken.

Recommendation E5.4
Level of consensus: strong consensus
The woman must be asked when, with whom and and how the last consensual and/or non-consensual sexual contact occurred and whether or which type of contraception was used, in particular, whether a condom was used.

5.1  Infection history

Recommendation E5.5
Level of consensus: strong consensus
From an infectious disease perspective, the following information must be collected to estimate the risk of acquiring an STI from the assault or whether there was a STI preexisting: Whether the affected woman has injuries or bleeding and, if known, whether the suspect does Whether the affected woman has a known prior history of STI and whether the suspect does Any STI symptoms present The affected womanʼs vaccination status must be checked (e.g., hepatitis B and tetanus)

5.2  History relating to the assault

Recommendation E5.6
Level of consensus: consensus
The course of events must first be freely described by the affected person. Leading questions must be avoided.

Recommendation E5.7
Level of consensus: strong consensus
The date, time, and place of the assault must be asked.

Recommendation E5.8
Level of consensus: strong consensus
Questions about the details of the assault must be limited to what is necessary for the investigation, the provision of care, and the securing of evidence.

Recommendation E5.9
Level of consensus: strong consensus
The affected person must be asked whether the suspect(s) are known to her (e.g., acquaintances or family members).

Recommendation E5.10
Level of consensus: strong consensus
The woman must be asked whether, and if so, where (oral, anal, vaginal) and with what (penis, finger, object) penetration occurred and whether, and if so, an ejaculation occurred and whether a condom was used.

Recommendation E5.11
Level of consensus: strong consensus
The affected person must be asked whether she has in the meantime: cleansed herself and her clothes in any way (incl. wiping), used a tampon/sanitary pad/panty liner or a barrier contraceptive, has urinated/had a bowel movement (especially in the case of vaginal and anal penetration), has eaten or drunk anything, has smoked, brushed her teeth, or used a mouth rinse (in the case of oral penetration).

Recommendation E5.12
Level of consensus: strong consensus
It should be asked whether and in which form violence was used and whether weapons or objects, including restraints, were used.

Recommendation E5.13
Level of consensus: strong consensus
Other possibilities and locations for the transfer of genetic materials should be asked about. This also includes kissing, licking, biting, touching and defensive measures such as scratching. It should also be asked whether and in what form the affected person may have injured the suspect(s) herself.

Recommendation E5.14
Level of consensus: strong consensus
When describing violence directed against the throat, the symptoms should first be described freely, with a particular emphasis on an associated loss of consciousness, involuntary defecation or urination, difficulty swallowing, sore throat, hoarseness, a foreign body sensation (globus sensation) or visual disturbances.

Recommendation E5.15
Level of consensus: strong consensus
Questions should be asked about any consumption of alcohol, drugs, medication, and memory loss (“blackout”) as an indication of intoxication with substances that affect the central nervous system.

Recommendation E5.16
Level of consensus: strong consensus
Questions should be asked about clothing and any jewelry worn, particularly in the case of extragenital injuries and/or indications of patterned injuries.

6  Recommendations for forensic medical investigations

Recommendation E6.1
Level of consensus: strong consensus
The investigation must be conducted in a timely, systematic, and standardized manner to meet the legal requirments of any (subsequent) investigation proceedings.

6.1  General requirements for the investigation, securing of evidence and documentation of injuries

The documentation of injuries and securing of evidence that can be used in court are central elements of a forensic medical investigation. The use of standardized evidence collection kits is useful for this [9], [27].

6.2  Bodily examination and documentation of injuries

Recommendation E6.2
Level of consensus: strong consensus
A photographic documentation of identified injuries and other findings must be carried out. This should consist of overview images for the reliable identification of the location of the injury and detailed images with a scale.

Recommendation E6.3
Level of consensus: strong consensus
A description of injuries should include information about the type, shape, size, color and location of the injury. Interpretations should be avoided.

Recommendation E6.4
Level of consensus: strong consensus
For clarity, all injuries should be outlined on a body diagram which is part of standardized examination forms.

6.3  Securing of evidence

Recommendation E6.5
Level of consensus: strong consensus
The securing of evidence should be based on the specific circumstances of the case (case history).

6.3.1  Marks on the body

Recommendation E6.6
Level of consensus: strong consensus
Potential foreign genetic material should be secured using special self-drying forensic cotton swabs (swabs and abrasions) and by securing clothing and objects that may carry DNA in breathable evidence bags or paper bags.

6.3.2  Time interval to secure evidence on the body and from the anogenital area

Recommendation E6.7
Level of consensus: strong consensus
Molecular genetic evidence should be secured as quickly as possible. Swabs and abrasions should always be taken within 72 hours of the incident regardless of whether the body has been washed; in individual cases this may be done up to 7 days after the incident.

6.3.3  Clothing and other trace carriers

The clothing worn during the incident as well as any sanitary pads/panty liners/tampons and any condoms that may be present must be secured as possible sources of molecular genetic evidence, especially any ejaculate [9], [28], [30].

6.3.4  Contamination

Recommendation E6.8
Level of consensus: strong consensus
Strict hygiene measures must be observed during the examination to avoid contamination with foreign DNA (from the examiner).

Recommendation E6.9
Level of consensus: strong consensus
Gloves and a surgical mask must be worn.

Recommendation E6.10
Level of consensus: strong consensus
If there is a possibility of contamination, gloves should be worn to avoid any transfer of DNA. Any contact between the (gloved) hands or the instruments used for the examination with areas of the body that still need to be swabbed/wiped must be avoided.

Recommendation E6.11
Level of consensus: strong consensus
If there is no acute need for treatment, the collection of swabs and scrapings should precede any medical care.

6.4  Gynecological examination

Recommendation E6.12
Level of consensus: strong consensus
Individual anatomical structures should be precisely listed using consistent terminology for the anogenital region.

Recommendation E6.13
Level of consensus: strong consensus
Doctors who are contacted directly by persons affected by sexualized violence and who do not have the necessary expertise should nevertheless provide care to the affected person and arrange for them to be transferred to an institution with the appropriate expertise.

Recommendation E6.14
Level of consensus: strong consensus
Genital injuries must be documented using the TEARS classification; interpretations of injuries must be avoided.

Recommendation E6.15
Level of consensus: strong consensus
An examination of the anogenital area using colposcopy should be carried out as part of the examination of any person affected by sexualized violence.

Recommendation E6.16
Level of consensus: strong consensus
Given the controversial discussions in the literature, the use of toluidine blue samples (Collins test) is not recommended.

Statement S6.1
Level of consensus: strong consensus
The absence of genital injuries is not an argument against the claim that the sexual contact was non-consensual, just as the presence of genital injuries does not invalidate the claim that the sexual contact was consensual.

Recommendation E6.17
Level of consensus: strong consensus
Documentation of anogenital findings after sexualized violence must at least include their description and a schematic drawing. If the affected person consents, photographic documentation of anogenital findings should be carried out (close-up photographs, if possible, which permit the injuries to be assigned to specific anatomical areas, no overview photography).

6.5  Carrying out the gynecological examination

Recommendation E6.18
Level of consensus: strong consensus
The examination of the anogenital area of a person affected by sexualized violence must be carried out in the lithotomy position; if only the anal region is examined, inspection may be carried out with the patient in the lateral position with flexed legs.

Recommendation E6.19
Level of consensus: strong consensus
Potentially present pubic hairs can be combed out using a DNA-free comb and the obtained material should be collected and stored together with the comb in a paper bag/evidence bag. Pubic hairs which are stuck together should be cut off and also secured as evidence.

Recommendation E6.20
Level of consensus: strong consensus
After the evidence from the external genitalia has been secured, the next step is to inspect the vulva and its different anatomical structures. It is important to focus on any changes as listed in the TEARS classification. A moistened cotton swab should be used to additionally wipe around the edge of the hymen.

Recommendation E6.21
Level of consensus: strong consensus
When taking a vaginal swab, either with or without a speculum, it is important to ensure that no external traces are spread to the inside of the vagina.

Recommendation E6.22
Level of consensus: strong consensus
Depending on the type of penetration (vaginal/anal), swabs/scrapings should be taken from the following locations of the anogenital area using self-drying swabs: Visible traces (e.g., dried secretions, saliva, traces of semen) 1× external genitalia 1× inside of the labia minora to the hymen 1× vagina 1× uterine cervix (if a speculum is used for the examination) 1× peri-anal/anal region 1× rectum

Recommendation E6.23
Level of consensus: strong consensus
The decision to use a speculum for the gynecological examination must be done on a case-by-case basis and must depend on the account of the assault and the clinical symptoms. Using a speculum during the examination may be helpful to secure evidence and discover possible injuries and foreign bodies.

Recommendation E6.24
Level of consensus: strong consensus
Whether or not to use a speculum for the examination, which of course can only be done with the consent of the affected person, must be discussed in detail with the affected person.

Recommendation E6.25
Level of consensus: strong consensus
No wet mount smears to provide evidence of spermatozoa should be taken as it is important to ensure that sufficient material is available for any subsequent trace analysis.

6.6  Recommendations for the affected person

Recommendation E6.26
Level of consensus: strong consensus
If there is a prior contact with the affected person(s) (e.g., telephone contact), they should be instructed not to clean their body or change their clothes prior to the medical forensic examination. If oral penetration occurred, the affected person(s) should be told to avoid eating, drinking, cleaning their teeth, rinsing their mouth, and smoking until the examination has been carried out.

6.7  Taking blood and urine samples

Recommendation E6.27
Level of consensus: strong consensus
Blood and urine samples must be taken and stored as quickly as possible after the assault if there is a suspicion that intoxicating substances may have been involved (at the latest within 72 hours of the assault).

6.8  Handling and storage of evidence

Recommendation E6.28
Level of consensus: strong consensus
Blood and urine samples must be stored in a refrigerator until they can be forwarded.

7  Medical care

7.1  Documentation sheets

Recommendation E7.1
Level of consensus: strong consensus
The medical history, findings, and all evidence secured must be taken and collected using standardized documentation forms.

7.2  Physical examination

Recommendation E7.2
Level of consensus: strong consensus
Physical injuries should be properly identified, documented, and cared for; specialists from other medical disciplines may be called in for consultation.

7.3  Tetanus vaccination

Recommendation E7.3
Level of consensus: strong consensus
The womanʼs tetanus vaccination status must be recorded as part of her medical history.

Recommendation E7.4
Level of consensus: strong consensus
If genital or extragenital findings are identified during the examination, combined passive/active immunization with a tetanus vaccine should be administered in the absence of any vaccination protection or if the status of the womanʼs vaccination protection is unknown or insufficient.

7.4  Choking/strangulation

Recommendation E7.5
Level of consensus: strong consensus
An ENT examination should be arranged if there are indications of violence directed against the neck area (choking/strangulation), possibly accompanied by imaging (CT/MRI of the neck/throat).

7.5  Emergency contraception/pregnancy test

Recommendation E7.6
Level of consensus: strong consensus
If indicated, the affected woman must be offered emergency contraception.

Recommendation E7.7
Level of consensus: strong consensus
A pregnancy test must be carried out before administering emergency contraception.

Recommendation E7.8
Level of consensus: strong consensus
Irrespective of any emergency contraception, the affected person may be offered a pregnancy test to identify the status quo or if she requests it.

8  Sexually transmissable infections

8.1  Screening for sexually transmissible infections

Recommendation E8.1
Level of consensus: strong consensus
Persons affected by sexualized violence must be offered STI screening to diagnose any preexisting infections or infections transferred during the assault.

Recommendation E8.2
Level of consensus: strong consensus
STI screening should have a starting point (“zero status”) and include follow-up examinations as listed in the framework below.

Recommendation E8.3
Level of consensus: strong consensus
STI screening should be carried out to test for the following types of infection: HIV, hepatitis B, hepatitis C, Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis.

8.2  Bodily samples

Recommendation E8.4
Level of consensus: strong consensus
Blood samples should be taken for serological testing to screen for HIV, hepatitis B, hepatitis C and Treponema pallidum.

Recommendation E8.5
Level of consensus: strong consensus
Swabs of the location(s) of the attempted or perpetrated penetration(s) should be taken to screen for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis.

8.3  Exposure prophylaxis

8.3.1  Antibiotic prophylaxis against bacterial STIs

Recommendation E8.6
Level of consensus: strong consensus
No post-exposure antibiotic prophylaxis to prevent bacterial STIs should be administered.

Recommendation E8.7
Level of consensus: strong consensus
If the perpetrator has a known active bacterial STI, targeted post-exposure prophylactic antibiotic therapy should be administered in accordence with the currently relevant guideline recommendations on infection.

Recommendation E8.8
Level of consensus: consensus
If there is strong wish on the part of the affected person for post-exposure prophylactic administration of antibiotics, a prophylactic administration of a one-time dose (ceftriaxone [1 g IV or IM] plus azithromycin [1.5 g orally]; possibly metronidazole [2 g orally] within 24 hours or maximally within 72 hours after exposure) may be considered.

Recommendation E8.9
Level of consensus: strong consensus
If an STI has been confirmed during initial screening or at follow-up examinations, it must be treated in accordance with the currently applicable guideline recommendations.

8.4  Hepatitis B

Recommendation E8.10
Level of consensus: strong consensus
The hepatitis B vaccination status of the affected person should be determined.

Recommendation E8.11
Level of consensus: strong consensus
The HBs antibody titer (HBsAb titer) must be determined if the vaccination status is unknown or if the recorded vaccination was with an unknown HBsAb titer.

Recommendation E8.12
Level of consensus: strong consensus
If no basic immunization against hepatitis B was administered at the time of presentation, the HBsAb titer is < 100 IU/l or cannot be determined within 48 hours, active vaccination with the HBs antigen vaccine should be carried out within 48 hours after the assault.

Recommendation E8.13
Level of consensus: strong consensus
If the HBsAb titer was not at least 100 IU/l earlier on, the alleged perpetrator is hepatitis B-positive, and the assault occurred less than seven days previously, then HB immunoglobulin should be administered.

Recommendation E8.14
Level of consensus: strong consensus
If basic immunization against hepatitis B is initiated as part of medical care after sexualized violence, information should be provided about the necessary follow-up vaccinations.

8.5  HIV

Recommendation E8.15
Level of consensus: strong consensus
The affected person(s) must be advised about HIV post-exposure prophylaxis (HIV PEP).

Recommendation E8.16
Level of consensus: strong consensus
HIV PEP should be offered after unprotected anal or vaginal penetration.

Recommendation E8.17
Level of consensus: strong consensus
No HIV PEP should be offered if penetration was only oral.

Recommendation E8.18
Level of consensus: strong consensus
HIV PEP must be initiated immediately, at the latest within 72 hours of the assault, and should not be delayed by waiting for laboratory results.

8.6  Follow-up checks

Recommendation E8.19
Level of consensus: strong consensus
The following follow-up examinations must be carried out:
Time since first presentation	Recommended examinations	Investigated sample
2 weeks	Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium	Swab of the location of the successful/attempted penetration (alternative: first urine)
6 weeks	HIV, hepatitis B (if there is no immune protection), hepatitis C and Treponema pallidum	Serum
12 weeks	HIV, hepatitis B (if there is no immune protection), hepatitis C and Treponema pallidum	Serum
24 weeks	Hepatitis C	Serum

When diagnosing a bacterial STI, the currently relevant AMWF guideline on the treatment of sexually transmissble infections applies.

9  Psychological and psychosocial care

Recommendation E9.1
Level of consensus: strong consensus
The basic attitude of caregivers providing psychosocial care to persons affected by sexualized violence should be directed towards conveying reassurance and offering a hopeful future-oriented perspective, strengthening the womanʼs confidence in her own ability to act, and promoting social contacts.

Recommendation E9.2
Level of consensus: strong consensus
Outpatient follow-up in the first few weeks after the assault should be recommended to all affected women, but especially to those with pronounced psychological symptoms.

9.1  Self-endangerment and self-harming behavior

Recommendation E9.3
Level of consensus: consensus
Self-endangerment should be investigated.

Recommendation E9.4
Level of consensus: consensus
A psychiatric examination should be carried out if there is a risk of self-harm and the patient should be admitted to hospital, if necessary.

9.2  Risk factors

Recommendation E9.5
Level of consensus: strong consensus
Outpatient follow-up should be recommended in the first few weeks after the assault, especially for affected women who have risk factors for developing long-term psychological symptoms (= the suspect is a current or former intimate partner, the woman has a preexisting mental illness, a prior history of rape, no social support).

9.3  Familial and social support

Recommendation E9.6
Level of consensus: strong consensus
As part of outpatient care, short-term relief of the affected woman should be supported and resources for this should be discussed, e.g., support by the affected womanʼs social environment.

9.4  Assessment of risk

Recommendation E9.7
Level of consensus: strong consensus
The (acute) danger to the affected person posed by third parties should be clarified and the options to protect the affected person should be explored; care should be taken to discharge the affected woman into a safe environment.

9.5  Information material

Recommendation E9.8
Level of consensus: strong consensus
The affected woman should be offered written information on specialized counseling centers, womenʼs shelters, trauma clinics, trauma-focused psychotherapy, and other points of contact.

9.6  Psychoeducation

Recommendation E9.9
Level of consensus: strong consensus
The affected woman can be informed about common, typically occurring psychological reactions in an easily understandable, concise, and non-written form so that she will be able to classify these as understandable reactions, a depathologizing effect can occur, and the woman can seek help if symptoms persist.

Recommendation E9.10
Level of consensus: strong consensus
Behavioral recommendations (balanced sleep patterns, healthy meals, moderate physical activity, attempts to maintain normal daily routines, spending time with other people) and information about positive coping strategies (conversations with caregivers, relaxation exercises, professional support) should be discussed with the affected woman and should be provided to her in writing if necessary.

9.7  Information about “the right to social compensation”

Recommendation E9.11
Level of consensus: strong consensus
The affected woman should be informed about her right to obtain support and compensation in accordance with the right to social compensation under German law, this duty of information may also be delegated to a counseling center.

9.8  Information for the affected woman

Sexualized violence is a potentially traumatizing event that can have negative consequences for the somatic and psychological health of affected women. Acute and, in some cases, also long-term psychological care and treatment is therefore necessary [23].

9.9  Benzodiazepines

Recommendation E9.12
Level of consensus: strong consensus
Affected women must not be prescribed benzodiazepines.

10  Aftercare

10.1  Importance of aftercare and follow-up examinations

Recommendation E10.1
Level of consensus: strong consensus
Physical and psychological symptoms after experiencing sexualized violence (especially sleep disturbances, emotional numbness, intrusive and distressing thoughts about the event, overwhelming feelings, despair, dissociative symptoms) should be enquired about and, if necessary, the affected person should be referred on to the appropriate care facilities (e.g., specialist counseling center or trauma clinic or [possibly trauma-focused] psychotherapy).

10.2  Psychological aftercare

Persons affected by sexualized violence have a significantly higher risk of developing mental disorders. The effectivity of early psychotherapeutic interventions has not yet been conclusively proven and is sometimes contradictory [32], [33], [34]. Given that improvement at first is rapid but slows down after three months, it makes sense to monitor progress regularly and assess the mental health of the affected woman at this stage (“watchful waiting”) [29], [31]. The use of appropriate questionnaires to assess mental health can be used to identify the need for treatment.

10.3  Check-ups for infectious diseases

Recommendation E10.2
Level of consensus: strong consensus
The importance of follow-up checks should be explained and the affected person should be supported to attend them.

Recommendation E10.3
Level of consensus: strong consensus
Follow-up checks should be carried out in accordance with the currently applicable recommendations on infectious diseases.

10.3.1  Follow-up care appointments

Recommendation E10.4
Level of consensus: strong consensus
Affected persons should be recommended to have follow-up care.

Recommendation E10.5
Level of consensus: strong consensus
Follow-up care should include follow-up examinations for infectious disease(s) and psychosocial follow-up care as well as the offer of a check-up to review any injuries sustained.

Recommendation E10.6
Level of consensus: strong consensus
A pregnancy test should be offered.

Recommendation E10.7
Level of consensus: strong consensus
The affected woman should be provided with a medical report which includes information on the examinations and treatments that were carried out and those recommended as part of her follow-up care.

Conflict of Interest

The conflicts of interests of all the authors are listed in the long German-language version of the guideline.

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Publication History

Received: 19 January 2026

Accepted: 22 January 2026

Article published online:
09 March 2026