Content warning:
This passage includes sensitive content about sexual violence and may be triggering for some readers.
The exam can feel exposing, particularly for women who haven’t been sexually active for decades.
In my role, the services I help provide fall broadly into three main areas. The first is our 24/7 crisis sexual assault response, which runs out of a purpose-built suite in a major hospital. It’s staffed by a specially trained counsellor — usually a social worker — and a specially trained medical officer or forensic doctor. The service is free and available to anyone aged 14 and above who presents within seven days of a sexual assault. We do see older women, although it isn’t a service specifically for them.
Everyone who comes through crisis response is offered ongoing sexual assault counselling. Our counsellors, all specialist-trained, are located just across the road from the emergency department. We have a priority system that allocates people based on urgency, and while we currently have a wait list, it’s not too long. Beyond this, we also provide domestic violence counselling, which at the moment can only be accessed through GP referrals or referrals from within the local health district.
Our approach is entirely person-centred. We don’t offer a specialist older persons stream, but we regularly work with people who have cognitive challenges — whether lifelong or age-related. Each person’s circumstances are different: trafficking, sex work, domestic violence, incest, or historical assault. We shape our response around their needs.
Over the last few years, I’ve noticed two recurring reasons older women come forward about historical sexual assault. One is the increasing awareness of fawning as a legitimate trauma response. Many older women spent decades believing that because they didn’t fight, shout, or run, “it wasn’t really sexual assault.” Understanding fawning helps them finally make sense of their trauma and its long-term impact.
The second reason is concern for others — family or community. If the person who harmed them still has access to younger people, that can push them to disclose now.
When it comes to recent sexual assault, older women often face additional challenges. I remember responding to one older woman who disclosed to her daughter. The daughter advocated strongly to get her to the crisis service, but the examination process was extremely confronting for the woman. Even with skilled, gentle doctors, she found the idea of a forensic exam unbearable — like another violation. In her case, forcing the process would have been re-traumatising.
This is something we see often: older women declining the forensic examination, even when the alleged offender was a worker in a facility. The exam can feel exposing, particularly for women who haven’t been sexually active for decades. Even so, the doctors take great care, breaking the process down step by step, always prioritising consent and comfort.
If someone prefers a female doctor, we do everything we can to accommodate that. Most of our doctors are women, and if a male doctor happens to be on shift, we’ll arrange for a female doctor to come in — usually within a few hours.
Our crisis space itself is beautiful — recently refurbished, soft colours, artwork, flowers. When someone comes in, the counsellor sits with them for the first 20–30 minutes to understand what they’re most worried about: STI risk, fear of not being believed, fear of the process, pregnancy concerns for younger people. We explain all the options. We always encourage the forensic exam because people often feel differently weeks or months later. Capturing evidence early means they can choose what to do with it later — it doesn’t force them into a criminal process. It also helps in identifying repeat offenders.
But we never push. Some people simply cannot do it, and it’s not our role to impose.
There are less invasive ways to gather forensic evidence when someone can’t tolerate the full exam — saliva on skin, DNA on underwear, or areas where DNA should not reasonably be. Our doctors work hard to collect what they can if the person consents to those methods.
When someone lacks capacity, it becomes ethically complex. In exceptional circumstances, we have gone through the Guardianship pathway, but always with the person’s psychological wellbeing at the centre. No one wants an exam imposed on them, and there are limits we will not cross.
There is a big difference in supporting someone who has been recently assaulted compared to someone disclosing historical abuse. For recent assaults, residential services are usually mandated to report, and police will often bring the person in. Older people, however, often don’t continue with counselling — particularly if they rely on others for transport. We offer phone, online and face-to-face counselling, but face-to-face remains the most effective.
Historical disclosures often come from people with long, complex trauma histories — mental health issues, drug and alcohol use, incarceration, entrenched self-medication. I’ve worked with women who spent decades coping this way. One woman I’ve supported for years traced everything back to her childhood sexual abuse. She rebuilt her life, went through redress, gained financial stability, and is now thriving. Recovery is absolutely possible, but it requires time, patience, and sustained support.
We never pressure people to finish counselling. If they’re engaging and benefiting, we stay with them for as long as they need. Many people don’t engage immediately after a crisis — they try to “put it behind them,” only to come back years later when the trauma resurfaces. We always try to emphasise that even a short early intervention can greatly reduce long-term distress.
Our service is extremely busy — likely the busiest in the state — because we see anyone who presents, regardless of where they live.
We do some outreach — for example, a contract with a university, and some youth services — and we provide training to services, including on how to recognise disclosures and when to refer to specialist support. I believe there is great potential to extend this training into aged care.
Older women’s interactions with the legal system can vary. Some police commands are excellent; others are extremely challenging. In one command, senior police have openly made comments blaming women for how they dress or how much they drink. They’ve dismissed disclosures or labelled them “false” without conducting an investigation. It is devastating, especially for older women who already doubt themselves or minimise their experiences.
Younger women tend to push back more, but many older women defer to authority and may accept being dismissed. Having an advocate with them can be transformative.
There have been small improvements — such as police sexual assault portfolio holders, who are meant to create safer interview spaces and take statements — but not all commands embrace the change.
One part of my work is training police about trauma memory. Trauma memory is fragmented, sensory, and often delayed. People cannot give a linear account while still in the trauma. Some police push victims to sign statements too early, sometimes before the person has slept. Once signed, that statement can’t be amended. We encourage police to gather immediate investigative information, but delay the formal statement until the person has worked with a counsellor.
I often draw on Patrick Tidmarsh’s recent work, which explains grooming, trauma responses, and cognitive shutdown. Many cases hinge on misunderstandings about consent, particularly around fawning or survival responses. Not all police accept the research; some cling to outdated beliefs. I’ve had to challenge investigators who equated lack of resistance with consent.
I use practical exercises in training — for example, asking officers to imagine someone holding a gun to their head after a shift, then ask them why they would hand over their money or their car. It helps them understand survival behaviour in a way that lecture-style teaching does not.
There are systemic issues too: juries are rarely educated about trauma, grooming, or fawning. Some countries have trialled giving jurors training at the start of sexual assault trials — an idea I strongly support.
As for barriers faced by older women, culture plays a huge role. I’m nearly 60, and I grew up in a world where attitudes to sex and consent were profoundly different. Ideas about being “frigid” or “asking for it” shaped how many women evaluated their own experiences. Many older women still carry those messages. They may feel shame because they didn’t resist, or because the assault wasn’t violent in the way society expects. Grooming reinforces that shame.
Public conversations — like those led by younger advocates — have shifted understanding for young people. We need something similar for older women. Public stories make it easier for individuals to recognise themselves in the narrative and to disclose safely.
In our service, only a small proportion of clients are over 50 — just over 5% in the report I ran. Many older women simply never come forward, or if they do, they may not engage in ongoing support. Mobility, transport, fear, shame, and generational beliefs all play a role.
We do use art therapy and other non-verbal modalities, especially for people with cognitive challenges. In an ideal world, counselling would occur within aged-care facilities so that people wouldn’t have to travel or overcome the stigma of attending a sexual assault service. But resources are limited, and reaching older women remains an enormous challenge.
I think we need a dual strategy: system reform and public conversation. We need visible older public figures willing to lead the conversation and challenge long-held beliefs about sexual assault and survival responses. Someone who can speak openly about why they never disclosed earlier and how the experience shaped their life.
At the same time, we need the justice system to understand survival responses like fawning, and to stop interpreting them as consent. These responses can save lives, yet survivors — especially older women — are often blamed for them.
Ultimately, what older women need most is belief, safety, and a cultural shift that makes naming their experiences possible. Until then, many will continue to carry these stories alone.
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