Content warning:
This passage includes sensitive content about sexual violence and may be triggering for some readers.
Sometimes we also received referrals from aged-care facilities when there were concerns about women with disabilities or cognitive impairment, but these cases were complicated. Even arranging for them to be transported to the centre for examination could take considerable time and coordination.
In my career I worked as a Sexual Health Physician, focusing on women’s sexual and reproductive health and on sexual assault forensic services. I also served as Medical Director of a Sexual Assault Service for several years before retiring.
My work in general sexual health didn’t involve disclosures of sexual assault, but the forensic service certainly did. It was open to women of all ages, and older women did come in, although it wasn’t designed specifically for them. Our aim was always to provide each person with what they needed.
The main responsibility of the forensic service was to conduct the forensic examination and collect DNA. A counsellor was always present. After the forensic capture, we addressed health needs such as STI testing, treatment of injuries, and administering the morning-after pill, and then offered counselling for those who wanted it.
Most women were brought in by police or referred for the specific purpose of forensic examination. About half later consented to release the findings to police; the other half chose not to. Many underwent the exam simply so they had the information if they decided to take police or legal action later. The service was always framed as an option rather than a directive.
Women tended to speak very directly about what had happened to them. They weren’t using euphemisms or generalities; their purpose in attending was clear. But even so, there was still a lot for them to process and it could take time for them to work out what they wanted to do next.
I did support older women who came in, often referred by police or by family members who suspected something had occurred. Sometimes we also received referrals from aged-care facilities when there were concerns about women with disabilities or cognitive impairment, but these cases were complicated. Even arranging for them to be transported to the centre for examination could take considerable time and coordination.
In terms of differences between older and younger women, I’m not sure the distinctions fall neatly along age lines. Each situation is different. What shaped the experience in the forensic setting was what the woman wanted to do and how she was making sense of what had happened. Shame, feeling degraded, or feeling responsible were all factors.
When the offender was a stranger, decisions tended to be clearer and action was often taken more quickly. When the person was known to them, decisions were far more complicated. Often, by the time they attended, the window for finding DNA—especially if not semen—had already passed.
There are so many layered complications in how women relate to sex, and that colours how they respond to sexual assault. Sexual assault is not about sex, but women’s histories with sex often influence their feelings afterwards. Sex, for many women, can be tied up with keeping the peace, meeting someone else’s needs, or maintaining a relationship.
Those dynamics can feed into how they interpret an assault and what they feel able to do about it. Added to that is the sense of responsibility or blame some women place on themselves, and the impact on their relationships, families, or living situations. All of this can create significant confusion and delay disclosure.
I remember a case involving a woman in her sixties who had met a man through a dating app. They had both been drinking, and afterwards she felt intensely ashamed about the position she had put herself in. It took her four days of going back and forth before she came in. She didn’t want anyone she knew to find out. She felt used, and felt that her vulnerability had been taken advantage of. Women of all ages should be safe using these apps.
Trauma and mental health are complicated. Sometimes older women are disclosing something that happened long ago. Other times I have seen women who are very mentally unwell and sincerely believe they are being harmed, and it can be difficult to interpret what is happening.
Older survivors often hesitate more and feel greater shame discussing anything sexual. And for some vulnerable women—particularly those who are homeless—there are often more pressing needs, such as simply finding somewhere safe to live, before they can even begin to address what has happened to them sexually.
When an alleged incident occurs in aged care, staff need to take a stance of “if it could have happened, treat it as though it did.” Their role is not to investigate—that is for the police—but to report concerns, address immediate medical needs, and refer for support. Past trauma can shape a woman’s account even if the current incident is unclear, and that history still requires care and support.
We didn’t have active engagement with aged-care providers as a routine pathway, and I don’t recall many cases being referred from aged care. There is one I remember involving an older woman who lived with her son, who was her carer. He was responsible for washing her, and was allegedly very rough, even punching her in the genitals. She found this deeply degrading.
We couldn’t find conclusive evidence to support that the assault had occurred, and she was directed into alternative care pathways. We always try to find DNA if it is possible, but DNA can be short-lived. Many assaults involving fingers or objects leave no injury and often no DNA, unless something can be found on clothing, sheets, or the perpetrator’s belongings. Even then, it may not be conclusive in a legal sense, which can leave victims feeling disbelieved.
I’ve also found that women assaulted with a finger or object, or forced to perform oral sex—particularly anal assault—can feel even more degraded than by penile penetration. They may feel used, confused, worthless and may never disclose this to anyone. Cognitive impairment can make things even more difficult, limiting the detail or clarity of the account and complicating the gathering of evidence.
Throughout my work, each situation required sensitivity, patience, and an understanding that women’s responses—including delays, shame, uncertainty, or fragmented accounts—were shaped by complex histories, pressures, and vulnerabilities. My role was always to provide a safe environment, gather what evidence we could, and ensure they had support, whether they chose to take the matter further or not.
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