Not surprisingly, I have heard from many of you in the last 24 hours about your worries and concerns–there is a lot of angst about how many of you either work in facilities where patients are denied access to emergency contraception because it’s a religiously affiliated hospital or you’re hearing stories from others. There’s a lot to unpack here, and I can’t tackle all of it in this post, but I want to start with worst case scenarios. It’s never the ideal to have patients paying for/getting their own EC after a medical-forensic exam (it actually infuriates me that it still happens), but knowing that’s a reality, I did a search online for current prices, and here’s what it looks like for patients who must pay out of pocket at the biggest national retailers:

For those folks purchasing Plan B One-Step, the manufacturer has an online coupon that can be redeemed for $10 off. Still costly, but if that’s the only brand your pharmacy carries, it’s not nothing.

Now, I am aware many of our patients don’t have even 10 extra dollars. I am aware some of our patients don’t have access to pharmacies in their area. I am aware that some states allow pharmacists to refuse to sell EC. I am aware some will refuse regardless of what the law allows. There are a lot of barriers out there. But there are some things we as clinicians can do:

1. Know what’s available in your area and provide patients with regularly updated, accurate information. That should be part of the discharge plan.
2. Instead of raising all your money for shiny new equipment, consider putting some of those dollars into store gift cards for patients who need to access EC but cannot get it from your agency. Ensure patients have a way to get there right after or have someone who can go get it for them. [Related: when people ask if they can donate items to your program, yes, gift cards.]
3. Make sure you and your team are working with the most accurate science and know the current public policy issues related to EC. Guttmacher is my trusted resource for all thing policy. In regards to science, know what the research says about timeframes, potential weight impacts, and other considerations for the various types of EC. I am not providing you with a full research review on this (yet), but I have found articles like this one to be helpful in understanding the current evidence base.
4. Ensure that all patients who can become pregnant are being offered EC. In this, the year 2019, it is frustrating that we must remind folks that people of all genders can become pregnant. Just because someone does not look like your idea of a pregnant person does not mean they cannot become pregnant. Just because someone is taking testosterone does not mean they cannot get pregnant. We need to ensure that our trans-/nonbinary/gender non-conforming patients are screened for pregnancy exposure, too.

This space will contain a lot on EC (and abortion) access in the coming months because what’s happening here in the US has a very real impact on our patients and our practices. We need to be having a national dialog on what this means moving forward, but all of you should be having these same conversations at the local level because that’s where much of the work will be done. I welcome suggestions for future topics of concern and question. And much as I love all of the private messages I get, it wouldn’t kill you to use the Comments section so others could benefit from your feedback 😉 [I know–after 10 years, I should be used to the fact that the Comments section is the least used section of this website. But a girl can hope.]

ADD: Transphobic garbage has me linking to an article in point #4, as if I should even have to do that. It’s but one example in the medical literature. I’m annoyed I have to even justify the statement, but I guess some folks are going to engage in nonsense, so here we are.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Well, the news isn’t great. Alabama has become the latest state to pass a near abortion ban, and it’s time we talk about what this means for our patients in the US, because it’s certainly not something we can ignore.

For now, at least, abortion is still legal in all 50 states, so let’s begin there. But as (predominantly male, non-physician or nurse) legislators chip away at abortion access, the question needs to be asked: how does this change the way we counsel patients about emergency contraception? Should we be ensuring we can offer copper IUDs for women who are concerned that their weight may make Ella or Plan B less effective? Do we need to have far more nuanced conversations with our patients who can become pregnant about EC and subsequent options if pregnancy occurs? Pregnancy tests are expensive, so will we offer follow up testing for pregnancy to ensure that the EC worked, just to make sure any EC failure is caught prior to the 6-week cut-offs (assuming they end up being the threshold)?

Abortion is incredibly personal, but access to abortion should not be. Regardless of the decisions we might make if faced with an unplanned pregnancy, every single patient who has the potential to become pregnant deserves a clinician who will provide full-throated advocacy for their right to not be if that’s what they want. And laws that would punish clinicians for terminating the pregnancies caused by rapists more harshly than the actual rapists is such absurdity it’s hard to even type that sentence. It’s time, as a profession, to have some very real conversations about what it looks like to provide patient-centered care in the face of laws that are anything but.

If you have the means to donate some cash to support organizations doing the work of keeping abortion safe and legal for everyone in the US, consider:

https://yellowhammerfund.org/

https://sistersong.nationbuilder.com/donate

https://abortionfunds.org/

https://prochoice.org/about-naf/support-naf

(or add some of your favorites in the Comments)

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download. Plus, coming soon: the newest research compilation, Applying The Strangulation Research To Expert Testimony In Cases With Adult Victims.

Evidentia Publishing (publishers of the IAFN Pediatric Strangulation Case Review and Assessment) and MobileODT are co-hosting a webinar May 14th at 2pm ET, Teen Sex Trafficking: Recognizing the Signs and Creating a Safe Space for Disclosure. I haven’t attended any of their offerings before so I cannot tell you much except that it is an industry-sponsored event, for what that’s worth. I would expect some product promotion, but hopefully, there’s also some quality content contained in the session:

The average age of a victim’s entrance into sex trafficking is between 12 – 14 years old. At this developmental stage, teens are especially vulnerable to traffickers and may not even realize that they are victims of trafficking.

So how can healthcare professionals recognize the signs of sex trafficking and create a safe space for disclosure?

Our live webinar (co-hosted by MobileODT and Evidentia Publishing) featuring leading child abuse expert, Jordan Greenbaum, MD, Medical Director of the Global Health and Well-being Initiative with the International Centre for Missing and Exploited Children, is not to be missed. Be a part of the learning experience – get answers from experts and feedback from peers on this critical issue!

Gain knowledge in:

• Definitions and signs of sex trafficking in teens – what in adolescent development makes them vulnerable
• Using a trauma informed approach with adolescents in healthcare settings
• How forensic exams and medical documentation may be different for this population

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

SAFEta has a webinar coming up next month, Demystifying Care of Patients with Mental Illness Following a Sexual Assault. The session will be held June 10th at 2pm ET. As with all of their offerings, it will be archived in case you can’t attend live. From the website:

Recent research suggests that up to 40% of patients who present for care following a sexual assault have some history of mental illness. But there has been limited academic work that examines unique considerations that may arise when caring for this patient population. How do we best provide medical care and forensic services for patients with mental illness in the acute setting following a reported sexual assault? How do we determine when it is, and is not, appropriate to offer a sexual assault medical forensic exam (SAMFE)? In this webinar, an interdisciplinary panel of SANEs and psychiatrists will highlight some of the challenges faced and questions that may arise, including:

– What does the research suggest about prevalence of various mental illness among victims of sexual assault? What is the relationship between experiencing trauma and developing symptoms of mental illness? What are the practice implications?

– What are some circumstances in which a patient’s mental illness may limit their capacity to consent an SAMFE? How should we perform capacity assessments in these patients?

– What signs and symptoms of mental illness may not preclude capacity, but otherwise interfere with the SAMFE? How can we conceptualize other factors of a patient’s presentation when assessing whether the SAMFE is appropriate?

– What are some approaches that can be used when providing a SAMFE to a patient with mental illness, to facilitate delivery of compassionate and safe care?

Register for the webinar here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

We can’t update Part II and not update Part I, so here’s the updated clinical guide, Use of ALS to Identify Fluids on the Body. There’s much less new here, but it’s nice to be complete. Let me know if I’m missing something, but I think all the peer-reviewed literature is there. Please don’t read one clinical guide without the other–much of what is contained in the ALS for Bruising guide is applicable, particularly as it concerns understanding the underlying science of how ALS works and its limitations.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

Victim Rights Law Center has a webinar coming up on one of my favorite topics–patient privacy. That will be the focus of the session, Identifying and Protecting Survivors’ Privacy Rights: Schools, SANEs and Student Survivors, which will be held May 16th at 1pm ET. It’s a topic that’s pretty relevant to my work right now, and I know I’m not the only one. The always excellent Kim Day and Jesse Mindlin will be presenting, so try and attend if you can. I imagine it’ll be archived, but I don’t have fidelity on that yet. From the registration page:

During this webinar, Jessica Mindlin and Kim Day will discuss unique privacy issues campus sexual assault survivors face. Objectives include: outlining care-related privacy issues a survivor may confront post-assault; describing SANE privacy obligation when providing care to student survivors; and identifying and anticipating medical forensic exam-related privacy considerations for student survivors and the sexual assault examiner who provides their assault-related care.

You can register here.

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.

A few new updates re: STDs (since April is STD Awareness Month, in addition to Sexual Assault Awareness and Child Abuse Prevention Months)

There’s new surveillance data out from the CDC on extragenital chlamydia and gonorrhea infections in men who have sex with men, and it’s certainly relevant to sexual assault practice, so if you haven’t read the report, you can find it here. The study’s limited in that it only includes samples from 5 cities (and it’s critical you know what the incidence and prevalence rates are in your own service area), but it’s a good reminder that we need to consider more than just potential genital infection.

Not so coincidentally, I noticed IAFN posted this report to their social media pages today–apparently once again we can blame it on the hive mind. I haven’t had the opportunity to read it yet, but I’m about to get on a plane, and nothing says leave me alone like a report with the words syphilis and gonorrhea in the title 🙂

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Have you checked out the FHO store lately? You can find our newest research brief, Aging Bruises Based On Color, plus our original guide, Injury Following Consensual Sex. Both available now for electronic download.