Sexual Assault Forensic Exams (SAFEs) Pre- and Post-COVID-19: A Retrospective Analysis of SAFE Rates and Sex Differences

Background Sexual assault forensic exams (SAFEs) provide comprehensive physical and mental health care services after sexual assault (SA). During the COVID-19 pandemic, rates of SAFEs were lower in many hospitals and rebounded in the months following the initial shutdown. However, no examinations of changes in SAFEs five years postpandemic in the United States (U.S.) have been published to our knowledge. Aim To evaluate SAFE rates in a Southeastern hospital in a state that enacted limitations for a brief period during the COVID-19 pandemic. Methods SAFE rates were descriptively examined for the four years before and following COVID restrictions. Results One hundred eight more SAFEs were performed in the four years pre-COVID restrictions (Total SAFEs March 2016-February 2020 = 851; mean annual SAFEs = 212.75) compared with the four years post-COVID-19 restrictions (total SAFEs March 2021 to February 2025 = 743; mean annual SAFEs = 185.75). Results from analyses stratified by sex assigned at birth indicated that annual SAFEs among survivors assigned female sex at birth were lower during the four years post-COVID-19 (mean annual SAFEs March 2021 to February 2025=176.5) compared with the four years pre-COVID-19 (mean annual SAFEs March 2016 to February 2020=199.5). Annual SAFEs among survivors assigned male sex at birth were also lower during the four years post-COVID-19. However, there was a small sample of male survivors with high annual variability across all time periods, limiting the interpretation of these results. Discussion Observing fewer SAFEs indicates potential changes in help-seeking following SA in our community. Multisite research studies are needed to better understand trends in SAFE utilization in the U.S.