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They are able to conduct a focused medical-legal exam. This can be perpetrated by the rapist, friends, or relatives of the rapist. Using colposcopy has increased the detection of internal trauma from six percent to fifty-three percent. If such a trained clinician is not available, the emergency department has a sexual assault protocol that has been established for treatment and the collection of evidence. Dried semen that is on clothing and skin can be detected with a fluorescent lamp. Immediately following a rape, the survivor may react outwardly in a wide range of ways, from expressive to closed down; common emotions include distress, anxiety, shame, revulsion, helplessness, and guilt. This is especially the case in cultures where female virginity is highly valued and considered mandatory before marriage; in extreme cases, rape victims are killed in honor killings. This may become a source of shame and confusion for those assaulted along with those who were around them. Chlamydial and gonococcal infections in women are of particular concern due to the possibility of ascending infection. Maintaining the Chain of evidence from the medical examination, testing and tissue sampling from its origin of collection to court allows the results of the sampling to be admitted as evidence. The presence of infection is determined by sampling of body fluids from the mouth, throat, vagina, perineum , and anus.
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