**7. Medical examination and evidence collection**

The characteristics of sexual assaults as well as the victims' psychological capability are dissimilar and variable. Therefore, special care has to be given to each case individually. The physical examination is performed by a forensic pathologist and/or a gynecologist assisted by a forensic nurse having a master degree in Forensic Sciences. The injuries as well as the points of possible evidence traces are documented by external and internal examination. The victim is informed about her/ his right to stop the examination at any point. We have already developed a standard sexual assault kit that is used by our doctors in evidence collection. The kit contains all the required material for a correct collection of evidence. Nevertheless, it is very well known that every rape case may have its own characteristics, and further material may be required [25]. We are in a position to provide any additional equipment to document and collect evidence, both in the laboratory and in the hospital, the function of which will be explained later.

The generally accepted evidence collection period for evidence in sexual assault cases is within 72 hours [21, 22, 26]. However, the evidence identification and individualization techniques that are available today are highly developed, and DNA technology can reveal excellent results for trace amounts of material like a bite mark or even fingerprint [27–31]. Hence, careful pre-examination is essential for satisfactory collection. Apart from the physical and biological evidentiary material that is collected, samples of blood and urine are taken for further examination of pregnancy and sexually transmitted disease. In case that the blood and urine examination show positive results as for pregnancy, hepatitis, HIV, or any other sexually transmitted disease, the proper treatment is suggested and one-to-one counseling is offered. A regular psychological or medical treatment is given for all the cases for which the diagnosis is positive.

Although the evidence collected is analyzed in the various laboratories within the center, a secure chain of custody is followed [32]. The collected biological specimens are air-dried and placed in containers that are numbered according to the given case number. Cross contamination is maximally avoided [33]. In some cases, the victim is not ready to pursue; in these cases, the sexual assault kit that includes the collected biological material is kept according to the preservation protocol of the related laboratory.

The victim has no obligation to handle the collected evidence and transfer it anywhere. The center undertakes the responsibility to send the collected evidence to the appropriate laboratory for analysis. The laboratories that are functioning in the center are: DNA and biological evidence, toxicology, trace evidence, forensic anthropology, and andrology. The evidence-related report that comes out from the laboratories is sent to court-related services or to law enforcement, depending on the specificity of the case.

There is a well-reported relationship between rape, alcohol, and substance use in recent studies. The sexual assault may be drug facilitated in some cases [34–36]. The victim in such cases is unable to consent because of drug effects. The alcohol and/or drug use in these cases may be voluntary or involuntary. In both ways, this effect increases the severity of the crime, and its existence has to be indicated by analysis. That is why, a complete toxicology laboratory is established in the center.

In case the victim needs further medical care because of physical injuries, the center collaborates with the university hospital, which is a full-scale multitreatment hospital. All the diagnosis and treatment stages of a person who has been subjected to physical and/or sexual violence are being taken care in this facility. We have established a Forensic Science Department in the hospital supplemented with specially appointed and trained personnel for necessary evidence collection, forensic interview, etc. Anyone who has been raped can access the Forensic Science Department to be directed to emergency services and enter the one-step procedure. The main center and the hospital give a 24-hour telephone information and support. As a result, emergency response, examination, collection of evidence, assault report, giving testimony (history), psychological support, and notification to the forensic units, taking a shower, or providing clothing when necessary are realized both in the main center and the Hospital's Forensic Science Department. Such an interdisciplinary effort enables the detection of suspects or criminals in physical and sexual violence crimes and supports the victims by providing accommodation after violence, economic support, job opportunities, and legal aid, etc., by a cooperation that has been developed with the municipalities of Istanbul. The municipalities are centers where violated victims apply easily if they do not want to be involved in applying to law enforcement units, and they are the institutions that have the availability to support and protect the victims. Therefore, a close collaboration with them appeared to be vital for helping the victim.
