The emergency department staff is typically responsible for initially responding to the sexual assault survivor, including taking vital signs and treating any serious injuries prior to the arrival of the SANE. Whenever possible, the physician should wait to treat injuries until after the SANE documents injuries with pictures and collects evidence. Although there is still significant variation in what and how evidence is collected, even within the same State, the literature agrees on the following components: obtain written consent; take an assault history that includes orifices where violence was used or penetration occurred and by what, and forms of violence used and where; obtain pertinent medical information, including allergies, current pregnancy status, and menstrual cycle; conduct physical exam for trauma and areas of tenderness; examine involved orifices for trauma and to collect sperm and seminal fluid; collect any foreign matter present; comb the pubic hair for foreign hair and matter; complete fingernail scrapings; collect the survivor's blood for type and DNA screen; collect saliva for secretor status; and collect torn or stained clothing. Most protocols recommend that evidentiary exams be completed within 72 hours after a sexual assault. This paper provides greater detail on DNA evidence, seminal fluid evidence, sexually transmitted infections, pregnancy, crisis intervention and counseling, nongenital injuries, genital trauma, blood evidence, urine evidence, maintaining chain-of-evidence, maintaining evidence integrity, documentation, and post-exam procedures. A 59-item bibliography