Why Domestic Violence, Non-Fatal Strangulation, and Forensic Medical Exams Matter

From Debra Higgins, RN SANE A, SANE P, SafeHouse Forensic Medical Services Director

Domestic violence can happen behind closed doors, leaving survivors with physical injuries, emotional trauma, fear, and uncertainty about what to do next. Raising awareness is essential because understanding abuse can help communities recognize warning signs, respond with compassion, and connect survivors with the care and resources they need.

One area that deserves particular attention is non-fatal strangulation.

Non-fatal strangulation occurs when pressure is applied to the neck and interferes with breathing or blood flow. It can occur during domestic violence and may leave little or no visible injury. A person may appear physically well while still having experienced a potentially serious medical event.

That is why awareness matters.

The Importance of a Forensic Medical Examination

After an assault, a forensic medical examination can be an important part of a survivor’s care. The examination is not simply about collecting evidence. It is first and foremost about the survivor’s health, safety, dignity, and choices.

A forensic nurse or other appropriately trained healthcare professional can assess the survivor for injuries and symptoms, including concerns that may not be immediately visible. In cases involving non-fatal strangulation, careful assessment is especially important because some injuries or complications may not be apparent from the outside.

During the examination, the healthcare professional may:

• Assess and treat injuries and other medical concerns.
• Ask questions about what happened and document the survivor’s account.
• Carefully document physical findings.
• Photograph or otherwise document injuries when appropriate and with consent.
• Collect forensic evidence when indicated and when the survivor chooses to proceed.
• Explain medical findings and recommended follow-up care.
• Provide information about advocacy, safety planning, and community resources.

The examination can also provide something that is just as important as the medical care: a sense of control.

A survivor should understand what is happening and why. Whenever possible, they should be given choices about the examination and have the opportunity to ask questions, pause, or decline portions of care.

For someone who has experienced domestic violence, having control over their own body and decisions can be an important part of trauma-informed care.

When Injuries Cannot Be Seen

One of the most important messages we can share about non-fatal strangulation is that the absence of visible injuries does not mean there was no injury.

Survivors may experience symptoms involving breathing, swallowing, voice, vision, memory, or other functions. Some concerns may require prompt medical attention.

A forensic medical examination allows trained healthcare professionals to listen carefully, assess the survivor, document what is observed, and provide appropriate medical recommendations.

It also creates an opportunity for the survivor to be connected with an advocate who can provide emotional support and help navigate available resources.

Evidence Matters, But So Does the Person

A forensic examination may preserve information that could be important if a survivor later chooses to participate in a criminal or civil process. However, the examination should never reduce a survivor to evidence.

The survivor is the priority.

Whether someone chooses to report to law enforcement, pursue legal action, leave an abusive relationship, or simply seek medical care, they deserve to be treated with respect and without judgment.

There is no single path to healing.

Awareness Can Save Lives

Community awareness can change how we respond to domestic violence.

It means understanding that abuse is about more than physical injuries. It means recognizing that non-fatal strangulation is serious even when there are few visible signs. It means knowing that survivors may face complicated barriers to leaving and that asking, “Why didn’t you leave?” can add to their isolation.

Instead, we can ask:

“How can I support you?”

We can listen without judgment.

We can believe survivors.

We can learn about local resources.

We can encourage medical care when appropriate.

And we can support access to forensic medical examinations provided by trained professionals.

Forensic nurses and other healthcare professionals have an important role in this work. They bring together medical care, careful documentation, advocacy, and compassion at a time when a survivor may feel frightened or overwhelmed.

A forensic medical examination cannot erase what happened.

It cannot undo the trauma.

But it can provide medical care, document important findings, preserve options, connect survivors with support, and remind someone that their health and well-being matter.

Domestic violence awareness is ultimately about creating a community where violence is recognized, survivors are believed and supported, non-fatal strangulation is taken seriously, and every survivor knows that compassionate help is available.

One conversation can raise awareness.

One informed healthcare professional can make a difference.

One forensic medical examination can provide an important opportunity for care, documentation, and support.

And one community standing together can help ensure that survivors do not have to face the aftermath alone.