"This is a huge prosecutorial hurdle to overcome," she says. "It's one of those details that you walk into court expecting to have to testify to, and you tell the prosecutor to ask that question specifically, so I can tell the jury that no visible injury does not mean there was no trauma." In fact, she points out, vaginal injury is just as likely to occur as a result of consensual sex, so even when there are injuries, they aren't evidence of a crime.
Meanwhile, the injuries that victims should worry about are ones you almost never see on TV. "Interesting fact: If an assault, sexual or otherwise, involves strangulation, it is automatically deemed a felony offense," Amanda says. That's because even brief strangulation can lead to damage you don't even notice until much later. "When a person loses consciousness from strangulation, this is often caused by micro strokes in the brain," she explains. "These tiny strokes can often only be detected on CT or MRI, and can be deadly. Even if they don't kill you today, the cumulative effect is that of a traumatic brain injury and can lead to lifelong deficits."
Procedural crime dramas don't really brace you for that part.
That's why Amanda and other specially trained medical professionals always check for strangulation, even if the victim is pretty sure they would remember that kind of thing. Often they don't, Amanda says, and often the only sign is a thumbprint bruise behind the earlobe or broken blood vessels in the eyes, ears, or mouth. In other words, a lot of places you can't see on yourself. This is one reason Amanda is adamant about victims going to the hospital afterward, even if they think they escaped the attack unharmed.