First Weeks After Sexual Assault: Unveiling the Lived Experiences of Norwegian Survivors

Abstract

Sexual assault is associated with severe consequences for survivors, especially in the initial time following the assault. This study contributes to the literature by interviewing 13 survivors in Norway 2 to 4 weeks after a sexual assault to understand their daily lives during this critical, yet understudied, time. Survivors’ lived experiences were explored through a hermeneutic phenomenological analysis focusing on their personal perspectives and the meanings they ascribed to this period. Three essential themes emerged from analysis: The first theme, Losing ground, highlighted how difficult emotions, such as a sense of losing control, disrupted basic needs, while the second theme, Adapting to a changed life, captured survivors’ longing for their pre-assault lives while confronting their new realities. The third and last theme, Where to go? exposed the challenges survivors faced in accessing comprehensive psychosocial support in the Norwegian healthcare system. These early experiences may further elucidate how sexual assault acutely impacts survivors as well as why survivors sometimes struggle to seek, or follow up on, treatment and underscore the need for both immediate and continuous formal psychosocial support in Norway. The findings of this study thereby have significant implications for understanding and enhancing knowledge about survivors’ experiences in the initial weeks following a sexual assault.

Introduction

Sexual assault affects many people worldwide (Dworkin et al., 2021; World Health Organization, 2013). In this study, we used the overarching term “sexual assault” to encompass all forms of non-consensual and coercive sexual acts, including but not limited to rape. Sexual assault is not only a public health concern but also a criminal act and human rights violation with significant consequences for the individual, their relationships, and society (Dale et al., 2023; Dworkin & Schumacher, 2018; Dworkin et al., 2021; World Health Organization, 2013). Being exposed to sexual assault can be a life-altering experience with both immediate and long-term consequences, profoundly affecting survivors’ physical, emotional, and social well-being (Dworkin et al., 2017; Koss et al., 2020; Schou-Bredal et al., 2022).

The immediate time following sexual assault, referring here to the first days and weeks post-assault, is generally considered challenging (Dworkin et al., 2023; Reeves et al., 2024). During this time, survivors may experience, for example, shock, fear, anger, guilt, shame, and social withdrawal (Koss et al., 2020; Reeves et al., 2024). Even though Post-traumatic stress disorder (PTSD) cannot be diagnosed until after 4 weeks (American Psychiatric Association, 2013), a recent meta-analysis of 22 unique samples shows that many survivors display severe PTSD symptoms within the first month of the Sexual Assault (SA) and that 74.58% of survivors met diagnostic criteria for PTSD at the first month following SA (Dworkin et al., 2023).

Additional immediate health risks include sleep problems, physical injury, and pain, sexually transmitted infections, and pregnancy for women (Campbell et al., 2003; World Health Organization, 2013). Although these feelings and reactions are considered relatively universal, it is well known that the impact of sexual assault is individual and deeply influenced by factors related to the survivor, the perpetrator, the assault, and the broader social environment, such as available support, stigma, and access to care (Campbell, Dworkin, & Cabral, 2009). These immediate health risks, reactions and patterns highlight the relevance of trauma-informed care, which recognizes the pervasive impact of trauma and calls for services built on safety, trust, collaboration, choice, and empowerment (Levenson, 2017).

This study was conducted in Norway, a country often highlighted for its strong welfare system and commitment to social and gender equality (Saunes et al., 2020). Nevertheless, sexual violence remains a significant public health concern (Dale et al., 2023). A recent population-based study found that 22% of women and 3% of men have experienced rape in their lifetime. Yet, only 1 in 5 cases are reported to the police, often due to fears of not being believed or concerns about social consequences, and just 1 in 10 survivors seek help from the healthcare system afterward (Dale et al., 2023; Jørgensen et al., 2018). These figures suggest that sexual assault remains highly stigmatized, even in a society with progressive gender norms (Dale et al., 2023; Jørgensen et al., 2018).

Norway currently has 23 Sexual Assault Centers (SACs), which are integrated into the public healthcare system and located either within hospitals or in municipal emergency units. The SACs provide acute-phase care after sexual assault, including medical examinations, forensic evidence collection, psychosocial support, and some follow-up services. Norwegian SACs are staffed by multidisciplinary teams comprising physicians, nurses, and social workers, with considerable variation in staffing and resources between larger urban centers and smaller rural units. While personnel receive local training, they are also offered national courses in forensic examination, psychosocial support, and trauma-informed care.

The availability of resources and expertise varies considerably across locations, particularly regarding psychosocial follow-up in the period following the acute consultation (Johnsen et al., 2024). In Norway, survivors are not required to obtain a referral or file a police report to access SAC services. They may attend by presenting in person or contacting the center by phone. Upon arrival, survivors are typically first seen by a SAC nurse, followed by a medical and/or forensic examination conducted by the on-call physician. Both medical and forensic examinations are contingent upon informed consent, and survivors may choose to consent to only specific components of the services offered. The primary purpose of the medico-legal examination is to collect forensic evidence and document physical injuries, which may be relevant in the event of a subsequent police report. Due to the country’s small population (approximately 5.5 million) and large geographic area, many SACs serve rural communities and handle fewer than 50 cases annually. In contrast, larger centers, such as the one in Oslo, see up to 800 patients per year (Johnsen et al., 2024). Overall, the number of consultations at SACs has increased by 72% over the past decade, underscoring the growing demand for these services.

Despite this increase in SAC consultations, research documenting survivors’ experiences of sexual violence and post-assault care in Norway remains severely limited, particularly in the acute phase. Recently, however, studies such as the EIR study (Haugen et al., 2024), the Trust study (Thoresen, 2021), and a study by Haugan et al. (2025) focusing specifically on survivors experiences during the acute consultation at SACs have brought renewed attention to survivors’ early-phase needs and helped highlight the importance of centering survivors’ voices. Together with the present study, these efforts reflect a growing awareness of the need to adapt care systems to survivors lived realities.

Qualitative research is well suited to explore lived, embodied experiences (van Manen, 2014), and is particularly valuable in capturing the voices of sexual assault survivors (Campbell, Adams, et al., 2009). Previous qualitative studies have highlighted the difficult emotional landscape that survivors navigate in the aftermath of sexual assault (Dundas et al., 2021; Heath et al., 2011; Hutschemaekers et al., 2019; Rufa et al., 2022; Haugan et al., 2025). These emotional challenges strongly shape survivors’ willingness and ability to disclose, even though disclosure is often regarded as a gateway to support (Ahrens & Aldana, 2012; Ahrens et al., 2007; Ullman, 2023). However, many survivors choose not to disclose due to fear, self-blame, or stigma (Caswell et al., 2023; Resnick et al., 2000; Ullman, 2007; Zinzow et al., 2022). In navigating this landscape, many survivors struggle to reconcile their need for emotional and practical support with a desire to maintain autonomy and control over their daily lives. This need for control is particularly salient because sexual assault itself often entails a profound loss of power and agency (Campbell, 2013; Dundas et al., 2021; Lorenz et al., 2019; Starzynski et al., 2017; Stewart et al., 2024).

While previous qualitative studies have provided valuable insights into several aspects of survivors’ experiences, many have focused on specific elements of the aftermath, such as disclosure (Ahrens & Aldana, 2012), barriers to help-seeking (Zinzow et al., 2022), or evaluations of medical forensic procedures (Fehler-Cabral et al., 2011; Stewart et al., 2024). As Stewart et al. (2024) note in their scoping review, there is relatively little research capturing survivors’ firsthand experiences in the initial period following sexual assault, including but not limited to the medical forensic examination. Attending survivors’ voices in this early phase is particularly important because this is when their sense of agency and safety is most disrupted, and when care systems have the greatest opportunity to support recovery. Current literature often overlooks how survivors themselves experience and navigate the first weeks, leaving critical gaps in understanding how services can be better adapted to meet their needs. As Campbell, Dworkin and Cabral (2009) emphasize, sexual assault is embedded in both space and time: prevailing cultural norms influence how survivors experience an assault and what support is available, while the personal meaning of the assault evolves over time and is shaped by survivors’ prior experiences, including earlier trauma.

Building on this gap and guided by these insights, the present study explores how survivors in Norway navigate the first 5 weeks after an assault and how they make sense of the emotional, social, and practical changes during this period. By exploring survivors lived experiences, we aim to gain knowledge that can inform more responsive and trauma-informed post-assault care. To address this aim, we explored two research questions: (a) the acute consultation and (b) the experience of the initial time following the assault. In this study, the term “first weeks following sexual assault” refers to the acute post-assault period within 5 weeks of the incident. The first research question has been answered in a recently published study (Haugan et al., 2025).

Methods

This study was anchored in a phenomenological framework. By exploring individuals’ lived experiences, which refer to their personal and subjective encounters with life events, it is possible to gain insight into how phenomena, such as the first weeks after a sexual assault, are experienced. Van Manen’s (1997, 2014) “phenomenology of practice,” can provide a lens for understanding how people experience health and illness in a deeply personal and embodied way. Thomas Fuchs has extended this framework by highlighting the inseparability of mind, body, and lived experience, offering deeper insights into how bodily feelings shape our perception of the world (Fuchs & Schlimme, 2009; Ratcliffe, 2008). Fuchs particularly emphasizes the importance of mind, body, and lived experience in the context of trauma (Fuchs & Schlimme, 2009).

Recruitment and Participants

Survivors were recruited from four Norwegian SACs. Inclusion criteria required survivors to be over 18 years old and to have consulted a SAC within 1 week after the assault. Recruitment occurred during a follow-up consultation, typically scheduled within 2 weeks of the initial SAC visit. For the purposes of this study, it was particularly important that participants could reflect on everyday life 2 to 4 weeks after the assault. All interviews were conducted within 3 weeks of this follow-up, ensuring an interview window of maximum 5 weeks post-assault. A total of 13 Norwegian or English-speaking women aged 18 to 47 years (M = 24 years) participated in the study. Of the 13 participants, 9 were recruited from SACs located in urban areas and 4 from SACs serving primarily rural populations. While participants were not selected based on gender, all who volunteered self-identified as women, based on their self-reported gender identity. No further information about gender identity was collected. All names are pseudonyms. All received a gift card (500 NOK/45 USD) to compensate for time and expenses.

All participants attended at least one follow-up consultation after the acute forensic medical examination. However, the type and extent of further psychosocial follow-up varied from no scheduled appointments to ongoing support and follow-up. Psychosocial follow-up varied considerably across participants. While a few were scheduled for brief follow-up at the SAC, typically two consultations, most had no formal plan in place after the acute visit. Some were awaiting specialist mental health care or had been referred by their general practitioner, while others continued existing psychological treatment initiated prior to the assault. Several participants were informed about external support services such as Norwegian Support Centres for Survivors of Sexual Abuse (NOK), a non-profit organization offering psychosocial support to survivors of sexual assault. However, it remained unclear to what extent these referrals resulted in concrete follow-up.

Data Collection

All interviews were conducted between January 2022 and December 2022 by the first author (S.H.), a nurse, sociologist, and PhD student with 15 years of clinical experience working with vulnerable patients. Each interview lasted between 60 and 90 min.

A semi-structured interview guide was employed, featuring questions such as: Can you describe your experience of life after your consultation at SAC? Can you describe what you do to cope with and manage this situation? How have you experienced the follow-up from the SAC? and How have your family and friends responded? Following recommendations for phenomenological interviewing, we aimed to be open and flexible, to understand and capture the participants’ lived experiences (van Manen, 2014). To achieve this, the interviews incorporated detailed, exploratory follow-up questions such as Can you elaborate on that? and In what way? (van Manen, 1997).

Data Analysis

S.H. transcribed all the interviews verbatim, enabling continuous reflection on the participants’ descriptions throughout the process (van Manen, 2014, p. 137). The analysis was grounded in van Manen’s hermeneutic phenomenological approach. First, several members of the author team (S.H., K.A., and M.K.) conducted a holistic reading of all transcripts to identify overarching themes related to the participants’ experiences in the first weeks following a SA. Next, S.H. wrote summaries of each transcript, highlighting preliminary themes that emerged from the data. To explore these preliminary themes in greater depth, two authors (S.H. and M.K.) reviewed them through assisted by the lens of van Manen’s five phenomenological existential dimensions: lived body, lived time, lived space, lived relations, and lived things (van Manen, 1997, 2014, 2017).

These existential dimensions, inspired by phenomenological philosophy, represent universal themes of human life. They are present across time, place, and cultural context and form part of every individual’s lifeworld (van Manen, 2014). When doing phenomenological reflections, van Manen (2014) urges to search for variation in imagination with questions like: “What does this mean?” or “What can it be like?.” During analysis, we tried to discover the structural existential features of the experience of the first weeks after having been sexually assaulted. Variation was searched for with questions like: “What is it like to leave the SAC after the examination,” “What is it like to come back to the apartment?,” and “What is different than coming home after an ordinary day.” Finally, all the authors (S.H., C.T.H., K.A., M.H.B., M.H., and M.K.) contributed to the further development of the themes through reflexive discussions and collaborative interpretation during manuscript preparation.

The analysis process continued with interpretations of the results moving back and forth, returning to the data to modify or confirm the essential themes that shape the findings (van Manen, 1997, 2014). The manuscript for this study has been developed in accordance with the COREQ checklist for qualitative studies to ensure transparency, rigor, and methodological quality (Tong et al., 2007). To enhance validity, interviews were analyzed by a multidisciplinary research team (i.e., nurses, psychologists, physicians). This interdisciplinary composition of the research team strengthened the study’s rigor by ensuring a variety of perspectives and critical reflexivity throughout data collection and analysis. In addition, this variation helped address blind spots and preconceptions (Malterud, 2001).

Ethical Considerations

This study was designed in accordance with the Declaration of Helsinki (World Medical Association, 2025) and approved by the Norwegian Center for Research Data (SIKT Ref. 977881). Permission to carry out the study was obtained from the clinical director of each SAC where recruitment took place. The authors were aware of the sensitivity of the topic and the vulnerability of the participants (Bredal et al., 2024). Survivors were recruited from various regions and SACs in Norway to enhance anonymity. All participants provided written informed consent to take part in the study and to allow the publication of anonymized direct quotes. Participation was entirely voluntary, and declining to participate had no consequences for access to healthcare or follow-up services. Interviews were conducted with particular care to minimize potential harm (Short et al., 2024).

Interviews were conducted either in a private consultation room at a university, hospital, or at a SAC, depending on the participant’s preference. The location was chosen to ensure privacy and comfort, and participants were encouraged to select the setting where they felt most at ease sharing their experiences. The interviewer was attentive to ensuring that participants never felt pressured to answer, had ample time to respond, and that questions were balanced in tone and content. This included using open-ended, non-leading questions, allowing participants to set the pace of the conversation, and offering breaks whenever needed. Participants were offered follow-up by a designated healthcare professional; however, none reported immediate distress because of the interview. Prior research suggests that taking part in qualitative studies can be both empowering and meaningful, even when addressing traumatic experiences (Bredal et al., 2024; Burgess-Proctor, 2015; Campbell, Dworkin, & Cabral, 2009).

Findings

Three themes emerged from the survivors’ experiences in the first weeks after sexual assault: Losing ground, Adapting to a changed life, and Where to go? The three themes are described in the following sections.

Losing Ground

The first theme, “losing ground,” describes survivors’ sense of being destabilized in the immediate aftermath of the assault, capturing the loss of control over emotions, bodily responses, daily functioning (e.g., sleep, eating, work, study), and a diminished sense of safety and connection to self and others. The first weeks after the sexual assault were marked by difficult emotions that disrupted basic needs and created a profound sense of disconnection. Survivors described how their traumatic experience of being subjected to sexual assault caused a deep sense of loss of control, not only over what had happened, but over their bodies, emotions, and daily functioning. Sofia described the first weeks as follows: “I have lost myself, in a way, because now I am stuck with something, something I have no control over . . . He took away my dignity, in a way . . . He took away my control over my own life.”

In the first weeks after the assault, the survivors experienced both psychological and bodily disconnection, feeling numb and detached from themselves and their surroundings. Many reported they were unable to feel full joy or sadness, while others, in contrast, experienced emotional overload, what Olivia referred to as that feeling when you go bungee jumping: “That painful lump in your stomach, but without the fun afterwards.” These reactions left survivors physically and emotionally depleted, affecting their ability to sleep, eat, concentrate, or regulate daily rhythms. Birgit recalled:

I could hardly sleep at all, so my doctor and I decided I needed sleeping pills. I could not continue like that any longer [4 days after the assault] . . . I was struggling to calm down in this period after the assault. I have been on an adrenaline rush, but now I find myself completely exhausted with no energy.

Everyday life was no longer recognizable. Survivors who had previously managed studies, work, and social activities now struggled with basic tasks. To cope, several tried to maintain a façade of normalcy, avoiding acknowledgment of the assault and acting as if nothing had happened. This, however, required considerable emotional effort. As Lisa explained:

I constantly feel tired and drained of energy. Even when I engage in activities that usually bring me joy, I still find them exhausting. I must put on a facade when I am around others, even though they know my situation. Wearing this mask and maintaining the facade is incredibly exhausting.

Fear also played a central role. Survivors were preoccupied with the possibility of re-encountering their assailant, whether known or unknown. For many, this fear lingered and shaped their sense of safety in the world. Many survivors felt a constant dread that something similar might happen again, with several having already experienced multiple assaults, reinforcing their fears. Laura expressed it as follows:

I’m so frightened that it will happen again. When you go through anything like this, you lose control of your body and daily life. I walk around with continual concern about what will happen, and I’m not sure how long this will last.

Adapting to a Changed Life

The second theme captured how survivors’ lives, bodies, and relationships were profoundly altered after the assault, and how they struggled to adapt while longing for a sense of normalcy. Whereas the first theme described immediate destabilization and loss of control, this theme reflects the survivors’ attempts, sometimes successful, sometimes not—to recreate a sense of ordinariness in everyday life and regain control over themselves. The second theme captured the survivors’ longing for their pre-assault lives and their struggles to regain a sense of normalcy. Despite their varied situations, all the survivors described efforts to recreate a sense of ordinariness, reminiscent of life before the assault, believing this would help. Eva emphasized: “Getting back to work, was particularly important.” For Eva, returning to work was not only important because it provided a sense of normalcy but also a needed distraction from her thoughts: “It distracted me from myself.” Several of the survivors also described trying hard to prevent the assault from dominating their lives.

The survivors strove to let the positive aspects of their lives shine through and emphasized their appreciation for ordinary conversations. Several expressed a need for someone to be with them, like friends, and emphasized the value of maintaining ordinary social interactions, as Laura described in this reflection:

My friend and I talk quite a lot, and we talk about other things because I need that right now. I cannot talk about the assault all the time. I can’t sit and talk about it constantly; I need my daily life to be about something else. I’m trying to be mindful that it doesn’t take up too much space in my daily life.

At the same time, several survivors expressed a desire for time to rest, reflect, and be alone in their own home, to surmount such a life-altering incident. Tasks like taking a shower or being around people for extended periods were examples of situations that survivors found demanding. Sensory triggers like smells, sounds, and places that reminded them of the assault were also described as difficult: According to Sofia:

Regaining control of my life is what I struggle with the most. Small triggers can cause everything to fall apart. I can’t be around people for long, I can’t focus for extended periods, and I can’t shower without experiencing flashbacks. I feel dirty, like something has been taken from me. It hurts.

As part of regaining control over their lives, some survivors found that the assault had disrupted their intimate lives, and they described a desire to reestablish sexual intimacy on their own terms. For some survivors, the sexual assault disrupted their intimate lives, and they described a desire to reestablish sexual intimacy on their own terms. For a few, engaging in consensual sex became a way to regain a sense of control, reclaim ownership of their bodies, and “test” whether they still felt “intact.” For Kirsti, this meant choosing to have sex for the first time after the assault as a means of reclaiming control. She reflected:

I was determined to get back on the horse. I went out and had a few drinks . . . Then I chose to have sex again. It went well, and I felt in control of the situation. I wasn’t afraid, and it felt good. That experience was important to me.

Survivors wished for others to intuitively recognize their need for time to process emotions, without assuming they wanted to discuss the assault. Birgit expressed this as follows: “In the past two weeks, I have learned that I need time. I want those around me to understand why I am more fatigued now than before . . . I do not need to talk about the assault much.” At the same time, being alone was challenging for many survivors as it forced them to confront their feelings. Not all participants, however, had access to supportive friends or family, and some described feeling especially vulnerable when their social networks were limited or unreliable. They described how solitude led to doubt about their own perceptions of the assault, making them feel even more unsure and unsafe. Nora described it this way:

When I was alone, I fell into a vicious loop in which I began to doubt myself, what had truly happened, and lost the drive to continue. But then I tried to create a plan, meeting friends, going to training, knowing that routines benefited me.

While survivors recognized the importance of processing their emotions, the discomfort of being alone led to restlessness. Some survivors constantly arranged appointments to avoid being alone. As Eva put it: “It is about just doing things. Not sitting inside. I really don’t want to sit inside and get depressed.” However, the avoidance of being alone often interferes with essential needs like sleep and rest. Lisa described this struggle:

I hate being alone now; I need someone. I cannot fall asleep without my phone or watching TV, and I cannot handle the feeling of being alone in bed, so I must be completely exhausted when I go to bed to make sure I just sleep.

For some, being at home was particularly difficult because their home was the venue of the assault, making it feel like there were no safe spaces left. Being in that environment resurfaced memories, and even ordinary objects took on painful significance. Sara described how this affected her:

So, when he finally left my flat, I went directly into the shower and removed everything off the bed. I closed the door to the bedroom and haven’t returned there since [2 weeks]. Now, I am sleeping on the sofa in my living room.

Where to Go?

The third theme, “Where to go?,” captured survivors’ experiences with health and support services in the aftermath of sexual assault. This encompassed both the challenges of knowing where to seek help and the limitations of follow-up care, as well as survivors’ perspectives on what good care can look like when their needs were met. Survivors described uncertainty about available services, gaps in follow-up, and feelings of being left alone with their recovery, but also highlighted moments where support fostered safety and trust. The type and extent of support survivors received from SAC professionals varied considerably, shaped by factors such as the center’s geographical location (e.g., urban vs. rural) and whether the survivor had previous contact with mental health services. Several survivors were still awaiting access to mental health care at the time of the interview. Nevertheless, despite differences in their experiences, all survivors emphasized the importance of follow-up care, including acute medical attention, psychosocial support during the first few weeks, and prolonged psychosocial care. Sara described her experience as follows:

I feel that there has been little follow-up. The nurse [responsible for the forensic examination] at the SAC said that someone would call occasionally, but they have only called once in the last three weeks. So, perhaps there has been a bit of a lack of follow-up afterwards.

In addition to describing a lack of follow-up, several survivors expressed feelings caught between different parts of the support system, with no clear understanding of who to turn to. In Norway, post-assault care may involve a range of services beyond SACs, including municipal and state-funded healthcare providers, general practitioners, non-governmental support centers, and victim assistance units within the police. Another common barrier was long waiting times for psychological treatment, particularly within the specialist mental health services, where several participants reported being placed on waiting lists. Nora described:

I tried to contact a psychologist [at a public health service center], but they told me I needed to wait one year. Yesterday, I was told the mental health service [public health system] lacked information and couldn’t see any long-term effects yet, so I must wait another six months to get any help.

Nora’s experience reflects a system in which access to care, particularly in the publicly funded specialist mental health services, often depends on having a formal diagnosis or clearly documented symptom severity. These requirements appear to delay support during a critical period. Her case also illustrates the consequences of poor coordination between services. Information was not exchanged between providers, which meant that survivors like Nora had to start from scratch each time, re-explaining their situation to every new professional they encountered. Survivors frequently reported that this lack of communication between support units created an additional emotional burden. As Laura noted:

It is tough to deal with three separate “support services” at the same time: the SAC, non-governmental organizations, and the psychiatric ward. This leads to a lot of repetition of my story and status when all I truly want is to focus on improving my daily life.

Some survivors described the value of receiving professional guidance in the early aftermath of the assault, particularly support that helped them understand and articulate their emotional responses. Susan shared how a healthcare worker helped normalize her experience by outlining what to expect in the first few weeks, Susan explained: “She [healthcare provider] helped me articulate my feelings, especially by explaining the process: ‘The first week is like this, the second week is like that.’ She detailed the stages I was going through, which I found extremely encouraging.”

Survivors also emphasized the importance of continuity in care, particularly the ability to return to a familiar setting where professionals already knew their story. This not only reduced the emotional strain of repeating traumatic details but also fostered a sense of safety and being understood. As Ann expressed:

It was nice to return to the SAC and get consultations there in the weeks that followed [after the assault]. It was wonderful since they understood my story, so I did not have to repeat those awful parts, such as the unpleasant odor. It is quite helpful. They understood my thoughts well.

While some received this kind of supportive continuity, many experienced the opposite: fragmented care, unclear responsibilities, and inconsistent follow-up. The type and extent of support survivors were offered often felt arbitrary or difficult to access, particularly after initial contact with the SAC had ended. Survivors also described uncertainty about the seriousness of the assault, sometimes questioning whether it “counted” as sexual assault at all. This internal doubt shaped their decisions around reporting to the police, seeking help, or even feeling entitled to support, and was often reinforced by ambiguous pathways in the support system and mixed responses from others. Together, these factors left many unsure of where to turn or what kind of help they could expect, and in some cases contributed to disengagement from health services altogether.

Discussion

This study provides valuable insight into the initial aftermath of sexual assault, an understudied, yet critical period, by exploring how survivors attending SACs in Norway experienced the first weeks following the assault. Three main themes emerged: Losing Ground, Adapting to a changed life, and Where to go? These themes are briefly summarized and discussed in the following sections.

The first essential theme specifically highlighted how being exposed to sexual assault disrupted survivors’ ability to meet basic physiological and emotional needs. Many reported being physically depleted and emotionally overwhelmed, with some requiring prescription medication to manage sleep disturbances or anxiety. While previous research has described similar challenges (Campbell, 2008; Campbell, Dworkin, & Cabral, 2009; Dworkin, 2020), this study highlights how everyday life, bodily sensations, emotional states, and psychological responses may interact in the immediate aftermath of sexual assault, potentially influencing how individuals make sense of and cope with their experiences. Survivors described, for instance, how intense crying, feelings of dirtiness, or loss of control were used as evidence that the assault was “real,” even when self-doubt led them to question its seriousness.

Several survivors described a profound sense of disconnection from their bodies and the traumatic experience itself, reporting sensations of numbness, emptiness, and bodily discomfort. These accounts illustrate how trauma can fundamentally disrupt bodily awareness, especially when the body is experienced as the site of violation. Survivors’ accounts suggest that bodily sensations did not only reflect trauma but also shaped their meaning making of the assault; for some, feelings of numbness, emptiness, or dirtiness became evidence that “something had happened,” even when self-doubt made them question its seriousness. Fuchs’ theory of embodiment (Fuchs & Schlimme, 2009) helps to interpret and understand this phenomenon, emphasizing that our bodily presence forms the basis of how we experience, interpret, and engage with the world. Survivors’ descriptions illustrate precisely this: how trauma was registered and understood through the body, with sensations such as exhaustion, numbness, or being physically overwhelmed.

When trauma distorts the body-mind relationship, survivors may experience their bodies as an alien, fragmented, or unresponsive, a condition Fuchs describes as “disembodiment” (Fuchs & Schlimme, 2009). From this perspective, numbness can be understood as a loss of bodily resonance: the body’s diminished ability to respond meaningfully to the world around it. This also resonates with philosopher Finke’s (2023) notion of the traumatized body as one that “expresses trauma but struggles to articulate it,” a body that, in effect, becomes silent: unable to verbally convey what it has endured. This may be significant, as much of the literature on sexual assault sequalae has tended to focus primarily on psychological reactions alone or treated physical and psychological symptoms and reactions as separate entities and not intrinsically linked, as evident from the present study (Buchbinder et al., 2021; Hutschemaekers et al., 2019).

The second essential theme reflected survivors’ strong desire to return to life as it was before the assault, a longing for normalcy that often clashed with the emotional and existential weight of their new reality, as emphasized by Hutschemaekers et al. (2019). Many described the post-assault period as a difficult attempt to regain a sense of routine and stability, while simultaneously dealing with fear, emotional turbulence, and a heightened sense of vulnerability. Several survivors expressed a strong need to be alone to process what had happened. At the same time, spending time alone also proved emotionally challenging for some, as solitude could bring up difficult feelings or increase a sense of vulnerability. This reflects findings from Dundas et al. (2021), who highlight how survivors struggle to reclaim their sense of identity while navigating the delicate balance between seeking support and maintaining autonomy. Likewise, survivors in this study actively tried to re-engage with everyday routines, such as returning to work or school, as a way of restoring order and meaning. This aligns with research by Hutschemaekers et al. (2019), Haag et al. (2023), and Herman (2015), who, in different ways emphasize the role of structure, familiarity, and daily routines in supporting recovery. The desire for ordinariness and meaningful interactions also aligns with van Manen’s (2014) phenomenological view that everyday conversations help individuals make sense of experience, build connection, and counteract isolation. For many survivors, such conversations with people who did not treat them as broken were vital in re-establishing a sense of belonging and identity.

Informal support networks, particularly close friends, were consistently described as the most helpful source of support in the early aftermath among our study survivors. These everyday interactions often promoted a sense of normalcy, providing ordinary conversations and familiar routines that counteracted feelings of brokenness. This underscores survivors’ preference for interactions that feel genuine, familiar, and non-clinical, an echo of what Ahrens and Aldana (2012) and Dworkin et al. (2019) describe as the critical role of supportive social responses following disclosure. Positive informal support can offer emotional validation, help survivors feel less alone, and act as a buffer against trauma-related distress. Yet not all survivors in our study had access to such support, and their accounts illustrated how its absence increased feelings of vulnerability and isolation. This reliance on informal support also exposes a point of vulnerability. Survivors often depend on the strength, availability, and stability of their personal networks, resources that are unevenly distributed. Those who are socially isolated, marginalized, or economically disadvantaged may lack access to consistent, affirming support. Over-reliance on relational care thus risks reinforcing existing social inequalities, leaving the most vulnerable survivors with few or no pathways to recovery (Ullman, 2023).

The third essential theme highlighted a lack of clarity, consistency, and coordination in post-assault care, revealing systemic shortcomings that left many survivors feeling confused and unsupported. Although all survivors had accessed SAC, the quality and duration of follow-up care varied considerably. Many described this period as especially challenging due to profound physical and psychological distress combined with gaps in available services. Survivors reported inconsistent support, long waiting times, limited access to psychosocial care, and poor coordination between services. Navigating the system was described as overwhelming, and the lack of clear pathways hindered recovery. Survivors emphasized the need for both professional and informal support during this critical phase. Taken together, the findings illustrate both the value of coordinated, continuous support when it was available, and the strain caused by fragmented or absent care, underlining the unevenness of survivors’ experiences in follow-up.

This study also revealed geographic disparities in service provision, often reflecting differences between urban and rural areas. Despite national guidelines mandating referral systems for medical and psychosocial follow-up (Johnsen et al., 2024), and international recommendations from organizations such as the World Health Organization (2003), access to integrated care remains limited. A recent national report (Johnsen et al., 2024) found that only one in four SACs offer routine medical follow-up, and just half provide any form of psychosocial support. The report also points to a lack of national guidelines for psychosocial care, contributing to regional disparities and reinforcing systemic fragmentation. Given that SACs are intended to promote recovery and prevent retraumatization (Johnsen et al., 2024; O’Doherty et al., 2023), these findings raise serious concerns about the ability of the current system to meet survivors’ medium- and long-term needs.

Many survivors in this study described feeling abandoned and left to navigate the complexity of follow-up care on their own. This is particularly concerning given the long-standing knowledge that early crisis intervention can prevent long-term psychological and health problems (Caplan, 1964). Information flow between professionals was frequently lacking, which placed the burden of coordination on survivors themselves. These findings reflect a broader pattern also noted in previous research: sustained, personalized support is essential for building trust and promoting psychological recovery (Hutschemaekers et al., 2019). Tailored approaches are particularly important for survivors facing multiple adversities such as poverty, marginalization, or prior trauma (Bach et al., 2021; Steinbrenner et al., 2017; Yuen et al., 2021).

A growing body of literature underscores the importance of supportive, empathetic care from both formal and informal systems (Bach et al., 2022; Yuen et al., 2021). Yet the ability to provide such care over time depends on system stability and continuity in provider relationships. As Sandvik and Hunskaar (2024) argue, the retention of qualified healthcare professionals is essential to maintaining consistent care, particularly in rural and underserved areas. Ultimately, the fragmented nature of follow-up services not only fails to meet survivors’ needs but may also compel them to suppress their trauma and attempt to recover in isolation. This lack of support increases the risk of long-term psychological harm, including anxiety, depression, and post-traumatic stress disorder (Dworkin, 2020). Viewed through a trauma-informed lens, fragmented services risk undermining recovery and highlight the importance of consistent and coordinated support (Levenson, 2017).

Implications

The findings underscore the need for care that addresses both the physical and existential impact of sexual assault. Survivors often experience profound bodily and emotional disruption in the immediate aftermath, highlighting the importance of clinicians being attuned to embodied distress and supporting safety, agency, and coherence. A strong desire to return to normalcy, sometimes by minimizing the event, can lead survivors to disengage from support. In this study, such minimization was often linked to self-doubt and to social or systemic responses that downplayed the seriousness of the assault, making survivors less likely to seek or remain engaged with care. This calls for proactive, personalized care approaches, particularly for those facing compounding vulnerabilities (Bach et al., 2021; Hutschemaekers et al., 2019; Yuen et al., 2021). Applying trauma-informed principles means ensuring that survivors encounter predictable, respectful, and empowering care environments designed to prevent secondary victimization and foster long-term healing (Levenson, 2017).

Survivors should not be left to “figure it out” on their own. As Herman (2015) argues, trauma, especially trauma rooted in sexual violence, is often privatized and socially silenced, leaving the responsibility for recovery to rest primarily on the individual rather than on collective systems of care and accountability. By “privatization of trauma,” Herman (2015) refers to how survivors are left to carry the burden of trauma largely on their own, with limited societal recognition or structural support.

Clinicians must help counteract the privatization and silencing of trauma by offering validation, psychoeducation, and step-by-step support. In practice, this means explicitly communicating belief in the survivor, providing written as well as verbal information about common trauma reactions, and ensuring that survivors leave each contact with a clear follow-up plan. Relational continuity and emotional presence emerged as deeply meaningful aspects of care, especially in the early phase when survivors may struggle to voice their needs. This includes validating survivors’ experiences, providing psychoeducation to reduce self-blame, and explicitly conveying belief and support. As Ullman (2023) emphasizes, professionals must balance supporting survivors’ autonomy while also helping them understand the impacts of trauma and countering secondary victimization.

The findings also highlight the significance of the lived body in survivors’ experiences, pointing to the deep interconnection between physical, emotional, and existential responses in the aftermath of sexual assault. Fuchs (Fuchs & Schlimme, 2009) framework helps illuminate how bodily sensations, such as numbness, disconnection, or physical exhaustion, are not merely symptoms, but integral to how trauma is processed and experienced. While post-assault care in Norway predominantly focuses on medical, legal, and psychological dimensions, somatic aspects of trauma may receive less attention. Based on these findings and prior literature on trauma-informed care (Crews et al., 2016), it may be valuable to explore how body-based practices, such as trauma-informed yoga, could support recovery by fostering bodily awareness and self-compassion. Although not widely implemented in Norwegian follow-up services, such approaches may offer a holistic complement to existing psychosocial support.

Beyond individual interactions, the study points to significant structural gaps in follow-up care in Norway. Survivors reported inconsistent services, unclear pathways, and fragmented systems; a concern echoed in recent national evaluations (Johnsen et al., 2024). Improving care thus requires systemic efforts: stronger national guidelines, better coordination between services, and a collective responsibility to ensure accessible, consistent, and compassionate follow-up for all survivors. For healthcare providers, this means knowing local referral pathways, advocating for consistent follow-up routines, and collaborating closely with multidisciplinary teams to reduce fragmentation of care. International models, such as Sexual Assault Nurse Examiner (SANE) programs in the United States and Sexual Assault Referral Centers in the United Kingdom, demonstrate how integrated, multidisciplinary services can strengthen continuity of care and reduce secondary victimization, offering valuable lessons for the Norwegian context (Fernández-Collantes et al., 2024; O’Doherty et al., 2024).

In a country like Norway, with a publicly funded healthcare system and a formal commitment to the Istanbul Convention (2011), survivors should be able to expect comprehensive, coordinated care. However, the Group of Experts on Action against Violence against Women and Domestic Violence (GREVIO, 2022) has urged Norwegian authorities to ensure long-term psychosocial support for women subjected to sexual violence, with adequate regional coverage and financial stability. The absence of national guidelines and uneven access suggest that Norway is not yet fulfilling these obligations under Article 25 of the Istanbul Convention (Council of Europe, 2011).

Strengths and Limitations

This study provides valuable insight into the first weeks following sexual assault, an understudied, yet critical, period, by capturing survivors’ lived experiences within the Norwegian context. While the sample size (n = 13) is limited, this is consistent with the aim of phenomenologically inspired qualitative research, which prioritizes in-depth exploration of lived experience over broad representativeness. As Husserl (1931/2012) noted, individual experiences can carry relevance beyond their context. A key limitation, however, was the lack of gender and cultural diversity (i.e., exclusively cis women, primarily of majority background). While this reflects the typical demographics of SAC survivors in Norway, including more diverse survivors (e.g., men, non-binary individuals, and those with minority or migrant backgrounds) would likely have added important perspectives, as these groups may face distinct barriers to help-seeking (Bach et al., 2021; Ullman & Lorenz, 2020).

We did not systematically collect detailed information on participants’ cultural background or country of birth, as this was outside the scope of the present study, although recruitment was open to survivors from all backgrounds. Likewise, we did not collect information on participants’ sexuality, as the only demographic variable recorded was gender identity. Finally, 8 of the 13 participants reported previous experiences of sexual assault and/or prior consultations at a SAC, which may have influenced how they interpreted and described the aftermath of the recent assault.

At the same time, several of the findings, such as bodily destabilization, the struggle to regain normalcy, and the importance of relational support, represent human responses that may resonate across diverse groups and contexts. Future research should therefore both broaden the diversity of survivor voices and examine how universal and group-specific factors intersect in shaping post-assault experiences.

Also, we carefully considered our recruitment strategy, prioritizing ethical considerations but at the same time aiming to ensure richness and variation in the data. Participants were recruited from four different SACs in both urban and rural areas, with nine participants from urban SACs and four from SACs serving primarily rural populations, which may have shaped some of the experiences described. This allowed for geographical and organizational variation in experiences. In addition, we included participants across a broad age range (18–47 years), and recruitment was open to individuals regardless of prior mental health status or whether the assault had been reported to the police.

All interviews were conducted by the first author. Reliance on a single interviewer poses limitations, as it provides a more limited perspective. While SAC-based interviews ensured confidentiality, we acknowledge that the clinical setting may have influenced participants’ comfort in raising concerns about follow-up care. However, a multidisciplinary research team contributed to reflexivity and minimized bias (Malterud, 2001). Framing the interviews around “daily life” may have directed participants toward general reflections rather than explicitly focusing on challenges or unmet needs in the aftermath of the assault. Nevertheless, the variation in follow-up trajectories added depth to the findings and contributes to literature that values survivors’ perspectives. Future studies should examine the long-term impact of follow-up care within the Norwegian context, and how improved coordination between services in Norway can support recovery and reduce the burden survivors face in navigating fragmented systems.

Conclusion

This study explored the lived experiences of survivors in Norway during the initial time following the assault. The findings reveal how the assault disrupted both basic needs and survivors’ connection to their own bodies. Three essential themes emerged: Losing ground, which described how overwhelming emotions affected bodily stability and daily functioning; Adapting to a changed life, which reflected survivors’ efforts to reconcile their longing for normalcy with a fundamentally changed sense of self; and Where to go? which captured the confusion and fragmentation many faced in navigating psychosocial follow-up in the Norwegian healthcare system. Survivors described a need for ordinary, affirming interactions, even as they struggled with emotional numbness and vulnerability. Despite access to public healthcare, many felt unsupported in this critical period, as specialized sexual assault support was limited. These insights underscore the existential in-between state survivors inhabit as they try to make sense of the assault, regain agency, and reconnect with life.