ABSTRACT 
Historically, medico-legal practice has marginalised consent and autonomy in the forensic examination of sexual assault victims. Global and Indian frameworks have progressively emphasised survivors’ rights, but implementation gaps persist. This is an attempt to trace the evolution of legal, ethical, and clinical standards regarding consent and autonomy in sexual assault forensic examinations, analyse current gaps in India, and recommend reforms aligned with international human rights and forensic medicine best practices. A narrative review of legal statutes, case law, and medico-legal guidelines from India and selected international jurisdictions (UK, US, and WHO) was done, supported by forensic audit data, human rights reports, and scholarly literature. It was observed that the principle of informed consent evolved from implied or blanket consent to segmented, stage-wise processes respecting survivor autonomy. Indian legal reforms post-2012, including the Criminal Law (Amendment) Act and Ministry of Health and Family Welfare Guidelines, mandate consent at every stage. However, challenges remain with uniform implementation, training, and survivor-centred facility design. To conclude, respect for survivor consent and autonomy is central to ethical forensic medicine and effective criminal justice. Harmonised legal, medical, and human rights frameworks, along with institutional reforms, are essential for upholding these principles in practice.
Keywords: Consent; autonomy; forensic examination; sexual assault; BNSS Section 184.