BACKGROUND: Emergency Departments (ED) are a primary avenue for the initial assessment of sexual assault presentations in Australia. The aim of this study was to outline demographics and assault characteristics of people presenting to a Sexual Assault Service (SAS). METHODS: A retrospective review of 1218 presentations to the SAS in an ED of a tertiary referral centre in metropolitan Sydney between January 2020-May 2024 was conducted using the Medical Forensic Examination Record and electronic Medical Record. Variables related to nature of the assault, injuries, the ingestion of drugs or alcohol, sexually transmitted infections, and nature of the relationship with the perpetrator were assessed. RESULTS: Of all presentations, 89 % of cases identified as female, with a median (interquartile range) age of 26.8 (13.7) years. Victims reported that they consumed alcohol (n = 553, 45.4 %) and/or drugs (n = 368, 30.2 %) around the time of assault in a manner where it may have impacted their level of consciousness at the time of the assault. Penile-vaginal penetration was the most common mode of assault (54.6 %), while 37.4 % of cases were found to have bodily injuries documented. Chlamydia and gonorrhoea were detected in 4.5 % and 0.8 % of presentations respectively. Of all assaults 14.6 % were perpetrated by an intimate partner. CONCLUSION: Most victims of sexual assault were young females and involved penile-vaginal penetration. Intimate Partner Violence accounted for a large number of sexual assault presentations. Our findings will improve local understanding of sexual assault amongst Forensic Medical Examiner (FMEs) and Emergency physicians and inform future staffing, resourcing and research.