In contemporary Kenya, an estimated 15.2% of women have experienced sexual violence (National Crime Research Centre 2015), while the recent Covid-19 pandemic brought into sharp relief the obstacles to medical and psycho-social care that survivors in Kenya navigate: under-resourced and underfunded services, and poor preservation of medico-legal evidence. Through an examination of medical responses to sexual violence in colonial Kenya, this chapter historicises these issues. It explores the experiences of women and girls as they navigated colonial medico-legal structures, as well as the uses and meanings of medical evidence in colonial courtrooms. The chapter argues that medical responses to sexual violence in Kenya were rooted in the logics of a racially stratified settler colony, with both infrastructure and racial ideologies contributing to barriers to care. The chapter argues that African women experienced lower quality care than European women, although European women’s experiences were mediated by notions of respectability and acceptable behaviour in the colonial context. The chapter then explores how the colonial logics of medical responses to sexual violence went beyond the practical provision of care, with medico-legal evidence serving to produce and reproduce gendered, classed, and racialised knowledge about victims and survivors of sexual violence.