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Previous studies have identified that legal factors, such as indicators of crime seriousness (e.g., weapon use, victim injury) and extralegal factors, which center on victim, suspect, and contextual characteristics (e.g., age, education, perceived risky behavior), affect victim reporting and help-seeking decisions. However, women from different racial-ethnic groups consider these factors uniquely. There remains a need to adequately address the unique paradoxes Black women face during help-seeking decisions. To understand Black women’s victimization and subsequent help-seeking pathways, it is important to center and contextualize their experiences. Further, among the limited research that exists regarding Black women’s victimization and help-seeking experiences, methodologies generally include retrospective interview and survey data. However, research would benefit from examining Black women’s decisions in real-time. Drawing on Black feminist and narrative victimology works, the current study addresses these shortcomings by examining Black women’s victimization and help-seeking experiences as they seek medical assistance. Specifically, this study explored sexual assault exam records in which Black women decided not to report to police. Black women’s narratives during medical exams revealed five victimization and help-seeking experiences among non-reported sexual assault cases. The current study lends itself to several practical implications related to enhancing responses to Black women’s calls for help.