Pelvic examinations may be associated with terror and pain for survivors. Obstetric and Gynecologic Visits and Examinations in Abuse Survivors Not asking about sexual abuse may give tacit support to the survivor’s belief that abuse does not matter or does not have medical relevance and the opportunity for intervention is lost 20. Patients may bring up the subject at a later visit if they have developed trust in the obstetrician–gynecologist. If the physician suspects abuse, but the patient does not disclose it, the obstetrician–gynecologist should remain open and reassuring. Once the patient is ready for an examination, questions about whether any parts of the breast or pelvic examination cause emotional or physical discomfort should be asked. The examination may be postponed until another visit. The obstetrician–gynecologist should consider referral to a therapist. Listening attentively is important because excessive reassurance may negate the patient’s pain. Revelations may be traumatic for the patient.
#CHILDHOOD TRAUMA IN ADULTS PROFESSIONAL#
If the patient reports childhood sexual abuse, ask whether she has disclosed this in the past or sought professional help. Ask every patient about childhood abuse and rape trauma, but let her control what she says and when she says it in order to keep her emotional defenses intact 19.
Give the patient control over disclosure. Because these experiences can affect health, I ask all my patients about unwanted sexual experiences in childhood” 19. Physicians may offer explanatory statements, such as: “About one woman in five was sexually abused as a child. Make the question “natural.” When physicians routinely incorporate questions about possible sexual abuse, they will develop increased comfort 19. Patients overwhelmingly favor universal inquiry about sexual assault because they report a reluctance to initiate a discussion of this subject 18. With recognition of the extent of family violence, it is strongly recommended that all women be screened for a history of sexual abuse 15, 17. Obstetrician–Gynecologist Screening for Sexual Violence
Adult childhood sexual abuse survivors disproportionately use health care services and incur greater health care costs compared with adults who did not experience abuse 1.
The obstetrician–gynecologist should have the knowledge to screen for childhood sexual abuse, diagnose disorders that are a result of abuse, and provide support with interventions. Frequently, the underlying cause of these symptoms is unrecognized by both the physician and patient. Women who are survivors of childhood sexual abuse often present with a wide array of symptoms. Obstetrician–gynecologists can offer support to abuse survivors by giving them empowering messages, counseling referrals, and empathic care during sensitive examinations. Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care. Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, nonspecific vaginitis, and gastrointestinal disorders are common diagnoses among survivors. Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse. Many obstetrician–gynecologists knowingly or unknowingly provide care to abuse survivors and should screen all women for a history of such abuse. ABSTRACT: Long-term effects of childhood sexual abuse are varied, complex, and often devastating.
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