Gynaecologists could have important role in identifying sexual abuse in their patients

June 19, 2003

European research in this week's issue of THE LANCET highlights how gynaecologists could have an important role in identifying women who have experienced sexual, physical, and emotional abuse. A positive dialogue between gynaecologists and their patients could ensure that abused women do not receive inappropriate medical treatment, and would help abused women being signposted to appropriate support services.

Previous research has highlighted a high prevalence of emotional, physical, and sexual abuse among women. Physical and sexual abuse is often associated with gynaecological problems, although women rarely discuss abusive experiences with their gynaecologists. Barbo Wijma from Linkoping University, Sweden, and colleagues estimated the prevalence of abuse among women attending gynaecological clinics in five Nordic countries (Denmark, Norway, Sweden, Finland, and Iceland); they also assessed the frequency in which gynaecologists identified abused patients.

Over 3600 women attending gynaecology departments completed a confidential questionnaire that included questions about a history of abuse. The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit.

Barbo Wijma comments: "Why should gynaecologists know whether their patient has a history of abuse? First, gynaecologists are strategically placed to be able to identify victims of abuse, and refer them to other community support services. Second, on a theoretical basis it can be assumed that a patient with earlier abuse has experienced trauma in situations in which she felt subordinate, powerless, and maybe dependent. The consultation situation for such a patient could have enough similarities with the traumatic situation to provoke flashbacks of the abuse and of the feelings she had when it occurred. These conditions increase the risk of abused women experiencing routine health-care procedures as abusive. Third, on an empirical level it could be argued that when the gynaecologist and patient can discuss abuse they can also discuss the delicate issue of how to handle the consultation and the pelvic examination to avoid new trauma. A concrete outcome of such an approach might, for example, be an agreement not to do a pelvic examination at that time if the indications for the procedure would be outweighed by the risks."
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Contact: Professor Barbo Wijma,Division of Womens Health, Department of Molecular & Clinical Medicine, Faculty of Health Sciences, Linkoping University, S-581 85 Linkoping, Sweden. T) 46-13-22-31 26; F) 46-13-14-81-56; E) barwi@imk.liu.se

Lancet

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