Health News - Medical News Today, The gynecological care experiences of 44 adult survivors of childhood sexual abuse and 30 non-abused controls were investigated and compared. On a self-administered survey, survivors rated the gynecological care experience more negatively than the controls, experienced more intensely negative feelings, and reported being more uncomfortable during almost every stage of the gynecological examination than did the controls.
Survivors also reported more trauma-like responses during the gynecological examination, including overwhelming sexual, intrusive or unwanted thoughts, memories, body memories, and feelings of detachment from their bodies.
Eighty-two percent abuse the survivors abuse the sample had never been asked about a history of sexual abuse or assault by a gynecological care provider, despite clear evidence gynecology this study that such gynecology would be relevant to their care.
Implications of the study's findings for gynecological care practice and training are explored, and sexual for future research are discussed.
A procedure to intentionally end a pregnancy before a birth. Miscarriage is also sometimes called "spontaneous abortion ," even though it is usually not intended. Purposeful harm or mistreatment of another person, which can be verbal, emotional, physical or sexual. An ongoing pattern or cycle of such mistreatment or harm can characterize an abusive relationship. In the context of sexuality, an sexual for asexual. People older than you who probably drive you abuse. Or, gynecology whose age in years exceeds the legal age of majority; people considered to be adults by law.This bar-code number lets you verify that you're getting exactly the right version or edition of a book. The digit and digit formats both work.
- Gynecology sexual abuse Sexual assault is common
- Women Health. ;24(3) The gynecological care
A victim who is sexually assaulted loses control over her life during the period of the assault. After the assault, a rape-trauma syndrome often occurs. The acute, or disorganization phase, may last for days to weeks and is characterized by physical reactions such as generalized pain throughout the body, eating and sleeping disturbances, and emotional reactions such as anger, fear, anxiety, guilt, humiliation, embarrassment, self-blame, and mood swings 1, The next phase, the delayed, or organization phase, is characterized by flashbacks, nightmares, and phobias as well as somatic and gynecologic symptoms.
A longitudinal study of sexuality and gynecologic health in abused women.Posttraumatic stress disorder is characterized by a symptom cluster involving reexperiencing the trauma, avoidance, and a state of hyperarousal Symptoms may not appear for months or even years after a traumatic experience. Alcohol abuse, including binge drinking, and illicit drug use and dependence have long-term associations with sexual assault.
In a survey of women seeking substance abuse treatment, prevalence rates of completed rape or other types of sexual assault were The American College of Obstetricians and Gynecologists recommends that health care providers routinely screen all women for a history of sexual assault, paying particular attention to those who report pelvic pain, dysmenorrhea, or sexual dysfunction Early identification of victims of sexual assault can lead to prevention of long-term and persistent physical and mental health consequences of abuse.
When a history of sexual abuse is obtained, the clinician may expect that various health care procedures, such as pelvic, rectal, breast, and endovaginal ultrasonographic examinations, could trigger panic and anxiety reactions. Such reactions may stem from PTSD and may have a connection with more remote events. Clinicians should screen women with a history of sexual assault for substance abuse. Conversely, clinicians should screen for a history of sexual assault in women with a history of substance abuse.
Counseling can help the woman to understand her psychologic and physical responses, thereby diminishing the associated symptoms Recently, many hospitals have implemented programs to provide acute medical and evidentiary examinations for sexual assault victims by sexual assault nurse examiners or sexual assault forensic examiners.
In some settings, however, obstetrician—gynecologists remain the first point of contact for the evaluation and care of sexual assault victims.
If called on to perform a sexual assault examination, the physician who has no experience or limited experience should consider requesting assistance to ensure appropriate evidence collection.
Improper evidence collection, including a break in the chain of custody and incorrect handling of samples, virtually eliminates options to prosecute the case. The health care provider conducting an evidentiary evaluation of a sexual assault victim must comply with state and local statutory or policy requirements involving the use of evidence gathering kits.
Many jurisdictions use a hour cutoff time for collection of evidence in a sexual assault case, whereas some have extended the time to 1 week. When collecting evidentiary materials, health care providers should comply with the required time frame within that jurisdiction A history of obstetric and gynecologic conditions should be recorded, including current pregnancy or risk of pregnancy 1.
A detailed examination of the entire body should be performed and injuries should be photographed or drawn. Rape and sexual assault are legal terms that should not be used in medical records.
Gynecology sexual abuse Rich Kaplan, MSW, MD, FAAP Dr. Kaplan (deceased August 19, ) was a board-certified pediatric child abuse specialist at Children's Hospitals and Clinics of Minnesota, Professor of Pediatrics and Director of the Center for Safe and Healthy Children at the University of Minnesota Amplatz Children s Hospital, and Associate Medical Director at Midwest Children's Resource Center. This bar-code number lets you verify that you're getting exactly the right version or edition of a book. The digit and digit formats both work.Rather, the health care provider should only report the findings and not state a conclusion. Using direct quotes or information from the patient for the history and detailed descriptions and photos of the physical findings are sufficient.
The health care provider should document the emotional condition of the woman as judged by direct observation and examination 1. University of Southern California and Dr. George Tyndall, a gynecologist who worked at a USC clinic for 30 years, have been sued by four former students. Tyndall is accused of sexual battery and sexual harassment. Los Angeles police are investigating allegations by more than 50 women about possible sexual abuse by a University of Southern California gynecologist dating back decades, authorities said Tuesday. Police said allegations against Dr. George Tyndall date from to during a period in which they estimate he could have treated over 10, women. If the woman is a minor or a vulnerable adult those unable to care for their daily needs due to mental or physical disabilities , the health care provider should report the incident to the appropriate authorities as required by state law.
Efforts should be made to involve a parent or caregiver unless that individual represents a security threat to the woman. Emergency contraception should be provided, requiring its immediate availability in hospitals and facilities where victims of sexual assault are treated. The most common sexually transmitted infections STIs reported in sexual assault victims include trichomoniasis, gonorrhea, and Chlamydia trachomatis Prophylaxis for these STIs is recommended Of particular concern is human immunodeficiency virus HIV , where the status of the assailant is often unknown or unavailable.
Multiple characteristics increase the risk of HIV transmission, including genital or rectal trauma leading to bleeding, multiple traumatic sites involving lacerations or deep abrasions, and the presence of preexisting genital infection or ulcers in the victim Department of Health and Human Services recommends that an individual seeking care within 72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infective body fluids from an HIV-positive individual receive a day course of highly active antiretroviral therapy, initiated as soon as possible after exposure.
For individuals initiating care less than 72 hours after exposure some guidelines restrict initiation of nonoccupational postexposure prophylaxis to within 36 hours following exposure 21 , clinicians may consider prescribing nonoccupational postexposure prophylaxis for exposures conferring a serious risk of transmission if, in their judgment, the unknown potential benefit of treatment outweighs the potential risk of adverse events from antiretroviral medications The decision to prescribe nonoccupational postexposure prophylaxis should be made after a thorough risk assessment, taking into account the preference of the woman, the prevalence of HIV in the geographic area or institutional setting where the assault occurred, the estimated risk of infection in the perpetrator, and the nature of the exposure 17, Low rates of medication completion have adversely affected the utility of the nonoccupational postexposure prophylaxis regimen.
If the patient starts nonoccupational postexposure prophylaxis, a 2—5 day initial supply with a follow-up visit within several days helps increase continuation rates and allows for a comprehensive discussion after recovery from the attack. Regardless of whether nonoccupational postexposure prophylaxis is initiated, the clinician should provide HIV risk reduction and primary prevention counseling.
USC gynecologist accused of sexual abuse by more than 50 women, police sayGynecology sexual abuse Health care providers are urged to assemble and maintain a list of individuals and other resources for patient referral.
Because of the emotional intensity of the experience, a woman may not recall all the information provided during an office visit. Therefore, it is helpful to provide all instructions and plans in writing.
Generally, a visit for clinical and psychologic follow-up should take place within 1—2 weeks with additional encounters scheduled thereafter as indicated by results and assessments. The American College of Obstetricians and Gynecologists recommends the following in the evaluation of sexual assault victims:.
American College of Obstetricians and Gynecologists. Women's Health Care Physicians. Replaces Committee Opinion Number , August Definitions Sexual assault is a crime of violence and aggression, and encompasses a continuum of sexual activity that ranges from sexual coercion to contact abuse unwanted kissing, touching, or fondling to rape 1.
Incidence and Prevalence Methods of obtaining data influence estimates of the incidence and prevalence of rape and sexual assault. Medical Consequences of Sexual Assault Acute traumatic injuries of sexual assault can be relatively minor, including scratches, bruises, and welts. Psychologic and Mental Health Consequences of Sexual Assault A victim who is sexually assaulted loses control over her life during the period of the assault.
Roles and Responsibilities of Health Care Providers The American College of Obstetricians and Gynecologists recommends that health care providers routinely screen all women for a history of sexual assault, paying particular attention to those who report pelvic pain, dysmenorrhea, or sexual dysfunction If the physician suspects abuse, but the patient does not disclose it, the obstetrician-gynecologist should remain open and reassuring.
Patients may bring up the subject at a later visit if they have developed trust in the obstetrician-gynecologist. 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 Once identified, there are a number of ways that the obstetrician-gynecologists can offer support.
These include sensitivity with the gynecologic or obstetric visit and examination in abuse survivors, the use of empowering messages, and counseling referrals.
Pelvic examinations may be associated with terror and pain for survivors. Feelings of vulnerability in the lithotomy position and being examined by relative strangers may cause the survivor to re-experience past feelings of powerlessness, violation, and fear.
Many survivors may be traumatized by the visit and pelvic examination, but may not express discomfort or fear and may silently experience distress All procedures should be explained in advance, and whenever possible, the patient should be allowed to suggest ways to lessen her fear. For example, the patient may desire the presence of friends or family during the examination and she has the right to stop the examination at any time.
Techniques to increase the patient's comfort include talking her through the steps, maintaining eye contact, allowing her to control the pace, allowing her to see more eg, use of a mirror in pelvic examinations , or having her assist during her examination eg, putting her hand over the physician's to guide the examination It is important to ask permission to touch the patient.
Pregnancy and childbirth may be an especially difficult time for survivors. The physical pain of labor and delivery may trigger memories of past abuse Women with no prior conscious memories of their abuse may begin to experience emotions, dreams, or partial memories.
Pregnant women who are abuse survivors are significantly more likely to report suicidal ideation and depression 7, There are no consistent data regarding adverse pregnancy outcomes for women with histories of childhood sexual abuse. Some positive and healing responses to the disclosure of abuse include discussing with the patient that she is the victim of abuse and is not to blame.
She should be reassured that it took courage for her to disclose the abuse, and she has been heard and believed 19, Traumatized patients generally benefit from mental health care. The obstetrician-gynecologist can be a powerful ally in the patient's healing by offering support and referral.
Efforts should be made to refer survivors to professionals with significant experience in abuse-related issues. Physicians should compile a list of experts with experience in abuse and have a list of appropriate crisis hotlines that operate in their communities. Contacting state boards of psychology or medicine can be beneficial in locating therapists who are skilled in treating victims of such trauma.
Veterans' centers, battered women's shelters, and rape crisis centers often are familiar with therapists and programs that treat various types of trauma, as are many university-based counseling programs.
Because of the relationship between trauma histories and alcohol and drug abuse, therapists should be skilled in working with individuals who have dual diagnoses When discussing with a patient referral to a mental health professional, it is helpful to identify a specific purpose for the referral.
For example, "I would like Dr. Hill to assess you to determine if your past abuse is contributing to your current health problems" is more effective than telling the survivor that her symptoms are all psychological and that she should see a therapist It is important to secure the patient's express authorization before referring her to a mental health specialist, as well as helping the patient to not feel abandoned or rejected when a counseling referral is made.
For some survivors of childhood sexual abuse, there is minimal compromise to their adult functioning. Others will experience psychologic, physical, and behavioral symptoms as a result of their abuse. An understanding of the magnitude and effects of childhood sexual abuse, along with knowledge about screening and intervention methods, can help obstetrician-gynecologists offer appropriate care and support to patients with such histories.
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American College of Obstetricians and Gynecologists. Women's Health Care Physicians. This information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Definitions Child sexual abuse is defined as any sexual activity with a child where consent is not or cannot be given. Sequelae Symptoms or behavioral sequelae are common and varied. The primary aftereffects of childhood sexual abuse include the following: Emotional reactions Emotions such as fear, shame, humiliation, guilt, and self-blame are common and lead to depression and anxiety.
Symptoms of posttraumatic stress Survivors may experience intrusive or recurring thoughts of the abuse as well as nightmares or flashbacks. Distorted self-perception Survivors often develop a belief that they caused the sexual abuse and that they deserved it. These beliefs may result in self-destructive relationships. Physical Effects Chronic and diffuse pain, especially abdominal or pelvic pain 1 , lower pain threshold 7 , anxiety and depression, self-neglect, and eating disorders have been attributed to childhood sexual abuse.
Sexual Effects Disturbances of desire, arousal, and orgasm may result from the association between sexual activity, violation, and pain. Interpersonal Effects Adult survivors of sexual abuse may be less skilled at self-protection. Obstetrician-Gynecologist Screening for Sexual Violence With recognition of the extent of family violence, it is strongly recommended that all women be screened for a history of sexual abuse 15, Following are some guidelines: Make the question "natural.
Physicians may offer explanatory statements, such as: Because these experiences can affect health, I ask all my patients about unwanted sexual experiences in childhood" Give the patient control over disclosure. 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 If the patient reports childhood sexual abuse, ask whether she has disclosed this in the past or sought professional help.
Revelations may be traumatic for the patient. Listening attentively is important because excessive reassurance may negate the patient's pain. The obstetrician-gynecologist should consider referral to a therapist. The examination may be postponed until another visit. 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.
Obstetrician-Gynecologist Intervention for Sexual Violence Once identified, there are a number of ways that the obstetrician-gynecologists can offer support. Obstetric and Gynecologic Visits and Examinations in Abuse Survivors Pelvic examinations may be associated with terror and pain for survivors.
Positive Messages Some positive and healing responses to the disclosure of abuse include discussing with the patient that she is the victim of abuse and is not to blame. Counseling Referrals Traumatized patients generally benefit from mental health care.
Conclusion For some survivors of childhood sexual abuse, there is minimal compromise to their adult functioning. Saul J, Audage NC. Preventing child sexual abuse within youth-serving organizations: Caring for victims of childhood sexual abuse.
J Fam Pract ; Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: Department of Justice, Office of Justice Programs; Retrieved May 5, Teenagers in the United States:
12 More Women Sue Former USC Gynecologist Over Alleged Sexual Assault
Adult Manifestations of Childhood Sexual Abuse - ACOG Women Health. ;24(3) The gynecological care experience of adult survivors of childhood sexual abuse: a preliminary investigation. Robohm JS(1). May 29, - Los Angeles police are investigating allegations by more than 50 women about possible sexual abuse by a University of Southern California. ABSTRACT: Reproductive-aged victims of sexual assault are at risk of unintended Please refer to the American College of Obstetricians and Gynecologists'. Gynecology sexual abuse