Childhood sexual abuse: a reference handbook

Children's Literature as Prevention of Child Sexual Abuse

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I Am Nobody: Bay St. My Tears Were for Her: This book contains the actual diarized, dated journals of a young woman who had been sexually abused. It's real, it's raw and it has purpose in a world that would love nothing more than to keep the damaging secrets. Janet M Little.

Steward Doghouse Press June August Duncan Praeger Publishers August Whitfield Editor , Joyanna L.

Robinson, Foreword by Julia A. Boyd Seal Press February Freeman-Longo Neari Press December What About Me? October Download a copy of the book here. Phillips Jr. A Very Touching Book Satullo Rape Crisis Center of the May Mia's Secret Peter Ledwon. No Touching Secrets! Melissa Pirwani. Legal definitions vary by state; however, state guidelines are available by using the Child Welfare Information Gateway www. Shame and stigma prevent many survivors from disclosing abuse. Incest, once thought to be rare, occurs with alarming frequency 3.

Survivors come from all cultural, racial, and economic groups 4.

Approximately one in five women has experienced childhood sexual abuse 4. Symptoms or behavioral sequelae are common and varied. More extreme symptoms can be associated with abuse onset at an early age, extended or frequent abuse, incest by a parent, or use of force. Common life events, like death, birth, marriage, or divorce may trigger the return of symptoms for a childhood sexual abuse survivor. The primary aftereffects of childhood sexual abuse include the following:. 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.

Adults abused as children are four to five times more likely to have abused alcohol and illicit drugs 8. They are also twice as likely to smoke, be physically inactive, and be severely obese 8. Disturbances of desire, arousal, and orgasm may result from the association between sexual activity, violation, and pain.

Survivors are more likely to have had 50 or more intercourse partners, have had a sexually transmitted infection, and engage in risk-taking behaviors that place them at risk of contracting human immunodeficiency virus HIV 8, 9.

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Early adolescent or unintended pregnancy and prostitution are associated with sexual abuse 10, Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, and nonspecific vaginitis, are common diagnoses among survivors Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care Adult survivors of sexual abuse may be less skilled at self-protection.

They are more apt to accept being victimized by others 15, This tendency to be victimized repeatedly may be the result of general vulnerability in dangerous situations and exploitation by untrustworthy people. With recognition of the extent of family violence, it is strongly recommended that all women be screened for a history of sexual abuse 15, Patients overwhelmingly favor universal inquiry about sexual assault because they report a reluctance to initiate a discussion of this subject Following are some guidelines:.

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.

Childhood Sexual Abuse

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.

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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. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Adult manifestations of childhood sexual abuse. Committee Opinion No. American College of Obstetricians and Gynecologists. Obstet Gynecol ; 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.

Normalize the experience. Physicians may offer explanatory statements, such as: "About one woman in five was sexually abused as a child. 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.

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