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Fulton J, Snyder H, Chalif J, Delwiche K, Chambers LM. Evidence and best practices for trauma-informed care in gynecologic oncology patients. Int J Gynecol Cancer 2024; 34:1077-1088. [PMID: 38816002 DOI: 10.1136/ijgc-2024-005300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Diagnosing, treating, and managing gynecologic cancer can lead to significant physical and emotional stress, which may have lasting effects on a patient's overall health and quality of life. The physical symptoms of gynecologic cancer, such as pain, discomfort, and loss of function, may also contribute to emotional distress and anxiety. Further, the diagnosis, treatment, and surveillance of gynecologic cancer may be traumatic due to the need for invasive exams and procedures, especially in women with a history of sexual assault or other traumatic experiences.Women with gynecologic cancer may experience various emotional and psychological symptoms, including anxiety, depression, post-traumatic stress disorder, and fear of recurrence. Trauma-informed care is an approach to healthcare that emphasizes the recognition and response to the impact of trauma on a patient's life. Further, trauma-informed care acknowledges that prior traumatic experiences may affect a patient's mental and physical health and that the healthcare system may unintentionally re-traumatize patients.Implementation of trauma-informed care can improve patient outcomes, increase patient satisfaction with care, and reduce the risk of re-traumatization during cancer treatment and follow-up care. Therefore, gynecologic oncology providers should become familiar with the principles and practices of trauma-informed care and implement trauma-informed screening tools to identify patients who may benefit from additional support or referrals to mental health services. This review will explore the importance of trauma-informed care in patients with gynecologic cancer and its impact on outcomes. Further, we discuss principles and evidence-based practices of trauma-informed care and strategies to implement trauma-informed screening tools to identify patients who may benefit from additional support or referrals to mental health services.
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Affiliation(s)
- Jessica Fulton
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Haverly Snyder
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julia Chalif
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Katelyn Delwiche
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
| | - Laura M Chambers
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio, USA
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Iraola E, Menard JP, Buresi I, Chariot P. Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter. BMC Womens Health 2024; 24:264. [PMID: 38678204 PMCID: PMC11055245 DOI: 10.1186/s12905-024-03112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Domestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations. METHODS We analyzed the data following inductive thematic analysis methods. RESULTS Between April 2022 and January 2023, we conducted 25 semi-structured interviews, lasting on average 90 min (range: 45-180), with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. The women described physical and psychological violence mainly in the domestic sphere, their altered gynecological and mental health and their perception of gynecological care. The levels of uptake of gynecological care were related to the characteristics of the violence and their consequences. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied. CONCLUSION This study can help question the appropriateness of professional practices related to the prevention of violence against women and gynecological examination practices. Any gynecological examination should be carried out within the framework of an equal relationship between caregiver and patient, for the general population and for women with a history of violence. It participates in preventing violence in the context of care, and more widely, in preventing violence against women.
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Affiliation(s)
- Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR, CNRS U997 Inserm EHESS UFR SMBH, Université Sorbonne Paris Nord, 8156-997, 93300, Aubervilliers, France.
- Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, 94000, Créteil, France.
| | - Jean-Pierre Menard
- Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, 94000, Créteil, France
| | - Isabelle Buresi
- Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, 94000, Créteil, France
| | - Patrick Chariot
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR, CNRS U997 Inserm EHESS UFR SMBH, Université Sorbonne Paris Nord, 8156-997, 93300, Aubervilliers, France
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Coleman JN, Arthur SS, Shelby RA. Psychological distress and pain related to gynecologic exams among female survivors of sexual and physical violence: A systematic review. J Trauma Stress 2024; 37:217-230. [PMID: 38123528 DOI: 10.1002/jts.23006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
Gender-based violence is prevalent globally, yet the impacts of sexual and physical violence on women's experiences of routine gynecologic care are not well understood. The purpose of this systematic review of quantitative research is to describe (a) psychological distress and pain related to gynecologic exams among female survivors of sexual and physical violence and (b) differences in distress or pain between survivors and women without this history. Fourteen articles based on 12 discrete studies met the inclusion criteria. Studies were heterogeneous, with a moderate risk of bias; therefore, a descriptive summary approach was utilized rather than a meta-analytic approach. Synthesized results indicated that survivors of violence experience mild-to-severe levels of distress and mild-to-moderate levels of pain related to gynecologic exams. The findings suggest that survivors of sexual or physical violence experience higher levels of distress than women without this history (i.e., moderate to severe), and this difference was further accentuated among women with more severe posttraumatic stress symptoms (PTSS). Differences in pain by violence history and PTSS severity were not consistently observed, possibly due to a lack of variability in ratings and small sample sizes. Additional research is needed that bolsters the measurement of exam-related distress and pain, adjusts for confounding variables, and explores mechanisms by which sexual and physical violence impact care experiences. Further empirical work will be critical to developing interventions at the patient and provider levels to improve women's experiences of care.
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Affiliation(s)
- Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Sarah S Arthur
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
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DeAndrade S, Pelletier A, Grossman S, Lewis-O'Connor A, Dutton C, Royce CS, Bartz D. Trauma-Informed Care Training in U.S. and Canadian Ob/Gyn Residencies. Violence Against Women 2024:10778012241230328. [PMID: 38356282 DOI: 10.1177/10778012241230328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This is a cross-sectional study investigating the prevalence and nature of trauma-informed care (TIC) training in obstetrics and gynecology residency programs. In our sample, 20% of programs had annual TIC training, 53% had less than annual training, and 27% had no training at all. Only 25.3% of respondents were satisfied with their current training in interpersonal trauma and TIC. A lack of facilitators to conduct such training was the primary barrier to implementing TIC. Significant opportunity exists to improve TIC education for Ob/Gyn trainees.
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Affiliation(s)
- Samantha DeAndrade
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrea Pelletier
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samara Grossman
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA
| | - Annie Lewis-O'Connor
- Harvard Medical School, Boston, MA, USA
- Division of Women's Health and Internal Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Caryn Dutton
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Celeste S Royce
- Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deborah Bartz
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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MacLeod RGK, Parmar G, Zhang S, Noga H, Allaire C, Albert A, Flannigan R, Brotto LA, Orr NL, Wahl K, Yong PJ. Acceptability, reliability, and validity of a vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia: a cross-sectional study. J Sex Med 2023; 21:44-53. [PMID: 38014766 DOI: 10.1093/jsxmed/qdad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia. AIM The aim of this study was to assess the acceptability, test-retest reliability, and validity of a vaginal insert for a self-assessment of endometriosis-associated deep dyspareunia. METHODS Participants were recruited from a tertiary endometriosis center. Inclusion criteria were: 19 to 49 years of age, self-reported deep dyspareunia of ≥4 of 10, and surgically confirmed endometriosis. Participants completed 2 self-assessments using the vaginal insert to self-assess tenderness at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac (vaginal fornix). The participants recorded tenderness at each pelvic site and completed a questionnaire regarding the acceptability of the vaginal insert to assess deep dyspareunia. Test-retest reliability was assessed by correlating the tenderness scores between the 2 assessment dates. Over a 4-week period, the participants also recorded deep dyspareunia severity at each penetrative vaginal sex encounter. Validity was assessed by correlating vaginal insert tenderness to deep dyspareunia severity, and also to tenderness reported on a prior gynecologic pelvic examination. OUTCOMES The main outcome measures were the acceptability index score, tenderness (0-10) at each pelvic site, and prospective deep dyspareunia scores (0-10) over 4 weeks. RESULTS There were 19 participants (mean age 34 ± 7 years) who completed the study. The majority identified as female (94.7%), heterosexual (89.5%), and white (89.5%). The median acceptability index score was 0.72 (interquartile range, 0.66-0.81). For test-retest reliability, the intraclass correlation coefficients were 0.79 (P = .001) for the left pelvic floor, 0.82 (P < .001) for the right pelvic floor, 0.54 (P = .07) for the bladder, 0.89 (P < .001) for the cervix-uterus, and 0.77 (P = .003) for the cul-de-sac. The correlation between the highest self-assessed mean tenderness in each participant and self-reported deep dyspareunia over 4 weeks was r = 0.32, but correlations for each pelvic site varied significantly. Tenderness at each site on prior gynecologist pelvic exam was associated with higher self-assessed mean tenderness with the vaginal insert in each participant (effect sizes = 0.42-0.88). CLINICAL IMPLICATIONS The vaginal insert is acceptable and reliable for the objective self-assessment of endometriosis-associated deep dyspareunia, with initial evidence of validity. STRENGTHS AND LIMITATIONS A strength was the inclusion of participants who were avoiding sexual activity and a limitation was the small sample size. CONCLUSION Future studies with larger sample sizes are required to further establish the validity of the vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia.
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Affiliation(s)
- Rebecca G K MacLeod
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Gurkiran Parmar
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Sandy Zhang
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- British Columbia Women's Centre for Pelvic Pain and Endometriosis, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- British Columbia Women's Centre for Pelvic Pain and Endometriosis, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
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Marshall DC, Carney LM, Hsieh K, Dickstein DR, Downes M, Chaudhari A, McVorran S, Montgomery GH, Schnur JB. Effects of trauma history on cancer-related screening, diagnosis, and treatment. Lancet Oncol 2023; 24:e426-e437. [PMID: 37922933 PMCID: PMC10754479 DOI: 10.1016/s1470-2045(23)00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lauren M Carney
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Shauna McVorran
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth Cancer Center, Hanover, NH, USA
| | - Guy H Montgomery
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie B Schnur
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hira S, Sheppard-Perkins M, Darroch FE. "The facilitator is not a bystander": exploring the perspectives of interdisciplinary experts on trauma research. Front Psychol 2023; 14:1225789. [PMID: 37680237 PMCID: PMC10481530 DOI: 10.3389/fpsyg.2023.1225789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Objective This study investigates the concepts, knowledge, and guiding principles that inform the practice of professionals researching trauma or working directly with individuals who have lived and living experiences of trauma. These aspects are explored with the aim of identifying current practices and potential gaps which may contribute to more trauma-informed biomarker-based research approaches. Method The perspectives of experts were explored through semi-structured interviews with seven participants; these individuals represented trauma research, clinical practice, and trauma-informed physical activity domains. Results A thematic analysis of the collected data revealed three focal areas highlighted by participants from all disciplines: "If I want to know trauma in the body of a person I need to know the person's language" which related to experiences of discussing trauma with clients; "What all people need is a safe place" relayed the importance of safety for participants working with the trauma expert; and "the facilitator is not a bystander" framing trauma-related work as a collaborative process between participants and their care providers. Conclusion Evidence of formal implementation of trauma-informed practices within research settings is lacking. This gap is identified within background literature, while the importance of implementing these practices is emphasized by the participants of this study. This presents an opportunity to apply the insights of the interviewed experts toward advancing trauma research methodologies. Adapting biomarker-based research methodologies to fit a trauma- and violence-informed model may have benefits for the quality of participant experiences, research data, and knowledge of effective interventions.
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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9
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Iraola E, Menard JP, Chariot P. [Gynecological care among women reporting sexual violence: a qualitative study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:46-52. [PMID: 36210049 DOI: 10.1016/j.gofs.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Sexual violence can be followed by different levels of gynecological care. Our objective was to characterise gynecological care and to identify the related factors among women who had reported sexual violence. METHODS Twenty-five semi-structured interviews were conducted among adult women who reported sexual violence during childhood or as adults. Topics addressed included gynecological health, gynecological care and experienced violence, RESULTS: Interviewed women, aged 20-60, had a good professional integration and a high level of education. The violence had often been committed by a relative or acquaintance. For the women interviewed, the least use of gynecological care was motivated by a desire to avoid the gynecological examination. Among women who had regular check-ups, the desire to conform to the norm explained their need for gynecological check-ups, which was similar to that of women who had never been subjected to violence. Lastly, some care pathways were characterised by multiple recourse of gynecological care for complaints with identical motives. The women interviewed expected professionals to spontaneously identify the violence they had suffered and the gynecological consequences attributed to such violence. CONCLUSION Individual and interpersonal differences in levels of gynecological care use were related to the characteristics of the violence and its perceived effects on gynecological health. It would be interesting to extend this research by examining the care pathways of women with other socioeconomic characteristics. A quantitative study would measure the association between violence and the use of gynecological care.
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Affiliation(s)
- E Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, 94000 Créteil, France.
| | - J-P Menard
- Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - P Chariot
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France
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10
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Marshall D, Green S, Jones BM, Starrs C, Montgomery GH, Minassian K, Wunder B, Force J, Schnur JB. Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer. J Am Coll Radiol 2022; 19:1236-1243. [PMID: 36126825 PMCID: PMC10354668 DOI: 10.1016/j.jacr.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.
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Affiliation(s)
- Deborah Marshall
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York.
| | - Sheryl Green
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Medical Director, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Brianna M Jones
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Clodagh Starrs
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Guy H Montgomery
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin Minassian
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Bruce Wunder
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - James Force
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie B Schnur
- Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Co-Director of the Integrative Behavioral Medicine Program, Icahn School of Medicine at Mount Sinai, New York, New York
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11
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Zhang SXJ, MacLeod RGK, Parmar G, Orr NL, Wahl KJ, Noga H, Albert A, Flannigan R, Brotto LA, Yong PJ. OHNUT VS WAITLIST CONTROL FOR THE SELF-MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED DEEP DYSPAREUNIA: A PILOT RANDOMIZED CONTROLLED TRIAL PROTOCOL (Preprint). JMIR Res Protoc 2022; 12:e39834. [PMID: 36972117 PMCID: PMC10131731 DOI: 10.2196/39834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Endometriosis-associated deep dyspareunia is associated with reduced sexual quality of life, lower self-esteem, and impaired sexual function. OBJECTIVE The primary objective is to assess the acceptability of a phallus length reducer (brand name: Ohnut [OhnutCo]), which is a buffer worn over the penis or a penetrating object to reduce endometriosis-associated deep dyspareunia, and the feasibility of a definitive randomized controlled trial (RCT). The secondary objective is to obtain estimates of the effectiveness of the buffer. An embedded substudy will explore the acceptability and the preliminary validity and reliability of a vaginal insert for the self-assessment of deep dyspareunia. METHODS Ours is an investigator-initiated, 2-arm RCT. We will recruit 40 patient participants with diagnosed endometriosis between the ages of 19 and 49 years, as well as their sexual partners. The participating couples will be randomized in a 1:1 ratio into the experimental arm or the waitlist control arm. The length of the study period will be 10 weeks, during which time all participants will record deep dyspareunia severity following each episode of sexual intercourse. In weeks 1 to 4, all patient participants will record deep dyspareunia severity at each sexual encounter. In weeks 5 to 10, participants in the experimental arm will use the buffer during vaginal penetration; participants in the waitlist control arm will continue engaging in vaginal penetration as usual. Participants will complete questionnaires for assessing measures of anxiety, depression, and sexual function at baseline, at 4 weeks, and at 10 weeks. In the substudy, patient participants will self-assess dyspareunia by using a vaginal insert on 2 occasions, at least 1 week apart. The primary outcomes-the acceptability and feasibility of the buffer-will be assessed with descriptive statistics, and the secondary outcome-phallus length reducer effectiveness-will be assessed by using an analysis of covariance-based approach. For the vaginal insert, we will assess acceptability, test-retest reliability, and convergent validity via correlation analyses comparing the use of the insert to clinical examination in terms of dyspareunia assessment outcomes. RESULTS Our pilot will provide initial data on the acceptability and effectiveness of the buffer and the feasibility of the study methodology. The results from our study are expected to be submitted for publication by the spring of 2023. As of September 2021, we have consented 31 couples into the study. CONCLUSIONS Our study will provide preliminary evidence for the self-assessment and management of endometriosis-associated deep dyspareunia. The findings will inform the decision to proceed to a definitive RCT. TRIAL REGISTRATION ClinicalTrials.gov NCT04370444; https://clinicaltrials.gov/ct2/show/NCT04370444. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39834.
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Affiliation(s)
- Sandy X J Zhang
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca G K MacLeod
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Gurkiran Parmar
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Natasha L Orr
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Kate J Wahl
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
- British Columbia Women's Centre for Pelvic Pain & Endometriosis, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
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12
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Troutman M, Chacko S, Petras L, Laufer MR. Informed Care for the Gynecologic Day Surgical Patient with a History of Sexual Trauma. J Pediatr Adolesc Gynecol 2022; 35:3-6. [PMID: 34302950 DOI: 10.1016/j.jpag.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
The field of Obstetrics and Gynecology is one that provides intersections between one's most private and intimate moments with scenarios that could potentially trigger significant emotional trauma. As providers, one must balance providing appropriate care with the respect and autonomy of the patient. The perioperative and operative space presents many ethical dilemmas in navigating these boundaries, particularly among individuals with a history of sexual trauma. In our commentary, we present one case of an adolescent patient, with a history of sexual trauma and pelvic pain, who underwent laparoscopic surgery. We explore the interplay of delegating autonomy during amnesia, chronic pelvic pain, post-traumatic stress disorder, and hyperarousal within this period. There is knowledge to be gained amongst Obstetrics and Gynecology providers in navigating perioperative services in individuals with complex history of social stress and trauma so that we can better understand the landscape of providing competent care.
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Affiliation(s)
- Michele Troutman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Sabeena Chacko
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lisa Petras
- Boston Children's Hospital, Boston, Massachusetts
| | - Marc R Laufer
- Boston Center for Endometriosis, Brigham and Women's Hospital and Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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13
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Collins K, Hamlyn T, Bruxner G, Kothari A. Dangers in the dark: Calling for a safer practice of transvaginal ultrasonography. Australas J Ultrasound Med 2021; 24:5-12. [PMID: 34765410 DOI: 10.1002/ajum.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022] Open
Abstract
Background The intimate examination is an important component of the assessment of a patient presenting with obstetric or gynaecological concerns. Ultrasound practitioners, like any other medical practitioner, are in a unique and privileged position. During the examination, the sonographers engage in a very close and personal interaction with an individual whom they have likely never met. They are also most likely unfamiliar with their social situation, cultural background, previous experiences with the healthcare profession and more importantly, any history of sexual trauma. It is an extremely sensitive area of practice which places a great deal of responsibility on the clinician to ensure that they not only protect their patient from psychological distress, but also themselves, from the threat of litigation arising from such distress. Aims This paper highlights the current governance requirements for sonographers and makes suggestions to support them in safeguarding their patients and themselves from allegations of unprofessional conduct, until such a regulatory body exists. Materials and Methods A wide-ranging review of the literature exploring the perceptions of female patients regarding intimate sonographic examination was performed using standard search engines. Additionally, grey literature was searched for policy statements and government regulatory documents for guidance on the topic. Results Although much research has been undertaken in this field across diverse cultures and knowledge in this area is ever increasing; however, the guidelines for sonographers appear to be site specific and variable. At present, there is no overarching governance for sonographers, as there is with practitioners registered with the Australian Health Practitioner Regulation Agency. Discussion While there are practice standards for the purposes of Medicare set out by the Diagnostic Imaging Accreditation Scheme, there is no regulatory professional standard that sonographers are held accountable to. This is problematic and has the potential for inadvertent boundary transgression by the practitioner, as there is also no existing framework for management of such incidents in an equitable manner. Conclusion The intimate examination is generally well tolerated; however, there is a subset of the population who are vulnerable to psychological distress arising from the examination. The sonographer must be astute to signs of distress and act in accordance with the intimate examination guidelines set out by AHPRA, for the dual purpose of protecting their patients against harm and also themselves from the threat of litigation.
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Affiliation(s)
- Kelly Collins
- Wesley Hospital Auchenflower Queensland Australia.,University of Queensland St Lucia Queensland Australia
| | - Tina Hamlyn
- Redcliffe Hospital Redcliffe Queensland Australia
| | - George Bruxner
- University of Queensland St Lucia Queensland Australia.,Metro North Mental Health Service Brisbane Queensland Australia
| | - Alka Kothari
- University of Queensland St Lucia Queensland Australia.,Redcliffe Hospital Redcliffe Queensland Australia
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14
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Brunton R, Dryer R. Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature. CHILD ABUSE & NEGLECT 2021; 111:104802. [PMID: 33218712 DOI: 10.1016/j.chiabu.2020.104802] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/07/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth. OBJECTIVE This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth. METHODS Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies. RESULTS The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation. CONCLUSIONS The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.
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Affiliation(s)
- Robyn Brunton
- Charles Sturt University, School of Psychology, Bathurst, NSW 2795, Australia.
| | - Rachel Dryer
- Australian Catholic University, Strathfield, NSW 2135, Australia
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15
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Pape J, Herbison AE, Leeners B. Recovery of menses after functional hypothalamic amenorrhoea: if, when and why. Hum Reprod Update 2020; 27:130-153. [PMID: 33067637 DOI: 10.1093/humupd/dmaa032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation. WIDER IMPLICATIONS Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.
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Affiliation(s)
- J Pape
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - A E Herbison
- Department of Physiology, Development and Neuroscience, University of Cambridge CB2 3EG, UK
| | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, 8091 Zurich, Switzerland.,University of Zurich, 8091 Zurich, Switzerland
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Schütze I, Geraedts K, Leeners B. The association between adverse childhood experiences and quality of partnership in adult women. CHILD ABUSE & NEGLECT 2020; 108:104653. [PMID: 32771809 DOI: 10.1016/j.chiabu.2020.104653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/15/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACE) have a significant effect on psychological and physical child development and represent a risk factor for interpersonal difficulties. OBJECTIVE This study aims to investigate the association between ACE, in particular physical, sexual, emotional abuse and neglect, and partnership quality during adulthood in women. PARTICIPANTS AND SETTING This study is a secondary analysis of a retrospective multi-center study evaluating risk factors and quality of life in women with and without endometriosis, a chronic, disabling gynecological disease. The investigation includes 533 consenting adult women (159 with ACE and 374 women without) recruited from various hospitals in Switzerland, Austria and Germany. METHODS To evaluate the association between ACE and partnership, a questionnaire including the Childhood Trauma Questionnaire and a validated partnership questionnaire were used. RESULTS Altogether, 29.8 % (N = 159) women experienced maltreatment in childhood, 9.7 % (N = 52) of them more than one type. Women who went through ACE showed a lower level of happiness (P = 0.013) and of quality of partnership (P = 0.001) as well as a higher number of conflict areas (P < 0.001). Emotional (P = 0.03; 95 % CI=-1.27,-0.070) and sexual abuse (P = 0.01; 95 % CI=-1.765,-0.197) had the strongest association with reduced partnership quality. CONCLUSION Our study showed a significant association between ACE, in particular sexual and emotional abuse, and reduced partnership quality. As the quality of partnership is a key factor in the quality of life, improvement in social support with a special focus on intimate relationships should be part of the strategy to address the consequences of ACE already during childhood/adolescence.
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Affiliation(s)
- Ina Schütze
- Department of Reproductive Endocrinology, University Hospital Zurich, Switzerland
| | - Kirsten Geraedts
- Department of Reproductive Endocrinology, University Hospital Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Switzerland; University of Zurich, Switzerland.
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Katon JG, Callegari LS, Bossick AS, Fortney J, Gerber MR, Lehavot K, Lynch KE, Ma E, Smith R, Tartaglione E, Gray KE. Association of Depression and Post-Traumatic Stress Disorder with Receipt of Minimally Invasive Hysterectomy for Uterine Fibroids: Findings from the U.S. Department of Veterans Affairs. Womens Health Issues 2020; 30:359-365. [DOI: 10.1016/j.whi.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 12/28/2022]
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Reinhardt KM, Zerubavel N, Young AS, Gallo M, Ramakrishnan N, Henry A, Zucker NL. A multi-method assessment of interoception among sexual trauma survivors. Physiol Behav 2020; 226:113108. [PMID: 32721494 DOI: 10.1016/j.physbeh.2020.113108] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 06/01/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
It is well established that many female sexual trauma survivors experience dissociation, particularly disconnection from the body, in the aftermath of sexual trauma. This study aims to address the open question of how sexual trauma is associated with awareness of inner body sensations (i.e., interoception). Given the important role that interoception has in emotion regulation, a process with which survivors often struggle, it is important to understand the associations between interoception and PTSD symptoms among survivors. Through multi-methods, we assessed associations between interoception, dissociation, and PTSD symptoms among 200 female sexual trauma survivors. We assessed two components of interoception: interoceptive accuracy (IAc: accurately perceiving internal body sensations; via heartbeat perception task) and interoceptive sensibility (IS: self-report perception of sensitivity to interoceptive sensations). We hypothesized that IAc and IS would be positively correlated with PTSD, with interactions between IAc/dissociation and IS/dissociation qualifying those main effects, weakening them for survivors with higher dissociation. Results showed an opposite pattern than was predicted: although IAc did explain significant PTSD variance, as IAc increased, PTSD decreased. Although IAc did explain significant variance in PTSD symptoms, interestingly, IS did not. Consistent with extant literature, dissociation predicted significant variance in PTSD. These correlational results suggest that the ability to more accurately perceive inner body sensations is related to lower PTSD symptoms. Findings provide a foundation for future research that can assess if interventions (such as yoga or exercise) that target increasing interoceptive accuracy lead to decreases in PTSD symptoms. We discuss further clinical implications, limitations and future directions.
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Affiliation(s)
| | - Noga Zerubavel
- Department of Psychiatry and Behavioral Services, Duke University Medical Center
| | - Anna S Young
- University of Oregon; Oregon Health & Science University
| | | | | | | | - Nancy L Zucker
- Department of Psychology and Neuroscience, Duke University
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Reese S, Deutsch SA. Sexual Assault Victimization Among Children and Youth With Developmental Disabilities: Responding With Trauma-Informed Care. JOURNAL OF FORENSIC NURSING 2020; 16:55-60. [PMID: 32068678 DOI: 10.1097/jfn.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual assault victimization is a traumatic experience for children and youth, and care of survivors requires a trauma-informed approach. Children and youth with developmental disabilities are sexually victimized at higher rates than those without disabilities. Children with autism spectrum disorder (ASD), in particular, may be at an increased risk for both traumatic events and developing traumatic sequelae after sexual assault victimization. In this report, we present the case of a youth with ASD who sought acute sexual assault care, but whose care was compromised because of multiple systems failures, including gaps in communication regarding her unique needs, and inconsistent knowledge among multidisciplinary team members regarding necessary adaptations in the implementation of trauma-informed care for youth with ASD. Lessons learned, including proposed solutions to improve communication and education, and approaches to prevent unintended retraumatization are discussed.
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Ades V, Goddard B, Pearson Ayala S, Greene JA. Caring for long term health needs in women with a history of sexual trauma. BMJ 2019; 367:l5825. [PMID: 31640984 DOI: 10.1136/bmj.l5825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Veronica Ades
- NYU School of Medicine, Department of Obstetrics & Gynecology, New York, NY, USA
| | | | | | - Judy A Greene
- NYU School of Medicine, Department of Psychiatry, New York, NY, USA
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Reingle Gonzalez JM, Jetelina KK, Olague S, Wondrack JG. Violence against women increases cancer diagnoses: Results from a meta-analytic review. Prev Med 2018; 114:168-179. [PMID: 29981792 DOI: 10.1016/j.ypmed.2018.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/26/2018] [Accepted: 07/04/2018] [Indexed: 11/16/2022]
Abstract
The purpose of this project was to assess the magnitude of the relationship between violence against women and cancer; to identify the exposures and cancers for which this relationship was particularly robust; to identify the effect of violence exposure on cancer screening. We conducted a meta-analysis of 36 studies to determine the relationship between violence against women and cancer outcomes, including screening, in 2017. Results from this review provide evidence of a significant, positive relationship between violence and cancer diagnoses, particularly for cervical cancer. Women who were victims of intimate partner violence and sexual abuse were more likely to be diagnosed with cancer compared with non-victims. Violence against women did not appear to be related to cancer screening practices and routine clinical service utilization; however, violence was associated with greater odds of abnormal pap test results. Victims of intimate partner violence and women who suffered physical abuse were more likely to have abnormal pap test results. In conclusion, use of screening tools for violence against women in clinical settings may improve the breadth and quality of research on violence against women and cancer. Investigators should consider how to creatively apply case-control and retrospective cohort designs to investigate the complex mechanisms and moderators of the relationship between violence against women and cancer.
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Affiliation(s)
- Jennifer M Reingle Gonzalez
- University of Texas School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, United States of America.
| | - Katelyn K Jetelina
- University of Texas School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, United States of America
| | - Stefany Olague
- University of Texas School of Public Health, Department of Epidemiology, Human Genetics and Environmental Sciences, United States of America
| | - Jordan G Wondrack
- University of Texas School of Public Health, United States of America
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Liebermann C, Kohl Schwartz AS, Charpidou T, Geraedts K, Rauchfuss M, Wölfler M, von Orelli S, Häberlin F, Eberhard M, Imesch P, Imthurn B, Leeners B. Maltreatment during childhood: a risk factor for the development of endometriosis? Hum Reprod 2018; 33:1449-1458. [DOI: 10.1093/humrep/dey111] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/15/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- C Liebermann
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - A S Kohl Schwartz
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
- Division of Gynaecologic Endocrinology and Reproductive Medicine, University Hospital Bern, Effingerstrasse 102, Bern, Switzerland
| | - T Charpidou
- Cantonal Hospital Baden, 5405 Baden, Im Ergel 1, Switzerland
| | - K Geraedts
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - M Rauchfuss
- Charité Berlin, University Hospital Berlin, Sauerbruchweg 5, Berlin, Germany
| | - M Wölfler
- Division of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Graz, Auenbruggerplatz 1, Graz, Austria
| | - S von Orelli
- Triemli Hospital Zurich, Birmesdorferstrasse 497, Zurich, Switzerland
| | - F Häberlin
- Cantonal Hospital St. Gallen, Rorschacherstrasse 501, St. Gallen, Switzerland
| | - M Eberhard
- Cantonal Hospital Schaffhausen, Geissbergstrasse 81, Schaffhausen, Switzerland
| | - P Imesch
- Department of Gynaecology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - B Imthurn
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
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Abuse, cancer and sexual dysfunction in women: A potentially vicious cycle. Gynecol Oncol 2018; 150:166-172. [PMID: 29661496 DOI: 10.1016/j.ygyno.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/24/2018] [Accepted: 04/03/2018] [Indexed: 01/06/2023]
Abstract
More than 30% of women have a history of abuse. Women with cancer may be at substantially increased risk for abuse, but this issue is rarely discussed in the course of oncology care. Women with a history of abuse who present for cancer care commonly have a high prevalence of co-morbid illness. Sexual dysfunction, a highly prevalent but under-recognized condition among women of all ages, is also more common among both women with a history of abuse and women with cancer. Although common after cancer, sexual dysfunction, like abuse, can be stigmatizing and often goes undiagnosed and untreated. This review first examines the literature for evidence of a relationship between any history of abuse and cancer among women, addressing two questions: 1) How does abuse promote or create risk for developing cancer? 2) How does cancer increase a woman's susceptibility to abuse? We then examine evidence for a relationship between abuse and female sexual dysfunction, followed by an investigation of the complex relationship between all three factors: abuse, sexual dysfunction and cancer. The literature is limited by a lack of harmonization of measures across studies, retrospective designs, and small and idiosyncratic samples. Despite these limitations, it is imperative that providers integrate the knowledge of this complex relationship into the care of women with cancer.
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Watt MH, Dennis AC, Choi KW, Ciya N, Joska JA, Robertson C, Sikkema KJ. Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa. AIDS Behav 2017; 21:3209-3218. [PMID: 27866288 PMCID: PMC5438301 DOI: 10.1007/s10461-016-1617-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.
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Affiliation(s)
- Melissa H Watt
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA.
| | - Alexis C Dennis
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
| | - Karmel W Choi
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Nonceba Ciya
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Corne Robertson
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Cancer treatment experiences among survivors of childhood sexual abuse: A qualitative investigation of triggers and reactions to cumulative trauma. Palliat Support Care 2017; 16:767-776. [PMID: 28809134 DOI: 10.1017/s147895151700075x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Some 25% of women and 8% of men in the United States have experienced childhood sexual abuse (CSA) before the age of 18. For these individuals, healthcare visits and interactions can be retraumatizing due to perceived similarities to past abuse (e.g., pain, undressing, lack of control). However, no prior studies have provided formal qualitative analyses regarding CSA survivors' reactions to cancer treatment. Therefore, our study's objective was to identify key themes pertaining to CSA survivors' cancer treatment experiences. METHOD Male and female members of the Amazon Mechanical Turk (N = 159, mean age = 44.27 years, SD = 10.02) participated in an anonymous online survey study. The inclusion criteria included reporting: history of CSA; a diagnosis of colorectal, gynecological, breast, or skin cancer; and experience of triggers and/or difficulties during cancer treatment. Participants' responses to open-ended questions were analyzed using inductive thematic analysis. RESULTS We identified two primary themes describing CSA survivors' experiences: Theme 1: treatment-related triggers (key subthemes: procedure-related, provider-related, and emotional triggers); and Theme 2: questioning the meaning of cumulative trauma (e.g., "Why me again?"). SIGNIFICANCE OF RESULTS For CSA survivors, cancer and its treatment can trigger thoughts and emotions associated with the original abuse as well as negative evaluations of themselves, the world, and their future. Our findings are consistent with past research on CSA survivors' experiences in non-cancer healthcare settings and add to the literature by highlighting their struggles during cancer treatment. The present results can inform further research on trauma survivors' reactions to cancer treatment and give cancer care providers the context they need to understand and sensitively serve a substantial yet often overlooked patient group.
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Zelin JM, Cadman L, Amara P, Marnoch S, Vosper J. The 'My Body Back' Clinic: a specialist cervical screening and sexually transmitted infection testing clinic for women who have been sexually abused. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2017; 43:327-330. [PMID: 28780522 DOI: 10.1136/jfprhc-2017-101741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Jill M Zelin
- Barts Health NHS Trust, Bart's Sexual Health Centre, Kenton and Lucas Block, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Louise Cadman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Bart's and the London School of Medicine and Dentistry, Charterhouse Square, London, UK.,Barts Health NHS Trust, Gynaecology Outpatients, Women's Centre, London, UK
| | | | - Siobhan Marnoch
- Barts Health NHS Trust, Bart's Sexual Health Centre, Kenton and Lucas Block, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Jane Vosper
- Barts Health NHS Trust, Bart's Sexual Health Centre, Kenton and Lucas Block, St Bartholomew's Hospital, West Smithfield, London, UK
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Stevens NR, Tirone V, Lillis TA, Holmgreen L, Chen-McCracken A, Hobfoll SE. Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting. J Psychosom Obstet Gynaecol 2017; 38:103-110. [PMID: 27960615 DOI: 10.1080/0167482x.2016.1266480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs. METHODS Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit. RESULTS The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences. DISCUSSION Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.
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Affiliation(s)
- Natalie R Stevens
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Vanessa Tirone
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Teresa A Lillis
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Lucie Holmgreen
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Allison Chen-McCracken
- b Department of Obstetrics & Gynecology , Rush University Medical Center , Chicago , IL , USA
| | - Stevan E Hobfoll
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
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Schnur JB, Chaplin WF, Khurshid K, Mogavero JN, Goldsmith RE, Lee YS, Litman L, Montgomery GH. Development of the Healthcare Triggering Questionnaire in adult sexual abuse survivors. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2017; 9:714-722. [PMID: 28447815 DOI: 10.1037/tra0000273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE One in 4 women and 1 in 10 men in the United States are survivors of sexual abuse (SA). For these survivors, healthcare experiences may trigger memories, thoughts, feelings or sensations related to this past abuse. Such triggering can be associated with negative responses to healthcare (e.g., anxiety, avoidance). However, to date, no healthcare triggering assessment tool exists. Therefore, the study goal was to describe the prevalence of healthcare triggering, to develop a brief Healthcare Triggering Questionnaire (HTQ), and to examine its initial validity. METHOD An initial pool of 117 items was developed based on previous research. Two-parameter logistic item response theory models were used to develop the scales. SA survivors [male (n = 233), female (n = 222)] and a comparison group of non-SA individuals [male (n = 114), female (n = 106)] were recruited through Amazon Mechanical Turk and completed the study anonymously online. RESULTS Three 10-item scales were developed: (a) the HTQ-M for males; (b) the HTQ-F for females; and (c) the HTQ-U (unisex) for all respondents. The results supported the utility and initial validity of the gender-specific and unisex scales. CONCLUSIONS The HTQ scales are a psychometrically sound approach to evaluating healthcare triggering experienced by adult sexual abuse survivors. The HTQ may be considered for use by researchers interested in studying healthcare triggering, healthcare retraumatization, and healthcare adherence. The HTQ may also be of use to clinicians interested in identifying trauma survivors who are more likely to experience triggering in healthcare settings. (PsycINFO Database Record
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
| | | | | | | | - Rachel E Goldsmith
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
| | - Young-Sun Lee
- Department of Human Development, Teachers College, Columbia University
| | - Leib Litman
- Department of Psychology, Lander College for Men
| | - Guy H Montgomery
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
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Leeners B, Görres G, Block E, Hengartner MP. Birth experiences in adult women with a history of childhood sexual abuse. J Psychosom Res 2016; 83:27-32. [PMID: 27020073 DOI: 10.1016/j.jpsychores.2016.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Although childhood sexual abuse (CSA) may seriously impair childbirth experiences, few systematic evaluations on associations, mediating influences, risk and protective factors are available. As such information is mandatory to improve obstetric care, the present study aimed to provide such data. METHODS The study compared childbirth experiences from 85 women after CSA and at least one pregnancy resulting in a life birth with those from 170 control women matched for nationality, personal age and children's age. Trained specialists from support centers investigated CSA. Obstetrical data were collected from the official personal clinical record of each pregnancy (Mutterpass) and data on CSA as well as childbirth experiences were examined by questionnaires. RESULTS Childbirth was more often highly frightening (24.7 vs. 5.3%; p<0.01) and a negative experience (40.7 vs. 19.6%, p<0.01) in women with a history of CSA than in controls. Multivariate regression models support the hypothesis that at least part of this association was mediated by covariates (specifically, birth preparation classes, presence of a trusted person, participation in medical decision-making, pain relief, emergency during labor and extreme duration of labor), which represent important resources in improving obstetric care. In 41% of women with CSA, memories of traumatic experiences intruded during childbirth, whereas about 58% experienced dissociation. While dissociation may result in loss of contact with obstetric staff, it was also used to reduce labor pain. CONCLUSION Childbirth following a history of CSA is associated with particular challenges. Creating a trusting environment by evaluating and integrating individual needs could ameliorate birth experiences.
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Affiliation(s)
- Brigitte Leeners
- Clinic for Reproductive Endocrinology, University Hospital Zurich, Switzerland.
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Choi KR. Complex Psychological Trauma and Self-Dysregulation: A Theory Synthesis for Nursing. Res Theory Nurs Pract 2016; 30:10-25. [DOI: 10.1891/1541-6577.30.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complex psychological trauma is a phenomenon resulting from severe interpersonal trauma that can negatively affect how individuals experience health care. However, few theories conceptualizing complex trauma exist, and it has received only limited attention in the nursing literature. The purpose of this theory synthesis was to organize two theories of (a) self-regulation and (b) self-dysregulation following complex psychological trauma into a single conceptual framework for use in nursing practice. This article used the theory synthesis approach described by Walker and Avant. The theory has potential to advance nursing science by helping nurses and other health professionals understand how trauma can alter self-regulatory processes and result in unique challenges in care delivery. It also has potential to prevent retraumatization of trauma survivors at the hands of health care providers.
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Bergman AA, Frankel RM, Hamilton AB, Yano EM. Challenges with delivering gender-specific and comprehensive primary care to women veterans. Womens Health Issues 2015; 25:28-34. [PMID: 25530547 DOI: 10.1016/j.whi.2014.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services. METHODS We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics. RESULTS Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. CONCLUSION Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.
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Affiliation(s)
- Alicia A Bergman
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California.
| | - Richard M Frankel
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: "do no harm". Perm J 2015; 18:82-7. [PMID: 25106042 DOI: 10.7812/tpp/14-009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The health care literature describes treatment challenges and recommended alterations in practice procedures for female survivors of childhood sexual abuse, a subtype of adverse childhood experiences. Currently, there are no concomitant recommendations for best clinical practices for male survivors of childhood sexual abuse or other adverse clinical experiences. Anecdotal information suggests ways physicians can address the needs of adult male survivors of childhood sexual abuse by changes in communication, locus of control, and consent/permission before and during physical examinations and procedures. The intent of this article is to act as a catalyst for improved patient care and more research focused on the identification and optimal responses to the needs of men with adverse childhood experiences in the health care setting.
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Affiliation(s)
- Les Gallo-Silver
- Associate Professor of Health Sciences at LaGuardia Community College of the City University of New York, in Long Island City.
| | | | - Jaime Romo
- Commissioned Minister in the United Church of Christ for Healing and Healthy Environments in Carlsbad, CA,
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Abstract
Patients with a history of traumatic life events can become distressed or re-traumatized as the result of healthcare experiences. These patients can benefit from trauma-informed care that is sensitive to their unique needs. However, despite the widespread prevalence of traumatic life experiences such as sexual assault and intimate partner violence, trauma-informed care has not been widely researched or implemented. The purpose of this synthesis of the literature is to examine existing research on trauma-informed care for survivors of physical and sexual abuse. The following themes are discussed: trauma screening and patient disclosure, provider-patient relationships, minimizing distress and maximizing autonomy, multidisciplinary collaboration and referrals, and trauma-informed care in diverse settings. This synthesis also explores implications for trauma-informed care research, practice and policy. The themes identified here could be used as a framework for creating provider and survivor educational interventions and for implementing trauma-informed care across disciplines. The findings of this synthesis support further research on patient and provider experiences of trauma-informed care, and research to test the efficacy of trauma-informed care interventions across healthcare settings. Universal implementation of trauma-informed care can ensure that the unique needs of trauma survivors as patients are met, and mitigate barriers to care and health disparities experienced by this vulnerable population.
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Affiliation(s)
- Elizabeth Reeves
- a Duke University, School of Nursing , Durham , North Carolina , USA
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Boyer SC, Pukall CF. Pelvic examination experiences in women with and without chronic pain during intercourse. J Sex Med 2014; 11:3035-50. [PMID: 25243968 DOI: 10.1111/jsm.12701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although pelvic examinations (PEs) are an important component of women's health, some women experience difficulty during PEs due to anxiety and pain. These difficulties may be heightened in women with chronic pain during sexual intercourse. Some evidence suggests that this population experiences pain and distress during PEs, but their experiences in this context have not been empirically investigated from a multidimensional perspective. AIMS The aims of this study were to compare the PE experiences of women with and without pain during intercourse and to examine predictors of negative experiences in each group. METHOD Women with vulvovaginal pain (n = 90), pelvic pain (n = 89), and women without current intercourse pain (n = 207) completed an online survey including sections assessing demographics, gynecological and medical history, and PE experiences. Respondents completed questionnaires assessing vaginal penetration cognitions and body image. MAIN OUTCOME MEASURES Participants rated their most recent PE on numerical scales for pain, embarrassment, anxiety, and the overall quality of the experience. RESULTS Women with pelvic and vulvovaginal pain during intercourse reported significantly more pain and anxiety during their most recent PE compared with the no pain group, and women with a higher number of lifetime gynecological diagnoses reported significantly more pain. Multiple regression analyses indicated that various predisposing, examination-related, and psychological factors predicted specific PE ratings in each group. CONCLUSIONS The results provide empirical support that PEs are more physically and emotionally difficult for women who experience chronic pain during intercourse. These findings have important clinical implications, as PEs are a critical part of complete reproductive care and play an essential role in the assessment/management of sexual pain, including Genito-Pelvic Pain/Penetration Disorder.
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Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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The impact of sexual abuse in patients undergoing colonoscopy. PLoS One 2014; 9:e85034. [PMID: 24454784 PMCID: PMC3893132 DOI: 10.1371/journal.pone.0085034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/21/2013] [Indexed: 11/20/2022] Open
Abstract
Background Sexual abuse has been linked to strong effects on gastrointestinal health. Colonoscopy can provoke intense emotional reactions in patients with a sexual abuse history and may lead to avoidance of endoscopic procedures. Objective To determine whether care around colonoscopy needs adjustment for patients with sexual abuse experience, thereby exploring targets for the improvement of care around colonoscopic procedures. Methods Questionnaires were mailed to patients (n = 1419) from two centers within 11 months after colonoscopy. Differences in experience of the colonoscopy between patients with and without a sexual abuse history were assessed and patients' views regarding physicians' inquiry about sexual abuse and care around endoscopic procedures were obtained. Results A total of 768 questionnaires were analyzed. The prevalence of sexual abuse was 3.9% in male and 9.5% in female patients. Patients born in a non-western country reported more sexual abuse (14.9%) than those born in a western country (6.3%; p = 0.008). Discomfort during colonoscopy was indicated on a scale from 0 to 10, mean distress score of patients with sexual abuse was 4.8(±3.47) compared to 3.5(±3.11) in patients without a sexual abuse history (p = 0.007). Abdominal pain was a predictor for higher distress during colonoscopy (β = −0.019 (SE = 0.008); p = 0.02, as well as the number of complaints indicated as reason for colonoscopy (β = 0.738 (SE = 0.276); p = 0.008). Of patients with sexual abuse experience, 53.8% believed gastroenterologists should ask about it, 43.4% said deeper sedation during colonoscopy would diminish the distress. Conclusions Sexual abuse is prevalent in patients presenting for colonoscopy. Patients with a sexual abuse history experience more distress during the procedure and indicate that extra attention around and during colonoscopy may diminish this distress.
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Walker J, Allan HT. Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients? J Clin Nurs 2013; 23:1857-65. [PMID: 24942268 DOI: 10.1111/jocn.12390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the training needs and awareness of childhood sexual abuse amongst clinical staff taking cervical screening samples in one inner city primary care trust. BACKGROUND Studies exploring sexual abuse and nonparticipation in cervical screening have demonstrated that women can experience re-traumatisation if care during examinations is insensitive to their particular needs. DESIGN This was a mixed methods, service evaluation in three phases. METHODS A literature review, a questionnaire to cervical screening staff in an inner city primary care trust and a focus group of four staff drawn from questionnaire respondents to explore themes raised in the questionnaire data. RESULTS Data analysis of both quantitative and qualitative data showed that clinical staff underestimated the frequency of childhood sexual abuse although they were aware of the difficulties and reluctance some women experience undergoing gynaecological examinations. When women did disclose childhood sexual abuse or when staff suspected a history of childhood sexual abuse, staff reported feeling unsure of how they should proceed. There was no support or clinical supervision, and unmet training needs were identified. CONCLUSIONS Nurses expressed anxiety around the potential of the screening test to cause more harm than good and at their inability to provide more help than listening. Staff wanted support and further training after completing their cervical screening training course to assist in their provision of sensitive care to patients who have experienced childhood sexual abuse. RELEVANCE TO CLINICAL PRACTICE Whilst our results cannot be generalised to a wider population, they may be meaningful for the community of cervical screening takers. We argue that screening staff require further training and professional support (clinical supervision) to increase their confidence when providing safe and sensitive practice for childhood sexual abuse survivors. If staff feel more confident and competent when responding to disclosure of childhood sexual abuse in screening situations, women who have experienced childhood sexual abuse might participate in the screening programme more readily.
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Leeners B, Stiller R, Block E, Görres G, Rath W, Tschudin S. Prenatal care in adult women exposed to childhood sexual abuse. J Perinat Med 2013; 41:365-74. [PMID: 23314504 DOI: 10.1515/jpm-2011-0086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 11/28/2012] [Indexed: 11/15/2022]
Abstract
AIMS Several case reports show a negative impact of childhood sexual abuse (CSA) on prenatal care. The study aimed to systematically investigate this association in a larger study group. METHODS CSA was investigated by face-to-face interviews and by a modified questionnaire developed by Wyatt. All study participants completed a self-administered questionnaire designed to investigate the consequences of CSA on prenatal care during adulthood. Data from 85 women after CSA were compared to those of 170 matched women without such experiences. RESULTS Women exposed to CSA had fewer than five prenatal consultations more often than unexposed women (26%/7%; P<0.0001). Of the 85 women with a positive history for CSA, 9.4% had been asked for such antecedents, 36.5% had intense memories on original abuse situations during pregnancy, 56.6% mentioned specific consequences of CSA on prenatal care and 61.2% were satisfied with obstetrical support. Exposed women (62.4%) felt significantly less prepared for labor than unexposed women (75.9%) (P<0.0001). CONCLUSIONS CSA experiences are associated with impaired prenatal care. These results underscore the compelling need to improve prenatal care in women exposed to CSA through better education of obstetricians regarding the effects of CSA and in their ability to provide empathetic professional support.
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Affiliation(s)
- Brigitte Leeners
- Division of Reproductive Endocrinology, University Hospital Zürich, Zürich, Switzerland.
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Williams AA, Williams M. A guide to performing pelvic speculum exams: a patient-centered approach to reducing iatrogenic effects. TEACHING AND LEARNING IN MEDICINE 2013; 25:383-391. [PMID: 24112210 DOI: 10.1080/10401334.2013.827969] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Current training in the United States for pelvic speculum examinations (PSEs) has a primary focus on the physician-centered goal of visualizing the cervix but may not inform practitioners of potential iatrogenic effects. Such oversight leaves trainees unprepared and unskilled in preventing and addressing adverse outcomes. This article incorporates a literature review into a step-by-step guide to aid the teaching of PSEs. SUMMARY Iatrogenic effects of PSEs may include mild discomfort, extreme pain, anxiety, psychological (re)traumatization, and sexual pain disorders. A literature-based guide is presented to identify patients at risk for adverse outcomes, set up the exam room, set up the patient, perform the exam, calm distressed patients, and avoid exam-interfering behaviors. CONCLUSIONS Although PSEs can lead to adverse outcomes, awareness of the iatrogenic effects allows clinicians to utilize techniques to prevent or reduce negative effects. A method of incorporating techniques described in this article into teaching is provided.
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Affiliation(s)
- Adrienne A Williams
- a Department of Family and Community Medicine , University of Maryland School of Medicine , Baltimore , Maryland , USA
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McGregor K, Gautam J, Glover M, Jülich S. Health care and female survivors of childhood sexual abuse: health professionals' perspectives. JOURNAL OF CHILD SEXUAL ABUSE 2013; 22:761-775. [PMID: 23924181 DOI: 10.1080/10538712.2013.811143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model-transition to ethical practice-emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.
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Affiliation(s)
- Kim McGregor
- Rape Prevention Education-Whakatu Mauri, Auckland, New Zealand
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Cadman L, Waller J, Ashdown-Barr L, Szarewski A. Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study. ACTA ACUST UNITED AC 2012; 38:214-20. [PMID: 23027982 PMCID: PMC3470431 DOI: 10.1136/jfprhc-2012-100378] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To explore self-reported cervical screening history and barriers to attendance among women who have been sexually abused and to identify measures to improve the experience of cervical screening for these women. METHODS Women visiting the website of the National Association for People Abused in Childhood (NAPAC), who had been sexually abused, were invited to complete a survey of their views and experiences of cervical screening. This included closed questions on demographic characteristics and cervical screening attendance, open questions on barriers to screening, and the opportunity to submit suggestions to improve this experience for women who have been sexually abused. Content analysis was used to code responses to the open questions. Four women also participated in a discussion group. RESULTS Overall, 135 women completed the closed questions and 124 provided open-ended responses. 77.5% of responding women who were eligible for cervical screening in England had ever attended, 48.5% at least once in the previous 5 years, but 42.1% of women aged 25-49 within 3 years. A total of nine higher order themes were identified related to barriers to screening, one related to intention to attend screening and five related to suggestions to improve screening. CONCLUSIONS This study supports the idea that women who have experienced sexual abuse are less likely to attend for regular cervical screening, with under half screened in the last 5 years compared to the National Health Service Cervical Screening Programme figure of 78.6%. Suggestions to improve the experience for abused women focused on communication, safety, trust and sharing control. Further research in this area is warranted to ensure that this at-risk population is appropriately served by cervical screening.
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Affiliation(s)
- Louise Cadman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Bart's and the London School of Medicine, London, UK
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Ackerson K. A history of interpersonal trauma and the gynecological exam. QUALITATIVE HEALTH RESEARCH 2012; 22:679-688. [PMID: 22068042 DOI: 10.1177/1049732311424730] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Cervical cancer is preventable, in part, by routine Papanicolaou (Pap) testing, but some women avoid routine screening. African American women have the greatest mortality among all groups of women in the United States. Personal reasons have been found to contribute to screening avoidance behavior, such as a history of sexual abuse and intimate partner violence. Fifteen African American women with a trauma history participated in personal interviews. The Interaction Model of Client Behavior was employed for exploring the women's social influence, previous health care experience, cognitive appraisal, affective response, and motivation associated with routine Pap testing. Study findings suggest that providers need to assess and provide accurate information about Pap testing and cervical cancer to increase patients' knowledge. Personally reflecting on one's approach to conducting a woman's gynecologic exam (and how it is performed) might prevent triggering unwanted memories, making that visit a positive experience and facilitating repeat screening behavior.
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Affiliation(s)
- Kelly Ackerson
- Western Michigan University, Kalamazoo, MI 49008-5345, USA.
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Olesen SC, Butterworth P, Jacomb P, Tait RJ. Personal factors influence use of cervical cancer screening services: epidemiological survey and linked administrative data address the limitations of previous research. BMC Health Serv Res 2012; 12:34. [PMID: 22333392 PMCID: PMC3306758 DOI: 10.1186/1472-6963-12-34] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND National screening programs have reduced cervical cancer mortality; however participation in these programs varies according to women's personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data. METHODS The cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening. RESULTS Overall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%. CONCLUSIONS This study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.
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Affiliation(s)
- Sarah C Olesen
- Psychiatric Epidemiology and Social Issues Unit, Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Building 63 Eggleston Road, Acton, ACT, Australia.
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Weitlauf JC, Frayne SM, Finney JW, Moos RH, Jones S, Hu K, Spiegel D. Sexual violence, posttraumatic stress disorder, and the pelvic examination: how do beliefs about the safety, necessity, and utility of the examination influence patient experiences? J Womens Health (Larchmt) 2011; 19:1271-80. [PMID: 20509787 DOI: 10.1089/jwh.2009.1673] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted. AIMS This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. MATERIALS AND METHODS A total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey. RESULTS Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment. CONCLUSION Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.
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Affiliation(s)
- Julie C Weitlauf
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94025, USA.
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McGregor K, Glover M, Gautam J, Jülich S. Working Sensitively with Child Sexual Abuse Survivors: What Female Child Sexual Abuse Survivors Want from Health Professionals. Women Health 2010; 50:737-55. [DOI: 10.1080/03630242.2010.530931] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pregnancy complications in women with childhood sexual abuse experiences. J Psychosom Res 2010; 69:503-10. [PMID: 20955870 DOI: 10.1016/j.jpsychores.2010.04.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 04/27/2010] [Accepted: 04/29/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA. METHODS The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation. RESULTS Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59). CONCLUSION Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.
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Ackerson K. Personal influences that affect motivation in pap smear testing among African American women. J Obstet Gynecol Neonatal Nurs 2010; 39:136-46. [PMID: 20409114 DOI: 10.1111/j.1552-6909.2010.01104.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore personal influencing factors that contribute to Papanicolaou (Pap smear) testing in African American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing. DESIGN Qualitative using the interaction model of client health behavior. SETTING Community programs, homes, and churches. PARTICIPANTS Twenty four African American women aged 19 to 60. METHODS Face-to-face interviews. Data were analyzed using a constant comparison approach. RESULTS Routine-use group was socially influenced to value preventive health care while the non-routine-use group was not. Previous health care experiences with having a Pap smear and pelvic exam were positive for routine-use group and negative for non-routine-use group. Cognitively, both groups believed Pap smears tested for cancer and sexually transmitted diseases. Vulnerability to cervical cancer was thought to run in families; participants believed they were either safe from risk or hoped that the odds were in their favor. In addition, there was a link between avoiding routine preventive care and a trauma history (sexual, physical, medical), eliciting negative perceptions towards Pap smears and pelvic exams. CONCLUSION Differences and similarities in personal influencing factors associated with cervical cancer screening were found in the two groups. Further research is needed to explore these differences and similarities because they may contribute to the reason that African American women have a greater mortality rate from cervical cancer than White women.
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Affiliation(s)
- Kelly Ackerson
- School of Nursing, Western Michigan University, Kalamazoo, MI 49008-5345, USA.
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McGregor K, Jülich S, Glover M, Gautam J. Health professionals' responses to disclosure of child sexual abuse history: female child sexual abuse survivors' experiences. JOURNAL OF CHILD SEXUAL ABUSE 2010; 19:239-254. [PMID: 20509075 DOI: 10.1080/10538711003789015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study reports on a postal questionnaire, conducted in 2004, with female survivors of historic child sexual abuse. The questionnaire explored their experiences of health professionals' responsiveness to disclosure of child sexual abuse history. Of 61 participants, aged between 22 and 65, 69% had disclosed to health professionals. Those who had not disclosed reported that they would have liked to but were not asked about child sexual abuse. Thirty-five percent of participants suggested routine questioning about child sexual abuse. Most participants related a fear of common medical examination procedures to their experience of child sexual abuse, and 64% said this stopped them from attending regular health checks. The current study suggests the development of guidelines for dealing with possible child sexual abuse survivors would be useful for health professionals.
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Affiliation(s)
- Kim McGregor
- Rape Prevention Education-Whakatu Mauri, Auckland, New Zealand
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Nerum H, Halvorsen L, Øian P, Sørlie T, Straume B, Blix E. Birth outcomes in primiparous women who were raped as adults: a matched controlled study. BJOG 2009; 117:288-94. [DOI: 10.1111/j.1471-0528.2009.02454.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buehler S. Childhood sexual abuse: Effects on female sexual function and its treatment. CURRENT SEXUAL HEALTH REPORTS 2008. [DOI: 10.1007/s11930-008-0027-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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