Group Advises Clinicians to Routinely Screen Women for Sexual Assault History

Abstract

DURING MEDICAL VISITS, CLINIcians should routinely screen their female patients, particularly those who report pelvic pain, pain during menstruation, or sexual dysfunction, for a history of sexual assault, according to a new recommendation from the American College of Obstetricians and Gynecologists. As many as 18% of women report having been raped or having experienced an attempted rape in their lifetime, according to the National Violence Against Women Survey, which was sponsored by the US Centers for Disease Control and Prevention and the National Institute of Justice and collected data from a nationally representative sample of women and men between 1995 and 1996 (https: //www.ncjrs.gov/pdffiles1/nij/183781 .pdf). Such assaults may be associated with both acute and long-term health consequences, including traumatic injuries, a risk of pregnancy, sexually transmitted diseases, unexplained pain, or sexual dysfunction. They also may experience both short-term and longpsychiatric conditions, according to the recommendation. In the immediate aftermath of the attack, women often experience a rape-trauma syndrome that may last for days or weeks. This acute reaction may include generalized pain, eating and sleep problems, emotional reactions, and mood swings. After this initial phase, a woman may have flashbacks, nightmares, and phobias. These women may also develop posttraumatic stress disorder or substance abuse problems. But despite these serious consequences, women may be reluctant to discuss their assault. The recommendation aims to help more women get appropriate care, explained Veronica Gillispie, MD, a fellow of the college. “By screening, we can definitely help to stop the sequelae,” Gillispie said. The recommendation also advises clinicianstomakeemergencycontraception and prophylaxis for sexually transmitted diseases available in the immediate aftermath of sexual assaults. Additionally, clinicians shouldbeaware thatsomeproceduressuchaspelvic, rectal, breast, and endovaginal ultrasound examinations may trigger panic or anxiety forwomenwhohavebeenassaulted. Discomfort on the part of both the patient and physician may be one reason sexual assault is seldom discussed in clinical settings.“We need to get out of our comfort zone,” said Gillispie. She said that examinations for rape survivors are not very different than those for patients who want to be screened for sexually transmitted diseases, but that physicians may need to familiarize themselves with the local statutory requirements for clinicians conducting rape examinations. The guideline provides more detailed information about such exams. Additionally, the recommendation states that physicians must be prepared to refer women to professionals trained to provide care to rape-trauma victims and who can provide counseling. Many patients who have been raped may not volunteer the information, but maypresentwithsymptomsthathaveno clear cause. For example, women who have been sexually assaulted are more likely than those with no such history to presentwithchronicpelvicpain,painduringmenstruation,orsexualdysfunction. “Keep sexual assault in mind when that patient comes in with pelvic pain or sexual dysfunction,” Gillispie said. “That may be the underlying problem that needs to be treated.” news@JAMA From JAMA’s Daily News Site