An Introduction
Do you avoid certain medical procedures like Pap smears, because you find them upsetting?Are you a health care provider needing information about providing care for women with a child sexual abuse history? |
Child abuse is a very sensitive issue and is often very difficult to hear or read about. Many women have difficulty using the health care system because of a history of abuse. These survivors may avoid necessary health care or find medical procedures traumatizing. This web site is intended for women with an abuse history and their health care providers. We recognize that some of the following content may be disturbing as it involves situations of past abuse. Whether you are a survivor, know one, are a professional who works with survivors, or are simply interested in sensitive practices in care, we hope that this site provides you with some helpful resources and tools |
Survivors and the Health Care Encounter
Do you find that you get anxious before a doctor's appointment?Do you put off or even cancel your yearly check up? Do medical examinations trigger memories from the past? Do you ever "space out" or dissociate during a medical examination you find particularly difficult? |
Many women have difficulties or fear medical examinations or procedures. Medical examinations can include a complete physical examination with your physician, surgeries, dental procedures, or breast, rectal or pelvic examinations. If you have been abused, you may find medical examinations particularly upsetting. Many women find similarities between medical examinations and past abuse experiences. Some similarities include:
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What survivors can do to prepare themselves: |
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Health Care Providers
Have clients ever indicated that certain medical tests or procedures were especially difficult?Have there been any particular medical conditions or behavioural clues with clients that have made you wonder about a background of abuse? Have any clients voluntarily disclosed that they are survivors of childhood abuse? |
Despite the prevalence of abuse in society, child sexual abuse is not adequately dealt with in professional schools. Increasingly, we know that several profound, long-term effects may result from childhood abuse and in turn, may influence current encounters with health care providers without the awareness of one or both parties. Some of the long-term effects of child sexual abuse include post-traumatic stress disorder (PTSD) symptoms, psychological problems, interpersonal problems, self-abuse, pain, and other somatic complaints. In an effort to provide appropriate care for survivors, it is essential for health care providers to understand the origin of somatic symptoms, and to consider an abuse history in patients with multiple complaints without an organic cause. Studies have found that health examinations requiring touch by a person in a position of power can present difficulties for women with a history of child sexual abuse and in some cases may even trigger PTSD symptoms. With prevalence rates as high as one third of women, it is important to retain a high level of awareness regarding the possibility of an abuse history with all patients. Our research study 1 [1] showed that health care providers would like more information and specific way of addressing child sexual abuse issues in practice. There are many ways you as a provider can make the medical encounter easier for both you and patients with an abuse history. These suggestions are categorized by health care providers groups: |
Research Summaries
- The Advanced Practice Nursing Role Of Change Agent: An Analysis Of Implementing Change Related To Childhood Sexual Abuse Sequelae In A Family Practice Clinic [6]
by Loredana Clemente - Parenting Themes for Incest Survivor Mothers with Daughters [7]
by Christine Kreklewetz M.Sc. - Perception and Utilization of Health Care Services by Women Survivors of Childhood Sexual Abuse: A Preliminary Study [8]
by Tuula Heinonen, Anne Merrett-Hiley, Lynn McClure, Sari Tudiver and Christine Kreklewetz, M.Sc. - Women Survivors of Childhood Sexual Abuse: Knowledge and Preparation of Health Care Providers to Meet Client Needs
[9]by Sari Tudiver, Ph.D, Lynn McClure, NP, Tuula Heinonen, D.Phil, Carol Scurfield MD & Christine Kreklewetz, M.Sc.
Related Articles
- Remembrance of Things Past: the legacy of childhood sexual abuse in midlife women [10]
by Sari Tudiver, Ph.D, Lynn McClure, N.P., Tuula Heinonen, Ph.D., Christine Kreklewitz, M.A., and Carol Scurfield, M.D.
About the Researchers
Sari Tudiver, Ph.D is a researcher, writer and consultant on women's health. From 1993 - 1999, she worked as the Resource Coordinator at the Women's Health Clinic in Winnipeg, Manitoba, a community health centre run by and for women, where she was responsible for developing consumer information on a wide variety of women's health issues. An anthropologist by training, her research interests include the international pharmaceutical industry, reproductive and genetic technologies, and the impacts of a history of childhood sexual abuse on women's lives. She is the Associate Editor of A Friend Indeed, an international publication on menopause and midlife and a founding member of the Canadian Women's Health Network. She now lives and works in Ottawa, Ontario Canada.
Lynn McClure R.N. M.N. has worked as a nurse practitioner at a community health centre in Winnipeg for over 20 years. She has an interest in women's and community health services and continues to be involved in primary care delivery, research, and occasional teaching. Collaboration with others in research that has practical implications for the service setting, is a particular interest for this health care provider.
Tuula Heinonen, D.Phil. has worked as a social worker in health care before becoming an academic in 1993. She is currently Associate Professor at the Faculty of Social Work, University of Manitoba where she teaches undergraduate courses on social work practice, health and international social development and graduate courses in qualitative research. Her research interests include women's health, culture, social work practice, transitions, and healthy communities.
Christine Kreklewetz M.Sc. is an interdisciplinary Ph.D. candidate at the University of Manitoba. She attained her Master's degree in Family Studies. She has worked as a clinical therapist for several years with First Nations Peoples in the North. Her areas of research expertise include sexual abuse and violence within a family context including incest survivor mothers and parenting, incest offenders, and the intergenerational transmission of incest. She has also worked on research projects involving early childhood school transition and program evaluation for at-risk children and youth. Her current work is focusing increasingly on qualitative research, feminist research, and the effects of sexual abuse on women's health.
Loredana Clemente RN, MN has worked in an expanded nursing role for over 5 years. She was among the first to complete a masters degree in Advanced Practice Nursing at the University of Manitoba, Faculty of Graduate Studies. Her research and clinical interests include childhood sexual abuse survivors and women's health. She currently holds a position as a Primary Health Care Nurse Practitioner in the North Eastman Health Association, the regional health authority for the North Eastman Region and she represents the region for women's health provincially.
Dawn Shiloh B.A with research interests conducted in the fields of suicide, child abuse and hysterectomies. Medicine's treatment of women's health issues, and in particular the high rates of hysterectomies as a means of treating many non life threatening conditions, is a newly found concern for her. She is working on a book about her experiences as an abuse survivor and the impact a hysterectomy can have on someone with that history. Dawn has contributed artistically to a monument to survivors of child abuse to be located in Toronto, Canada in 2001. As an abuse survivor with recent health problems, she has had much personal experience with the difficulties and treatment women can receive within the health care system.
Carol Scurfield M.D.CCFP has been a family practitioner at the Women's Health Clinic in Winnipeg, Manitoba for 15 years. Her interest is primarily in women's health, concentrating in the areas of adolescent health care, reproductive health, and menopause. She has been very involved in the legalization of midwifery in Manitoba and is completing a Masters of Community Health Sciences on the topic of child sexual abuse.
Other Helpful Links
A Burden to Share: A personal account of the Effect of Childhood Sexual abuse on Birth [11]
Abuse Issues in Pregnancy and Labour: When your client discloses her abuse history, what do you say? [12]
Abuse Bibliography for Gentle birth web site [13]
Breastfeeding and the Sexual Abuse Survivor [14]
Kathleen Kendall-Tackett, From: LEAVEN, Vol. 33 No. 2, April-May 1997, p. 27
Child abuse survivors monument [15]
Childhood Sexual Abuse and Its Effects On Childbirth [16]
Choosing a Family Physician for Survivors [17]
Client handout from Gentle birth website [18]
Crisis in the Perinatal Period [19]
Dental tips for survivors [20]
Doctor, I'm an Abuse Survivor, and I Want To Tell You Something [21]
By Kasey Drake [22]
Health Consequences of Abuse in the Family: A Clinical Guide for Evidence Based Practice [24]
Helping Survivors Through Labor [25]
Helping Survivors of Sexual Abuse Through Labour [25]
Impact of Past Child Sexual Abuse on Breastfeeding [26]
Penny Simkin [27]
- When Survivors Give Birth - video [28]
- Notes from Penny Simkin's Video [29]
- Notes from Abuse Workshop with Penny Simkin [30]
Pregnancy to Parenting: A Guide for Survivors of Child Sexual Abuse [32]
Sexual Abuse in Childhood and Dental Fear [33]
Sexual Abuse in Childhood and Dental Fear - An Interview with Clinical Psychologist Dr Carmen Santos [34]
Victims of sex abuse refusing Pap tests [35]
Discussion Forums
- Anyone else traumatized by pelvic examinations? [37]
- Issues with going to the gynecologist/panic attacks [38]
- Sexual abuse survivors and gynecological exams [39]
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