ArticlesEmotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study
Introduction
According to the UN Declaration on the Elimination of Violence Against Women, “women are entitled to the equal enjoyment and protection of all human rights and fundamental freedoms in the political, economic, social, cultural, civil, or any other field”. These rights include those to life, equality, liberty, security of person, and equal protection under the law. Furthermore, states are instructed to pursue by all appropriate means and without delay a policy of eliminating violence against women. Unfortunately there is still a long way to go in achieving these aims. In studies in Nordic, American, Canadian, and Australian populations, high prevalences of emotional, physical, and sexual abuse have been reported.1, 2, 3, 4, 5, 6, 7, 8 Table 1 shows examples of how reported prevalences varied among studies in which different definitions of abuse were used.9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 Thus, the prevalence of abuse needs to be assessed with indices that clearly define and quantify what is being measured. Such instruments are scarce, and few have been validated and used in more than one sample.
Sexual and physical abuse are associated with gynaecological problems.20, 21, 22, 23, 24 Patients seldom spontaneously report their abusive experiences, and since many gynaecologists find it difficult to ask questions about abuse routinely, we postulated that gynaecologists rarely identify victims of abuse among their patients.25, 26 Such unidentified victims could receive misdiagnoses. These patients also risk having flashbacks to a traumatic event— eg, during pelvic examination involving penetration of a gynaecologist's fingers with the patient assuming a subordinate position. Furthermore, the patient's risk of experiencing pelvic examination as a traumatic situation could be increased if her history of abuse is unknown to the gynaecologist. Therefore, it would be beneficial if gynaecologists identified abuse victims.
We aimed to estimate the prevalence of emotional, physical, and sexual abuse in patients visiting five gynaecology clinics in the Nordic countries, and to assess the frequency with which abused patients were identified by gynaecologists.
Section snippets
Participants
We recruited gynaecology patients from university clinics: three departments of obstetrics and gynaecology in Glostrup (Denmark), Helsinki (Finland), and Linköping (Sweden); and two departments of gynaecology in Reykjavik (Iceland) and Trondheim (Norway). Consecutive inpatients and outpatients visiting the five departments were invited to participate, and received the norvold abuse questionnaire (NorAQ). Inclusion criteria were female sex, age 18 years or older, and understanding the written
Results
We recruited 4729 patients: 1011 from Denmark, 718 from Finland, 1000 from Iceland, 1000 from Norway, and 1000 from Sweden. Response rates were 80% in Denmark, 85% in Finland, 67% in Iceland, 71% in Norway, and 84% in Sweden. Thus, from 4729 eligible women, 3641 (77%) were included in the study. Participants' age, education, socioeconomic status, and occupation differed between countries (table 2).
2–3% of questions about abuse and 1% of sociodemographic questions were not answered. 6–12% of
Discussion
Our results show that prevalences of emotional, physical, and sexual abuse are high in patients visiting gynaecology clinics in the Nordic countries. Physical abuse was the most frequently reported, though severe forms of all types of abuse were common. Most victims of abuse are not identified by their gynaecologists.
Women in our study had applied for consultations at gynaecology clinics in five Nordic countries. The large variations in response rates between countries (67–85%) could be
References (36)
- et al.
The prevalence of sexual assault: a survey of 2404 puerperal women
Am J Obstet Gynecol
(1992) - et al.
The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases
Child Abuse Negl
(1997) - et al.
The combined effects of physical, sexual, and emotional abuse during childhood: long-term health consequences for women
Child Abuse Negl
(1993) - et al.
Relation between childhood sexual and physical abuse and risk of revictimisation in women: a cross-sectional survey
Lancet
(2001) - et al.
A global overview of gender-based violence
Int J Gynaecol Obstet
(2002) Prevalence of sexual abuse history in a random sample of Norwegian women
Scand J Soc Med
(1990)- et al.
Residents' experiences of abuse, discrimination and sexual harassment during residency training
Can Med Assoc J
(1996) - et al.
Physical, sexual and emotional violence against women: a general practice-based prevalence study
Med J Aust
(1996) - et al.
Prevalence of child physical and sexual abuse in the community: results from the Ontario Health supplement
JAMA
(1997) - et al.
Childhood emotional abuse and associated psychopathology in college students
J Coll Student Psychother
(1997)
Prevalence of intimate partner abuse in women treated at community hospital emergency departments
JAMA
Faith, hope and battering: a survey of men's violence against women in Finland
Prevalence of posttraumatic stress disorder among gynecological patients with a history of sexual and physical abuse
J Interpersonal Violence
Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse
Am J Psychiatry
History of physical and sexual abuse in women with chronic pelvic pain
Obstet Gynecol
Abuse history and chronic pain in women: I—prevalences of sexual abuse and physical abuse
Obstet Gynecol
Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome
J Psychosom Obstet Gynecol
Physical and sexual abuse: a middle-class concern?
J ReprodMed
Cited by (147)
Childhood sexual abuse, teenager pregnancy and the mediating role of psychiatric comorbidity
2022, Children and Youth Services ReviewViolence against Women
2016, International Encyclopedia of Public HealthSystematic review exploring the relationship between sexual abuse and lower urinary tract symptoms
2023, International Urogynecology Journal‘We experienced lack of understanding in the healthcare system’. Experiences of childhood sexual abuse survivors of the childbearing process, health and motherhood
2022, Scandinavian Journal of Caring SciencesProfessionals’ Views on the Comparatively Low Prevalence of Intimate Partner Violence Against Women in Spain
2022, Violence Against Women