Elsevier

The Lancet

Volume 361, Issue 9375, 21 June 2003, Pages 2107-2113
The Lancet

Articles
Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study

https://doi.org/10.1016/S0140-6736(03)13719-1Get rights and content

Summary

Background

Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims.

Methods

We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's χ2 test.

Findings

The ranges across the five countries of lifetime prevalence were 38–66% for physical abuse, 19–37% for emotional abuse, and 17–33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92–98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit.

Interpretation

Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

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

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