Intended for healthcare professionals

  1. Education
  2. Caring for long term...
  3. Caring for long term health needs in women with a history of sexual trauma
Practice Clinical Update

Caring for long term health needs in women with a history of sexual trauma

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5825 (Published 22 October 2019) Cite this as: BMJ 2019;367:l5825
  1. Veronica Ades, associate professor1,
  2. Brian Goddard, medical student2,
  3. Savannah Pearson Ayala, medical student2,
  4. Judy A Greene, clinical assistant professor3
  1. 1NYU School of Medicine, Department of Obstetrics & Gynecology, New York, NY, USA
  2. 2NYU School of Medicine, New York, NY, USA
  3. 3NYU School of Medicine, Department of Psychiatry, New York, NY, USA
  1. Correspondence to
    V Ades Veronica.Ades{at}nyumc.org

What you need to know

  • Trauma focused cognitive behavioural therapy interventions in the acute phase after sexual assault can potentially prevent development of post-traumatic stress disorder

  • Some people are hesitant to disclose a history of sexual trauma and may avoid routine medical care because of fear of retraumatisation

  • Some groups recommend routinely screening women for a history of sexual trauma, but you may individualise this and ask if specific concerns arise during the consultation

  • Exercise additional sensitivity during examination and explain the steps so the patient knows what to expect and can request to defer examination at any point

  • Annual pelvic examination may be avoided in people who express anxiety or discomfort; a thorough review of symptoms may suffice in these patients if they have no related symptoms

Globally, about 30% of women report intimate partner violence (physical, sexual, or both) (95% confidence interval 27.8% to 32.2%) and about 7.2% (95% confidence interval 5.3% to9.1%) of women face non-partner sexual violence in their lifetime.1 Sexual violence in men is less studied. In the United States, the National Intimate Partner and Sexual Violence Survey determined a lifetime prevalence of contact sexual violence (including forced penetration and fondling) of 36.3% (95% confidence interval 35.3% to 37.2%) among women and 17.1% (95% confidence interval 16.3% to 17.9%) among men.2

Experiences of sexual violence negatively affect a person’s long term physical and psychological wellbeing as well as their interaction with the healthcare system.

Most guidelines focus on treatment in the acute setting in the immediate aftermath of sexual assault, and rarely address long term care. Box 1 lists key aspects of acute medical care for people who have experienced sexual violence.

Box 1

Summary of acute care for people who have experienced sexual assault345

  • Access to sexual assault referral centres or a sexual assault forensic examiner, if possible

  • Assault history: location, positioning, timing, mechanisms of injury, coercion used, forms of …

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