:םירושיקה םינפמ םהילאש םיצבקה יגוס ליגר טנרטניא ףד תדחוימ הנכת ךירצמ וניאש PDF ץבוק :ןאכ םניח הדירוהל ןתינש ,Acrobat Reader תנכת הצוחנ הלא םיכמסמ אורקל ידכ

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OBJECTIVE: To explore how health professionals can practise in ways sensitive to adult women survivors of child sexual abuse.

DESIGN: Qualitative semistructured in-depth interviews.

SETTING: Small and midsize cities in Ontario and Saskatchewan.

PARTICIPANTS: Twenty-seven women survivors of childhood sexual abuse.

METHODS: Respondents were asked about their experiences with physical therapists and other health professionals and asked how practice could be sensitive to their needs as survivors. A grounded-theory approach was used. After independent analyses, researchers achieved consensus on the main themes. Findings were checked with participants, other survivors, and mental health professionals. MAIN FINDINGS: A crucial theme was the need to feel safe when consulting any health professional. Participants described specific ways for clinicians to facilitate the feeling of safety. Disclosure of abuse history was another key theme; analysis revealed no one “right way” to inquire about it. CONCLUSION Women survivors of child sexual abuse want safe, accepting environments and sensitive, informed health professionals with whom to work in partnership on all their health concerns.

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Adult survivors of childhood sexual abuse as patients: two case studies.
Hudson A, Jones LR, Weber MT.
Shands Hospital, University of Florida, Gainesville 32610, USA.
J Wound Ostomy Continence Nurs. 1999 Mar;26(2):60-6.

Adult survivors of childhood sexual abuse comprise a high percentage of the patients seen in gastrointestinal and genitourinary clinics and are commonly found among the patient population treated by WOC nurses. The physical and emotional consequences of sexual abuse may permeate the survivor's life, but rise to the forefront only with the additional stress of an ostomy or urinary diversion. Two case studies are described involving women the authors encountered in their practices.

The experience of hospitalization and restraint of women who have a history of childhood sexual abuse.
Gallop R, McCay E, Guha M, Khan P.
Faculty of Nursing, University of Toronto, Ontario, Canada.
Health Care Women Int. 1999 Jul-Aug;20(4):401-16.

Within psychiatric settings, many female clients report experiences of childhood sexual abuse (CSA). In this paper we explore the experience of 10 women who were hospitalized in psychiatric settings, restrained, and given forced medication (FM). All the women have histories that included CSA. Some authors have suggested that the experience of psychiatric hospitalization may represent an event that reenacts the experience of trauma. The results suggest that from the perspective of these women, the experience of restraint engendered traumatic emotional reactions such as fear, anxiety, and rage, and in no way was viewed as therapeutic even years later. Women felt powerless and unheard. The women wanted nurses who were empathic and responsive to their human needs as clients, but they felt nurses did not want to hear about the abuse or their internal distress. We hope that the perspective of these women will help in the consideration of alternatives and modifications to the use of restraint in psychiatric settings.

Incorporating routine screening for history of childhood sexual abuse into well-woman and maternity care.
Seng JS, Petersen BA.
Nurse-Midwifery Program, University of Michigan, Ann Arbor 48109.
J Nurse Midwifery. 1995 Jan-Feb;40(1):26-30.

Despite a rapid expansion in the understanding of the incidence and effects of childhood sexual abuse in the mental health disciplines, health care disciplines have only begun to look at the effect of an abuse history on women's health. Little is known from research about its influence on a woman's gynecology care or childbearing experience. The literature across disciplines advocates for routine screening for history of childhood sexual abuse. Asking about childhood sexual abuse will benefit women who have been abused and will help build a database from which to gain clinical knowledge about their care. This review presents clinical reasons to screen, discusses barriers and benefits, and emphasizes manageable ways to incorporate asking about childhood sexual abuse into practice.

Does a history of childhood sexual abuse affect sexual outcomes in breast cancer survivors?
Wyatt GE, Loeb TB, Desmond KA, Ganz PA.

Department of Psychiatry and Behavioral Sciences, School of Medicine, Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA 90095-6900, USA.
J Clin Oncol. 2005 Feb 20;23(6):1261-9.

PURPOSE: Little is known about a history of childhood sexual abuse (CSA) in breast cancer survivors and its relationship to sexual functioning after cancer. As part of a larger survey study examining sexuality and intimacy in breast cancer survivors, we conducted in-person interviews with a subsample of participants.

METHODS: A total of 147 women in Los Angeles, CA, and Washington, DC, completed a structured interview that addressed sexual socialization and a history of sexual abuse. Trained female interviewers conducted the interviews. Descriptive statistics and regression analyses were used to examine the prevalence of CSA, and its potential impact on sexual health and functioning. RESULTS: One in three women reported at least one CSA incident. Among women who had experienced CSA, 71% reported a single incident, and 22% reported a penetrative form of sexual contact. In multivariate regression analyses examining physical and psychological aspects of sexuality and body image, CSA was not a significant predictor of physical discomfort. However, a history of penetrative CSA was a significant predictor of psychological discomfort (P = .02). CONCLUSION: The prevalence of CSA in this sample was similar to the general population literature on this topic. In this small sample, a past history of CSA did not contribute significantly to the physical discomforts associated with sexual intimacy after breast cancer; however, our findings suggest that a past history of penetrative CSA is associated with increased psychological discomfort, and may warrant additional examination in future research.

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Caring for survivors of childhood sexual abuse in medical practice.
Jenny C, Roesler TA.

Child Protection Program, Hasbro Children's Hospital, Brown Medical School, Providence, RI, USA.

Surveys of adults in 21 countries have shown 7 to 36% of women and 2 to 29% of men reporting unwanted sexual contact in childhood.1 In Rhode Island, the Department of Children, Youth and Families confirmed 310 cases of child sexual abuse in 2001.2 This most likely represents "the tip of the iceberg", since most abused children do not disclose in childhood.

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