Adult survivors of childhood sexual abuse: suggestions for perinatal caregivers.
Roussillon JA.
Massachusetts General Hospital, Boston, Massachusetts, USA.
Clin Excell Nurse Pract. 1998 Nov;2(6):329-37.

As many as 1 in 4 women are survivors of childhood sexual abuse. This traumatic life event profoundly influences the care that advanced practice nurses provide throughout the life cycle, and particularly the care that is provided during times of physical and emotional stress. Despite the prevalence of sexual abuse, there has been little research on the experiences of survivors during the perinatal period, and few suggestions for interventions. This article reviews the literature on the implications of sexual abuse on a woman's experience of pregnancy, birth, and breastfeeding. It emphasizes the importance of routine screening for abuse, as well as assessment of a survivor's stage in the recovery process. Finally, this article suggests topics for appropriate perinatal anticipatory guidance for women who have a history of sexual abuse.

Survivors of childhood sexual abuse: implications for perinatal nursing care.
Hobbins D.
Primary Care, Veterans Health Administration, Salt Lake City Health Care
System, UT 84148, USA.
J Obstet Gynecol Neonatal Nurs. 2004 Jul-Aug;33(4):485-97.

Childhood sexual abuse has a lifelong impact on its survivors and may affect the childbearing experience in a variety of ways. Nurses caring for women during the perinatal period can benefit from understanding the phenomenon of child sexual abuse, its prevalence, and the sequelae experienced by childbearing women. Signs, symptoms, and correlates of prior sexual abuse manifested during the perinatal period are described, and nursing care responses are suggested. Nurses may be able to use this information to recognize survivors and facilitate both a positive childbirth experience and the healing process, by helping the survivor learn to trust, respect, and care for her body.

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Experiences of women healing from childhood sexual abuse.
Glaister JA, Abel E.

Psychiatric Mental Health Nurse Practitioner Track, University of Texas Medical Branch, School of Nursing, Galveston, TX 77555-1029, USA.
Arch Psychiatr Nurs. 2001 Aug;15(4):188-94.

Childhood sexual abuse has affected the lives of countless survivors who seek help within the health care system. Despite extensive research and clinical work, many survivors do not receive adequate help. This research aimed to add to the body of clinical knowledge by reporting on the experiences of childhood sexual abuse survivors who have achieved a measure of healing. Findings from a naturalistic study of 14 female survivors of childhood sexual abuse are presented. The character of healing, the relationship of context with healing, what facilitated healing, and what impeded healing are discussed. Copyright 2001 by W.B. Saunders Company

A practical approach to clients who are survivors of childhood sexual abuse. Holz KA.
Fairfax Hospital, Virginia.
J Nurse Midwifery. 1994 Jan-Feb;39(1):13-8.

Approximately 30% of all women have experienced some form of sexual abuse in childhood or adolescence. This abuse may result in serious long-term sequelae for the survivor, such as depression, low self-esteem, post-traumatic stress disorder, and addictive behaviors. Nurse-midwives are uniquely equipped to provide health care to survivors of childhood sexual abuse because of their commitment to thorough, sensitive health education. This article draws on current literature and the clinical experience of a nurse-midwife who has cared for many survivors of sexual abuse. It offers suggestions for incorporating identification of survivors into the initial health assessment. Interventions are reviewed including how to approach the physical examination of a survivor and how to provide appropriate care in the intrapartum and postpartum period. Emphasis is given to the development of a referral network.

Sequelae of abuse. Health effects of childhood sexual abuse, domestic battering, and rape. Bohn DK, Holz KA.
J Nurse Midwifery. 1996 Nov-Dec;41(6):442-56.

Violence against women is endemic in the United States. One third to one half of all women will experience one or more types of abuse in their lifetime, most often at the hands of a family member or an intimate or formerly intimate partner. One in 12 women is battered during pregnancy. Abuse survivors are disproportionately frequent users of health care services because of acute and chronic physical, somatic, emotional, and behavioral sequelae of abuse. Health care practitioners are often the first contact abuse survivors have with a potentially helping professional. It is, therefore, essential that health care providers learn to identify and to intervene appropriately with survivors of abuse. This article reviews and compares the health effects of three of the most common types of violence against women: childhood sexual abuse, domestic battering, and rape. Sequelae are divided into six categories: physical/medical, somatic, emotional/ psychological, social/interpersonal, behavioral/sexual, and pregnancy-related effects. The health effects discussed in this article include research findings, as well as effects noted in clinical practice. Recommendations are made for routine screening of all women for past and current abuse, as well as for intervention strategies.

PIP: This paper reviews and compares the health effects of three common types of abuse against women: childhood sexual abuse, domestic battering, and rape. In the US, violence against women has become a serious problem. One half to one third of all women in the country experience abuse in their lifetime that is usually inflicted by a family member, or an intimate or formerly intimate partner. One out of 12 women experienced abuse during pregnancy. Victims of violence frequently seek medical care because of the acute and chronic health problems that result from abuse. Since health care practitioners are often the first contact abuse victims have, it is essential that they learn to assess and intervene appropriately with survivors of abuse. In this discussion, the health effects of abuse were categorized as physical/medical, somatic, emotional/psychological, social/interpersonal, behavioral/sexual, and pregnancy-related. Recommendations are made concerning the routine screening of all women for past or current abuse, as well as for effective intervention strategies.

Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.
Schachter CL, Stalker CA, Teram E.

School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada. Phys Ther. 1999 Mar;79(3):248-61; discussion 262-9.

BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor.

Enhancing the health care experiences of adult female survivors of childhood sexual abuse.
Monahan K, Forgash C.

School of Social Welfare, State University of New York, Stony Brook, NY 11794-8231, USA. Women Health. 2000;30(4):27-41.

This article addresses the medical issues presented by women who were sexually abused in childhood and provides a detailed and direct link between the existing literature and its implications for the medical system. A profile of the sexual abuse survivor is given, including child sexual abuse (CSA) characteristics and sequelae that influence the adult female survivor's health. Post-traumatic Stress Disorder is outlined as part of a complex interplay of physiological and psychological symptomatology that can compromise the CSA survivor's ability to access health care treatment and forge a positive provider/patient relationship. This article emphasizes that effective treatment with sexual abuse survivors must include interdisciplinary collaboration among health care professionals. Management of the CSA patient, a case vignette illustrating salient themes, and finally, guidelines for the health care practitioner are presented.

A framework for practice with women survivors of childhood sexual abuse.
Creedy D, Nizette D, Henderson K.

School of Nursing, Griffith University, Nathan, Queensland, Australia. D.Creedy@mailbox.gu.edu.au Aust N Z J Ment Health Nurs. 1998 May;7(2):67-73.

Women who are victims of prolonged childhood sexual abuse involving penetration, and physical and emotional abuse are more likely to develop major psychiatric distress. These survivors may use defence mechanisms to block out the past, and their distress may only come to the attention of health professionals at times of crisis. However, health practitioners do not routinely assess for a history of sexual abuse. This state of affairs is compounded by limited research on survivors of childhood sexual abuse and a readiness to label them with adult psychopathology. Such labels result from a failure to listen and from a willingness to blame, processes replicated from the dominant culture.

Homeopathy in survivors of childhood sexual abuse.
Coll L.

North Glasgow University Hospitals NHS Trust, UK. colldrleo@hotmail.com Homeopathy. 2002 Jan;91(1):3-9.

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.

Working with childhood sexual abuse survivors during pregnancy, labor, and birth.

Heritage C.

Women's Health Clinic of Cottage Grove Healthcare Community, OR, USA.
J Obstet Gynecol Neonatal Nurs. 1998 Nov-Dec;27(6):671-7.

It is estimated that approximately 27% of women have a history of childhood sexual abuse. Long-term effects of this abuse include physical and psychologic consequences that can affect the pregnant woman during the prenatal, antenatal, and postpartum periods. Careful screening of all pregnant women and specific interventions during examinations and procedures can help survivors of childhood sexual abuse experience childbearing as healing and empowering. Care providers who are survivors of such abuse can better serve their patients by working therapeutically on their own healing.

Labor experiences of childhood sexual abuse survivors.
Rhodes N, Hutchinson S.
Birth. 1994 Dec;21(4):213-20.

This field study used the ethnographic method to describe and analyze the labor experiences of childhood sexual abuse survivors. The sample included seven sexual abuse survivors, five nurse-midwives, and three labor and delivery nurses. Data collection included in-depth interviews, participant observation in labor and delivery over a period of six years, and anecdotal material from the literature. Analysis followed Spradley's Developmental Research Sequence and included domain, taxonomic, componential and theme analysis. Women reported both forgetting and remembering abusive incidents, and described labor sensations reminiscent of sexual abuse. A heuristic for appraising labor styles suggestive of past sexual abuse includes fighting, taking control, surrendering, and retreating. These styles are considered extremes of women's reactions to labor and are directly linked to posttraumatic stress disorder. This study demonstrated that it is important for perinatal caregivers to understand the link between childhood sexual abuse and childbirth so that they can assist women to have a positive birth experience.

Care for female survivors of child sexual abuse in emergency departments.
van Loon AM, Koch T, Kralik D.

Royal District Nursing Service, Research Unit, 31 Flemington Street, Glenside 5065, South Australia. Accid Emerg Nurs. 2004 Oct;12(4):208-14.

INTRODUCTION: The health impact of child sexual abuse (CSA) continues into adulthood with such problems as depression, self-harm, suicide attempts; stress related disorders and addictions implicated. Emergency nurses can facilitate early intervention and direct people to appropriate help if they recognise the CSA survivor's 'common story' described in this paper. METHODS: Findings come from an on-going participatory action research program with women survivors of CSA aiming to build personal capacity for women and organizational capacity for service providers. Data collected by 1:1 interviews and fortnightly group meetings are transcribed, analysed and fed back to the women (n11) and service providers (n25) for reflection and action. RESULTS: Recommendations include increasing staff awareness of impact of CSA; creating a culture of privacy and confidentiality that promotes safe disclosure; advocating sensitive responses; promoting client driven interactions/interventions that allow women to control potentially intrusive procedures; examining personal qualities of staff that assist client satisfaction; and provision of literature, web sites and referral protocols identifying professional support and self-help resources, etc. CONCLUSION: This paper presents practical responses generated by women survivors of CSA to improve emergency care and reduce return visits for this concealed and needy client group.

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Nursing assessment of adult females who are alcohol dependent and victims of sexual abuse.

McKinney N, Frank DI.

Florida State University School of Nursing, Tallahassee, Florida 32306-5974, USA. Clin Excell Nurse Pract. 1998 May;2(3):152-8.

Women who develop alcohol dependence pose a serious health threat to themselves, their families, and their communities. One of the factors theorized to be a major influence in the development of maladaptive behaviors relative to alcohol use in women is childhood sexual abuse. This paper uses King's theory of dynamic interacting systems to examine relationships between the personal, family, and community variables that may influence women who have been victims of childhood sexual abuse and develop alcohol dependence. Guidelines for a research-based nursing assessment are suggested.

The sequelae of childhood sexual abuse: a primary care focus for adult female survivors.
Roberts SJ.
College of Nursing, Northeastern University, Boston, Mass., USA.
Nurse Pract. 1996 Dec;21(12 Pt 1):42, 45, 49-52.

Researchers have increasingly demonstrated that 15% to 30% of all women have been sexually abused as children. Information on the emotional, behavioral, and cognitive sequelae of this abuse has been available. Most recently, a literature on the somatic and medical sequelae has developed. This article reviews this literature and discusses its implications for primary care providers. Survivors are likely to suffer from insomnia, gastrointestinal problems, obesity, chronic pain, headache, and somatization, and they are frequent utilizers of primary care services. Specific suggestions about history taking, physical examination, and referrals are given to ensure that survivors receive care that is sensitive, supportive, and competent. The article also discusses the dynamics of abuse and how they relate to the ongoing relationship between the primary care provider and the survivor of sexual abuse.

Obstetric-gynecologic care and survivors of childhood sexual abuse.
Chalfen ME.
AWHONNS Clin Issues Perinat Womens Health Nurs. 1993;4(2):191-5.

Women's health care providers have few resources to guide them in giving sensitive care to survivors of childhood sexual abuse. This article reviews some commonly seen coping responses, discusses ways in which these coping responses may affect the experience of gynecologic or obstetric care, and provides suggestions on how the care provider can facilitate the patient's process of healing. Also addressed is the need of care providers to process the often intense feelings evoked by issues of sexual violence and abuse.

Relationship strategies and interdisciplinary collaboration. Improving maternity care with survivors of childhood sexual abuse.
Seng JS, Hassinger JA.

Nurse-Midwifery Program, University of Michigan School of Nursing, Ann Arbor 48109-0482, USA.
J Nurse Midwifery. 1998 Jul-Aug;43(4):287-95.

Women's health care providers are being challenged to screen for and respond to the effects of abuse and violence in their clinical practices. Many feel poorly equipped to do so. Addressing the impact of a history of childhood sexual abuse on the survivor client's experience of pregnancy, birth, breastfeeding, and postpartum adjustment is a particularly challenging task. Professionals from several disciplines experienced in working with trauma survivors responded to a case study. Valuable points common to all six case respondents focused on strategies to use to improve communication and relationships with survivor clients. These health care providers also advocate interdisciplinary collaboration.

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Breastfeeding and the sexual abuse survivor.
Kendall-Tackett K.
Family Research Laboratory, University of New Hampshire, USA.
J Hum Lact. 1998 Jun;14(2):125-30; quiz 131-3.

In this paper, the possible effects of child sexual abuse on a mother's breastfeeding experience are described. The long-term effects of sexual abuse are divided into seven domains that may impact breastfeeding behavior: posttraumatic stress disorder, cognitive distortions, emotional distress, impaired sense of self, avoidance, interpersonal difficulties, and health problems. In each section, the potential impact of past sexual abuse on current breastfeeding behavior and the mother-infant relationship is described. Finally, specific suggestions and strategies for lactation consultants are offered.

Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome.
Golding JM, Taylor DL, Menard L, King MJ.

Department of Social and Behavioral Sciences, University of California, San Francisco 94143-0646, USA. J Psychosom Obstet Gynaecol. 2000 Jun;21(2):69-80.

This study evaluated the prevalence and correlates of sexual abuse history among women seeking treatment for severe premenstrual syndrome (PMS). Of 77 women participating in a randomized clinical trial of non-pharmacological treatments for severe PMS, 42 were interviewed regarding their sexual abuse history. The interviewed women were a mean of 38 years old, and most were of European ancestry, heterosexual, married, employed and well-educated. At least one attempted or completed sexual abuse event was reported by 95% of the women, with 81% reporting completed penetration against their will and 85% of these sustaining physical threat or harm. Compared to prior studies of sexually abused women in general populations, these women were abused earlier in life, more frequently and by similar types of offenders. Most of the abused women (65%) were estimated to have post-traumatic stress disorder (PTSD). Most abused women (83%) had never disclosed the abuse to a health practitioner. The findings suggest that a history of sexual abuse, particularly in childhood or adolescence, may be extremely common among women seeking treatment for severe PMS, and that substantial undiagnosed PTSD may also be present in this population. Implications for patient screening and treatment are discussed.

Positive self-transitions in women child abuse survivors.
Hall JM.

College of Nursing, University of Tennessee, 1200 Volunteer Boulevard, Knoxville, TN 37996-4180, USA.
Issues Ment Health Nurs. 2003 Sep-Nov;24(6-7):647-66.

Clinicians need information about what factors contribute to women child abuse survivors' mental health and success. Most previous research has focused on negative after-effects of abuse, and correlating types and severity of abuse with specific mental and physical problems in adulthood. Two qualitative studies (total N = 55) were done with low-income women survivors of child abuse and neglect from a midwestern inner city area. The majority of these women were African American. All participants were in recovery from substance abuse problems. A secondary analysis of these accounts was done to examine positive life transitions made by these women after experiences of abuse, and throughout adulthood, despite having serious after-effects of abuse. The investigator and research team categorized themes from the narrative data into two processes--epiphanies and maintaining momentum--and six elements constituting the content areas of self-change: self-centering, ownership, interpersonal insulation, willfulness, seeing options, and spiritual connection. Maintaining momentum and shortening the time between epiphanies was found to be central. Tentative clinical implications are discussed. The study was preliminary in that it was a secondary analysis. Suggestions for further research are outlined.

Teenage Pregnancy and Associated Risk Behaviors Among Sexually Abused Adolescents By Elizabeth M. Saewyc, Lara Leanne Magee and Sandra E. Pettingell
Perspectives on Sexual and Reproductive Health
Volume 36, Number 3, May/June 2004

Since the early 1990s, rates of adolescent sexual initiation and pregnancy in the United States have declined,1 while teenagers' contraceptive use has increased.2 Nevertheless, each year in the United States more than one million adolescent pregnancies occur, and more than four million adolescents receive a diagnosis of a sexually transmitted disease (STD).3 The risk of becoming pregnant or getting someone else pregnant is higher for some teenagers than for others, and continued progress in reducing unintended pregnancy and risky sexual behaviors among teenagers requires targeting interventions to groups at greatest risk.

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