CHILDHOOD SEXUAL ABUSE

Childhood Sexual Abuse

Abstract

This study reports on a postal questionnaire, conducted in 2004, with female survivors of historic child sexual abuse. The questionnaire explored their experiences of health professionals' responsiveness to disclosure of child sexual abuse history. Of 61 participants, aged between 22 and 65, 69% had disclosed to health professionals. Those who had not disclosed reported that they would have liked to but were not asked about child sexual abuse. Thirty-five percent of participants suggested routine questioning about child sexual abuse. Most participants related a fear of common medical examination procedures to their experience of child sexual abuse, and 64% said this stopped them from attending regular health checks. The current study suggests the development of guidelines for dealing with possible child sexual abuse survivors would be useful for health professionals.

Childhood Sexual Abuse

Introduction

Adult survivors of child sexual abuse (CSA) are high users of health and mental health services and make up a significant proportion of many clinical health population groups. Despite the frequent interactions with health professionals (HPs), many CSA survivors often do not disclose their abuse. It is estimated that the prevalence rates of female CSA range from 13% to 30% (Havig, 2008; Hulme, 2000; Leserman, 2005; Stalker, Russell, Teram, & Schachter, 2005). A large random household survey in Aotearoa/New Zealand found that 1 in 4 girls had been affected by CSA (Fanslow, Robinson, Crengle, & Perese, 2007). Prevalence rates varied across urban (23.5%) and rural (28.2%) regions and by ethnicity. Health professionals are well placed to improve health outcomes for adult survivors of CSA by delivering a positive intervention post-CSA. This study aimed to explore female CSA survivors' interactions with and experiences of HPs' responsiveness to disclosure of CSA history.

Literature Review

Survivors of CSA are restricted in their ability to give verbal feedback to clinicians when they feel uncomfortable about a practice (Dale, 1999; Stalker, Schachter, & Teram, 1999). Some have falsely reported to psychotherapists that they have “recovered” so as to avoid further treatment with insensitive clinicians. This latter strategy, designed to avoid insensitive practice, has the added potential of reinforcing a clinician's less than optimal practice. It is not known if this practice by survivors of CSA is similar with HPs.

However, the lack of disclosure by CSA survivors with their HPs has been found to result in negative experiences during examinations, especially for gynecological procedures. Hilden, Sidenius, Langhoff-Roos, Wijma, and Schei (2003) found that a third of the female CSA survivors in their study reported experiencing discomfort during gynecologic examinations. Only 7.6% of them had disclosed their history of abuse to the gynecologists. Given that it is those with a history of CSA who find pelvic examinations and cervical screenings to be more traumatizing, their lack of disclosure and the HPs' lack of inquiry make them vulnerable to poor practice whereby the HPs are not able to modify their behaviors to suit the survivors' needs.

Methodology

The questionnaire was developed with assistance from a range of experts including members of Doctors for Sexual Abuse Care, a questionnaire development ...