THE IMPACT OF CHILDHOOD SEXUAL ABUSE ON WOMEN'S Healthcare

Prevalence studies show that between 15 and 30% of women have been sexually abused by a man by the age of 16. Child abuse survivors rarely spontaneously reveal this history to a doctor yet they are more likely than non‐abused patients to suffer multi‐system medical complaints and to indulge in high‐risk behaviours. This of course may make them more likely to appear in gynaecology or colposcopy clinics. It seems sensible that gynaecologists should be well informed about CSA and in particular the impact it may have on their patients so that they can offer the required sensitive treatment in an appropriate environment for these women in particular. Just as with rape the sexual component of child sexual abuse is of secondary importance to power over and manipulation of children, therefore psychological damage to children is much greater if the abuser is a parent or parent figure. Incest is most commonly between father or stepfather and daughter, with stepfathers being the worst offenders. The peculiar difficulties that follow sexual abuse of a child by a family member and which place the child in a seemingly impossible position in the family have been well‐described by Summit (1983). He uses the term CSA accommodation syndrome to describe a reaction, which allows for the immediate survival of the child within the family. There are 5 components to this syndrome:‐ (1) Secrecy (2) Helplessness (3) Entrapment and Accommodation (4) Delayed, Conflicted and Unconvincing disclosure (5) Retraction Unfortunately these children develop multiple psychological and emotional disorders in the process e.g. depression, high anxiety and panic attacks, obsessional concerns, eating disorders and abuse of self. They may also develop physical manifestations of emotional pain such as pseudo‐seizures or chronic pelvic pain. Not surprisingly, sexual problems are also common e.g. low sex drive or vaginismus. Despite the fact that abuse of children is very variable in severity, the treatment of abused women follows a recognised process which is similar in each case. Disclosure – therapy starts from this moment so it is important that it is handled well. She is encouraged to talk about the abuse as she remembers it and it is important that her therapist lets her know that her story is believed. Responsibility for the abuse is addressed. Almost without exception, victims of abuse feel responsible in some way for what happened so again her therapist must point out where the blame really lies i.e. with the abuser. Current family relationships have to be reviewed as she may still in fact be living with the abuser and part of the healing process may involve his confrontation. Finally moving from victim to survivor the woman addresses the damage that has been done. Many women attending colposcopy or gynaecology clinics will have suffered sexual abuse. They may find the experience traumatising and will be greatly helped to cope if the environment in which they are treated is sensitive and caring.