The independent and combined effects of physical and sexual abuse on health. Results Of a national survey

Background: Although physical and sexual abuse have been linked to health risk behaviors as well as mental health problems, it is unclear whether those young women who have experienced both physical and sexual abuse are at greatest risk. To examine the independent associations between physical, sexual, and/or both types of abuse and health status, mental health, and health risk behaviors among a national school-aged sample of girls. We hypothesized that the magnitude of risk would be highest for those reporting both types of abuse compared to those reporting neither or one type of abuse. Methods: In 1997, 3,015 girls in grades 5 through 12 participated in the Commonwealth Fund Adolescent Health Survey and responded to both questions inquiring about physical and sexual abuse. This sample was derives from a nationally representative cross-section of 265 public, private, and parochial schools with an oversampling of 32 urban schools to obtain ethnic diversity. Data were analyzed using chi-square and binary or multinomial logistic regression stratified by type of abuse (none, physical abuse, sexual abuse, or both). Results: About 8% (n = 246) of girls reported a past history of only physical abuse, 5% (n = 140) reported only sexual abuse, and 5% (n = 160) reported experiencing both physical and sexual abuse. Logistic regression controlling for demographic characteristics (grade level, ethnicity, family structure, and socioeconomic status) found those who reported both types of abuse as compared to those who did not report any abuse were significantly more likely to experience moderate-to-severe depressive symptoms (OR = 5.1), moderate to high life stress (OR = 3.3), history of bingeing and purging behavior (OR = 4.4), regular smoking (OR = 5.9) regular drinking (3.8), illicit drug use in the past 30 days (RR = 3.5) and fair to poor health status (OR = 1.9). In contrast, lowered adjusted odds ratios (1.8-2. 5) were seen for those reporting one type of abuse as compared to no abuse across most health outcomes.Conclusions: Those experiencing any type of abuse are at risk; however, those adolescent females who report both physical and sexual victimization are at much greater risk.     

Human lymphoblastoid interferon (Wellferon) in primary therapy of two children with condylomata acuminata

Human lymphoblastoid interferon (Wellferon) was administered parenterally to two prepubertal girls as primary therapy for genital condylomata acuminata. One child probably had contracted the disease as the result of sexual molestation. Both patients experienced minimal side effects during therapy and underwent complete remission within six weeks. These cases support use of interferon as primary therapy in young patients with extensive condylomata and in those who may have contracted the disease as the result of sexual abuse.     

Perceptions of sexual assertiveness among adolescent girls: initiation, refusal, and use of protective behaviors

STUDY OBJECTIVE: We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables. DESIGN: Cross-sectional analysis. SETTING: Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability. PARTICIPANTS: 106 sexually experienced girls (ages 14 through 21 years). METHODS: Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention. RESULTS: Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale. CONCLUSIONS: Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves.     

Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls

Adolescence is characterized by marked changes in the body, psychology, and sexual behavior due to increasing production of hormones. In this review we aimed to assess the effect of age at the time of first sexual intercourse (sexarche) on the health of adolescent girls, and identify factors that might protect against early initiation of sexual relations in girls. The PubMed, Lilacs, and Google Scholar databases were searched for clinical trials, comparative studies, case-control studies, cross-sectional studies, cohort studies, multicenter studies, observational studies, meta-analyses, and systematic reviews published up to December 2014 on this theme. The search terms were: “sexual debut,” “coitarche,” “sexarche,” and “young people,” “adolescent,” “unplanned pregnancy,” “adolescent contraception,” and “STDs.” Data were extracted from 28 studies and 41 references were used to introduce the theme and to support the discussion. Sexarche has been occurring in increasingly younger girls. A young age at sexarche can lead to subsequent risky sexual behavior. Girls who have sexarche when they are 14 years old or younger are less likely to use contraception on this occasion, take more time before they start using contraception in subsequent sexual relations, are more likely to have several sex partners, have a higher risk for depression, have lower self-esteem and more episodes of repentance, and have a higher risk for a sexually transmitted disease and cervical cancer. Girls with low educational, socioeconomic, and cultural status, little parental monitoring, parental separation, and absence of religiosity tend to experience sexarche at a younger age. Adolescent girls who postpone sexarche until they are 16 years old are physically and psychologically healthier than those who have sexarche at a younger age. This suggests that providing adolescent girls with appropriate education about sexual relations might reduce the negative effect of sexual relations at a young age.     

Childhood sexual abuse and the consequences in adult women

This paper reviews the literature on childhood sexual abuse and its implications for women. It is estimated that at least 15-38% of adults have been sexually abused as children, with figures higher for women than for men. Failure to report abuse is common, and only 20-50% of incidents may come to the attention of authorities. Although childhood sexual abuse is present in all socioeconomic groups, more severe forms of abuse appear to be associated with lower socioeconomic status. After the age of ten, a sharp increase is observed in vaginal intercourse, sexual assaults accompanied by physical violence, and abuse committed by strangers. Although fathers are frequently cited as the primary perpetrators, not all studies support this finding. Other relatives have been reported to account for 20-70% of the sexual abuse occurring within the family. A history of childhood abuse may contribute to sexual problems or multiple chronic complaints in the adult woman. Moreover, some of these women may experience depression, anxiety, and low self-esteem. The gynecologist should use empathetic questioning with all patients regarding abuse, and integrate the patient's history of abuse with current health care. Physicians who are uncomfortable with this topic or who observe ongoing distress in their patients should refer these women to a mental health practitioner who is familiar with the issues common to women who have experienced childhood sexual abuse.     

Participation of Adolescent Girls in a Study of Sexual Behaviors: Balancing Autonomy and Parental Involvement

Study ObjectiveThe process of research with adolescents should balance parental involvement and adolescent autonomy. The attendance of parents and peers at research study visits of girls participating in a 6-month study of topical microbicide acceptability is described, as well as the participants’ conversations with their parents.MethodsGirls, 14 through 21 years, were recruited from previous studies (3%), advertisements (14%), clinics (17%), and recommendations by friends (66%) to participate. Girls under 18 years were required to have parental consent, but parents could provide verbal phone consent as long as a signed consent form was returned before participation.ResultsThe 208 participants were 41% African-American, 30% Hispanic, and 29% Caucasian. Girls averaged 18 years of age, and 95 (46%) were under 18. Seventeen percent of parents attended the first visit; only 1 parent attended with a daughter older than 18 years of age. The mothers of older adolescents were less likely to attend the appointment with them. More Caucasian than African-American girls came with a mother. Parental attendance decreased at follow-up visits. Thirty-seven percent of girls brought a peer to the first visit; there were no age or race/ethnic differences. There was no relationship between attending with a parent or peer and talking to a parent about the study. Some adolescents obtained parental consent to participate in the study while keeping their sexual behaviors private.ConclusionsParental attendance at study visits may not be marker of parental involvement with the study. Creative ways for balancing concerns about confidentiality, promotion of autonomy, and adult involvement should be considered.     

Issues in gynecologic care for adolescent girls in the juvenile justice system

Incarcerated girls represent a captive audience, providing health care providers working in the juvenile justice system with a unique opportunity to intervene in this difficult to-reach population. Health care providers should promote and encourage healthy lifestyles with the aim of lowering their risk-taking behaviors, promote contraception and screen and treat sexually transmitted infections. For many delinquent girls this encounter represents their first contact with the medical care system as independent young women.It is important to encourage these girls to have a medical home and upon discharge from the facility, it is important to guarantee appropriate follow-up.     

Sexual function and satisfaction in adults based on the definition of child sexual abuse

IntroductionThe literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.AimThis study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.MethodsA sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.Main Outcome MeasuresSexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.ResultsDifferences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.ConclusionsDifferences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction. Rellini A, and Meston C. Sexual function and satisfaction in adults based on the definition of child sexual abuse.     

Experience of sexual violence among sexually experienced Japanese teenage girls and influencing factors

Aim  The aim of the present study was to identify influencing facors for sexual violence in sexually experienced teenage girls. Methods  Eighty sexually experienced teenage girls aged between 14 and 19 attending obstetrics and gynecology clinics in suburban Tokyo were selected as subjects. After completing a simple questionnaire on sexual behavior and lifestyle the subjects were interviewed using a semistructured interview technique. Logistic regression analysis was used to identify factors associated with sexual violence. Results  Police and government statistics for rape, sexual and domestic violence in Japan are extremely low. However, the present study showed that 52.5% of subjects had been victims of sexual violence. Furthermore, of these, 69.0% had been forced to have sex with a partner and 64.3% had been raped by someone other than a partner. Factors influencing the risk of sexual violence were sexual behavior and attitudes towards sexuality and lifestyle. Having a sexually transmitted infection was not an influencing factor. Conclusions  It is important to identify teenage girls attending obstetrics and gynecology clinics at risk of sexual violence and to teach them about the risks of sexual behavior associated with imbalances of power. Furthermore, it is essential to support victims of sexual violence to protect them from the recurrence of such abuse.     

Childhood sexual abuse (CSA) experiences: an underestimated factor in perinatal care

BACKGROUND: Childhood sexual abuse can have several negative consequences on pregnancy, birth, and the early neonatal period. However, most obstetricians are not aware if their patients have a history of childhood sexual abuse. We therefore investigated childhood sexual abuse experiences in 226 women three to eight months after delivery of a healthy child. METHODS: 415 women were approached to answer a self-administered questionnaire including obstetrical questions and questions focusing on abuse experiences. 320 women agreed to participate, 226 (69.1% of the women fulfilling inclusion criteria) of which returned a completed questionnaire. Sexual abuse was explored using a modified version of a questionnaire developed by Wyatt. The complete questionnaire was designed in cooperation with the German "Frauennotruf", a society providing care for victims of sexual abuse. RESULTS: The prevalence of childhood sexual abuse was a minimum of 11.5% and a maximum of 14.6% if women who were not sure about such experiences during their childhood were included. Another 1.3% of the women had experienced sexual abuse as an adult. Lifetime sexual abuse prevalence was 12.8% and 15.9%, respectively. Of the women with an experience of childhood sexual abuse, 42.3% mentioned an ongoing abuse situation for at least six months. CONCLUSIONS: As approximately every 9th woman presenting for obstetrical care has experienced childhood sexual abuse, and as those experiences may have a negative impact on fetal and maternal well-being, adequate counseling models should be offered to victims of sexual abuse.     

Violence against girls provokes girls' violence: from private injury to public harm

Young women adjudicated delinquent in juvenile court report suffering inordinate amounts of emotional, physical, and sexual trauma in early childhood and adolescence. In addition, adolescent girls' arrests for violent crimes rose dramatically in the 1990s. This article explores the relationship between those two factors. Drawing from interviews with court-involved girls, this article highlights two contexts in which girls committed aggressive offenses: an incidence of intimate violence in a lesbian relationship and a stabbing in self-defense against sexual assault. I argue that the trauma witnessed and experienced from prior childhood and adolescent injuries--much of it experienced in private--contributed to girls' coming to the attention of public authorities.     

Characteristics of female child sexual abuse in Hungary between 1986 and 2001: a longitudinal, prospective study

OBJECTIVE: To summarize the characteristics of female child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention. DESIGN: Prospective, longitudinal study. SETTING: A Hungarian county, University of Debrecen. PARTICIPANTS: Between 1986 and 2001, 209 girls under the age of 18 who had been exposed to sexual abuse visited the Department of Adolescent Gynecology. METHODS: We prospectively collected data illustrating the characteristics of all cases. Events in which victim and perpetrator were members of the same family were recorded as intrafamilial. Subsequent legal procedures were also evaluated. MAIN OUTCOME MEASURES: We describe the medical and legal approaches to handling child neglect. RESULTS: Seventy-five percent of the victims were students, and 47% of them were between 11 and 14 years of age. The perpetrator was familiar to the victim in 66% of the cases, and a stranger in 34%. Fifty-two (25%) perpetrators were members of the victims' families. In 11% of cases, the perpetrator was the victim's father and in 10%, her stepfather. The abuse had occurred on multiple occasions in 21%. The occurrence rate of assault was highest in the summer season (59%). Thirty-nine percent of victims were accompanied by their mothers when they attended the clinic and 43%, by police. officers. Vaginal penetration was the type of abuse in 80%, and sexual perversion in 20%. Sixty-six victims were physically injured, and in 38 cases the presence of sperm was confirmed in vulvo-vaginal smears. One pregnancy occurred as the result of the abuse. In all, 127 cases were reported to the police; 56 of the perpetrators were sentenced as a result of legal proceedings. CONCLUSION: A high proportion of female child sexual abuse takes place within the family and is revealed only after multiple episodes. The low reported prevalence of sexual assault is the consequence of the lack of cooperation between the emergency services in Hungary and the Hungarian criminal law. Prevention requires vigilance in out-of-school times, child education, early involvement of healthcare professionals, and adjustment of the administration of justice.     

Child sexual abuse examination: is there a need for routine screening for N gonorrhoeae and C trachomatis?

PURPOSE: To determine the yield of routine vaginal cultures for Neisseria gonorrhoeae and Chlamydia trachomatis from girls evaluated following sexual abuse. METHODS: Retrospective chart review evaluating results of cultures that were obtained from 2008 prepubertal girls seen within 72 hours following an assault over two periods of 3 years each. RESULTS: It was found that only 16 (0.8%) of cultures were positive for either gonorrhea or chlamydia. All but one of the prepubertal girls who had positive vaginal cultures for sexually transmitted disease had signs of acute vulvovaginitis. CONCLUSION: Routine vaginal cultures in asymptomatic pre-pubertal girls have a very low yield. Prospective studies are required to change current protocols for the evaluation of child victims of sexual abuse.     

Physician attitudes concerning legal coercion of pregnant alcohol and drug abusers

OBJECTIVE: We sought to determine the attitudes of obstetricians, pediatricians, and family practice physicians in Michigan concerning involvement of the criminal justice system in preventing drug and alcohol abuse during pregnancy. STUDY DESIGN: Physicians were sent a questionnaire by mail asking for their agreement with statements concerning the involvement of the criminal justice system with respect to substance abuse during pregnancy. RESULTS: Nearly all (95%) agreed that pregnant women have a moral duty to ensure they had healthy babies; 59% agreed that they should also have a legal responsibility to do so. Most physicians (77%) agreed that screening for acquired immunodeficiency syndrome during pregnancy should be mandatory. Almost as high a percentage (61% to 75% depending on subspecialty) were also in favor of mandatory screening for alcohol abuse; agreement for screening for illicit drugs was much lower (43% to 55% depending on subspecialty). Despite their consensus (61%) that fear of prosecution would deter pregnant abusers from seeking prenatal care, most were in agreement that existing laws regarding child abuse and neglect need to be redefined to include alcohol (54%) and drug abuse (61%) during pregnancy; 52% were in favor of enacting a statute that includes drug or alcohol use during pregnancy as "child abuse" for purposes of removing that child from maternal custody. Physicians were highly in favor of compulsory treatment for illicit drug use and alcohol abuse for women already in the criminal justice system (82%-83%), neutral with respect to court-ordered contraception for alcohol- (50%) and drug-abusing women (47%), and opposed to criminal prosecution for either alcohol abuse (18%-31% depending on subspecialty) or illicit drug use (23%-34%) during pregnancy. CONCLUSIONS: Other than criminal prosecution, physicians are not opposed to involvement of the legal justice system in preventing alcohol and drug abuse during pregnancy.     

And justice for all? Aboriginal victims of sexual violence

Concern for the recognition, support, and rights of victims within the criminal justice system has grown in recent years, leading to legislative and procedural changes in the administration of justice that have improved the experiences of victims. What is not clear is whether all victims have benefited from changes in the system regardless of race and social class. This study investigates the experiences Aboriginal people who are victims of sexual violence have with the Canadian criminal justice system. The authors seek to explore perspectives about their encounters with the judicial system from the point of first contact with the police through involvement with the court and community service providers, utilizing grounded theory qualitative methodology. They conclude that race is a key determinant in the manner in which a victim will be perceived by the people in the justice system and the manner in which the victim will approach the judicial process.     

Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study

PurposeTo examine substance use and mental health disparities between sexual minority girls and heterosexual girls.MethodsData from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.ResultsCompared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms.ConclusionsSexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.     

Child sexual abuse--genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations

In recent years the inspection of the vulva of sexually abused girls by magnification with a colposcope has become increasingly popular. However, data concerning the usefulness of colposcopy in such evaluations are lacking. In a prospective study, 130 prepubertal girls (mean age 5.5 years) who were identified by child protective agencies to be victims of sexual abuse were evaluated both by an unaided examination and by colposcopy. If the colposcopic findings differed from those of the unaided inspection, the macroscopic examination was repeated to determine whether the abnormality could have been detected without magnification. Altogether, 92 of the 130 girls were found to have abnormal findings. In the majority of girls with abnormalities (96%), the abnormalities were observed during the unaided examination. Of the four patients in whom the findings were detected initially by the colposcopic examination, these findings were observed during the repeat unaided examination. The findings were observed by colposcopic examination alone in only one patient. We conclude that unaided examination is adequate for the evaluation of most victims of sexual abuse.     

Sexual abuse during childhood and adolescence as predictors of HIV-related sexual risk during adulthood among female sexual partners of injection drug users

This study explores the relationship of sexual abuse during childhood and adolescence with HIV-related sexual risk behaviors during adulthood among female sexual partners of injection drug users. It analyzed data that was gathered between 1990 and 1993, which included a sample of 2794 women from the US, Mexico, and Puerto Rico. 6 HIV-related sexual risk behaviors that occurred during the month prior to interview were examined; namely, number of sexual partners, number of drug-injecting sexual partners, number of sexual intercourse while high on alcohol and/or other drugs, number of times trading sex for drugs and/or money, proportion of all sexual acts involving protection, and overall HIV-related sexual risk. The results showed that more than one-third of the women (36.3%) experienced some form of sexual abuse during childhood, whereas 34.4% reported that they had been abused sexually during adolescence; 1 in 5 women (18.4%) stated being abused during both periods. The results further indicate that there is a strong link between sexual abuse victimization early in life and involvement later in life in HIV-related sexual risk behaviors. It was found out that certain forms of sexual abuse, such as forced exposure and touching of one's sexual parts were more strongly related than other forms of sexual abuse to subsequent involvement in HIV-related sexual behaviors.     

Child sexual abuse--genital tract findings in prepubertal girls. I. The unaided medical examination

In a prospective study 205 prepubertal girls (mean age, 5.4 years) determined by Child Protective Services to be victims of sexual abuse were examined. Sixty-five girls (32%) had normal-appearing genitalia, 45 girls had nonspecific findings, and 95 girls had findings considered to be specific for sexual abuse. Whereas normal-appearing genitalia were most often observed in girls reporting digital assault, specific findings were more commonly observed in girls reporting genitogenital assault. Overall it was possible to document the presence of abnormal genital findings indicating or strongly suggesting sexual abuse in only 46% of the patients in this study group. Failure to document findings suggestive of abuse in half of the girls highlights the limitations of the medical evaluation in validating sexual abuse.     

Concomitant forms of abuse and help-seeking behavior among white, African American, and Latina women who experience intimate partner violence

This study uses National Violence against Women Survey data to investigate the differential impact of concomitant forms of violence (sexual abuse, stalking, and psychological abuse) and ethnicity on help-seeking behaviors of women physically abused by an intimate partner (n = 1,756). Controlling for severity of the physical abuse, women who experienced concomitant sexual abuse are less likely to seek help, women who experienced concomitant stalking are more likely to seek help, whereas concomitant psychological abuse is not associated with help seeking. Ethnic differences are found in help seeking from friends, mental health professionals, police, and orders of protection. Implications for service outreach are discussed.