The risk of HIV infection in a national sample of women with injection drug-using partners.

OBJECTIVES. This study reports on a large, national cohort of women with injection drug-using sex partners. Information is provided on demographic characteristics; human immunodeficiency virus (HIV) risk factors, including unprotected sex and incidence of sexually transmitted diseases; use of noninjected drugs; HIV serostatus; and other selected health variables. METHODS. A sample of 5162 heterosexual women was recruited for a national acquired immunodeficiency syndrome (AIDS) research and demonstration project. A structured interview was administered, and the women had the option of undergoing HIV testing. Statistical analyses compared three groups on variables of interest: women with single sex partners, women with multiple partners, and women with multiple partners who exchanged sex for drugs and/or money. RESULTS. These groups differed significantly on virtually all of the demographic and risk variables examined. Women with multiple partners who exchanged sex for drugs and/or money were at higher risk for HIV than women in the other groups, even when selected demographic variables were controlled. CONCLUSIONS. Research is needed on the efficacy of prevention efforts involving these diverse groups of women at risk for AIDS.     

Prevalence of sexual abuse history in a random sample of Norwegian women

In order to obtain an estimate of the prevalence of sexual abuse history among adult women, data from a gynecological interview of a random sample of 118 women aged between 20-49 were analysed. Childhood sexual abuse involving genital contact was reported by 8.5% of the women. Intrafamilial sexual abuse in childhood was reported by 7%, 10% of all women who had ever lived in a relationship reported sexual abuse by a violent spouse, additionally 7% had experienced sexual abuse by a non-violent spouse. 5% of all women had experienced adult sexual abuse by other than their spouse. Sexual abuse in childhood and by violent spouse was associated with a history of psychological problems and of suicidal ideation or attempts.     

Sexual functioning and sexual satisfaction among women who report a history of childhood and/or adolescent sexual abuse

This study examined the relationship between sexual functioning, sexual satisfaction, and predictor variables (experiential avoidance, relationship violence, relationship satisfaction, anger, and psychological distress) in 22 women reporting a history of childhood and/or adolescent sexual abuse. Sexual satisfaction correlated significantly with all predictor variables. Sexual functioning correlated significantly with relationship violence only. Interestingly, sexual satisfaction and sexual functioning were not significantly correlated. Two hierarchical regression equations, using sexual satisfaction and sexual functioning as dependent variables and using the same predictor variables, were tested. Results suggest that different factors may account for sexual satisfaction and sexual functioning and more research is needed to clarify this relationship.     

Psychophysiological sexual arousal in women with a history of child sexual abuse

On the basis of literature that suggests that child sexual abuse (CSA) survivors with post traumatic stress disorder (PTSD) have higher baseline sympathetic nervous system (SNS) activity than healthy controls and research that suggests that the SNS plays a critical role in female physiological sexual arousal, we examined the impact of SNS activation through intense exercise on sexual arousal in women with CSA and PTSD. We measured physiological and subjective sexual arousal in women with CSA (n = 8), women with CSA and PTSD (n = 10), and healthy controls (n = 10) during exposure to nonerotic and erotic videos. After exercise, women with CSA and women with CSA and PTSD showed no significant differences in the physiological sexual response compared with no exercise, which was different from the increased physiological sexual response after exercise observed in control women.     

Individualized obstetrical care for women with a history of sexual abuse

The consequences of a history of sexual abuse for pregnancy and delivery are illustrated in case histories of three women, aged 28, 27 and 31 years respectively. The first woman (who had a history of sexual abuse, like the other women) reacted to labour with dissociative behaviour. This was anticipated by giving her directions for the proceedings during labour, which helped restoring contact. The second patient expressed insecurity during her prenatal check-ups, the reaction to which was inadequate. When labour started her fear had grown and led to an early plea for a caesarean section. An epidural made caesarean section redundant. The third patient had re-experiences during her prenatal check-ups. External examination or an ultrasound were a burden to her. Together with the patient a detailed treatment plan was made which gave her control over the situation. It is advised to question all women during prenatal care about a possible history of sexual abuse and if found, to discuss the consequences of these experiences in her everyday life, especially during her pregnancy. The obstetrical care-giver has to be aware of the circumstances that might provoke traumatic memories and anxious feelings. By knowing and anticipating these events--also called triggers--, the professional can give 'tailor-made' care during pregnancy and delivery.     

Menstruation disorders more frequent in women with a history of sexual abuse

OBJECTIVE: To determine the relationship between menstruation disorders and prior sexual abuse. DESIGN: Questionnaire investigation. METHOD: A questionnaire was developed consisting of 50 questions about menstruation disorders, premenstrual syndrome and sexual abuse. The questionnaire was mailed to all female patients aged 12-54 years (n = 1805) of one family practice in Den Helder, the Netherlands. RESULTS: The response rate to the questionnaire was 69% (n = 1254). After excluding women who were postmenopausal, pregnant, without a uterus, or who did not answer the questions on sexual abuse, 947 remained. Of these women, 83 (8.7%) reported having experienced sexual abuse. These women had significantly more dysmenorrhoea, more dysfunctional menstrual bleeding and significantly more menstrual cycle irregularities. CONCLUSION: A statistically significant association was found between menstrual problems and prior sexual abuse. Sexual abuse should be considered in the differential diagnosis and treatment of women who seek medical help for inexplicable menstrual disorders.     

Group treatment of sexual dysfunction in men without partners.

This paper describes various group techniques used to treat sexually dysfunctional men who have no regular sex partners or whose partners are unwilling or unable to come for treatment. The relative effectiveness of two male co-leaders versus a male and female combination is also discussed. Preliminary results show that the program has been successful in achieving the goals of most of the members. Many of the men also reported favorable changes in nonsexual areas. Group treatment, therefore, does seem promising as a viable, relatively inexpensive, and efficient method of dealing with the sexual problems of men without available partners.     

The experience of hospitalization and restraint of women who have a history of childhood sexual abuse

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.     

Child sexual abuse in early-childhood care and education settings

When the author was adviser to the Australian Minister for Education for writing the national Safe Schools Framework (2003), meetings were held with early-childhood care and education administrators from all state, Catholic and independent sectors. Their unexpected message was that educators were facing new problems, those of child sexual abuse in early-childhood settings including pupils forcing younger children to provide oral sex. In January 2013, the South Australian Minister for Education lost her position following well-publicised parental anger that the Education Department had concealed the sexual abuse of children in early-childhood centres and schools. Parental outrage led to a Royal Commission and ‘Report of Independent Education Inquiry’ (2013) conducted by former Justice Bruce Debelle QC. Public dissatisfaction with some aspects of the Commission led further to a Parliamentary Select Committee Inquiry (February 2014) ‘Matters Relating to the Independent Education Inquiry’¹1.?http://www.parliament.sa.gov.au/Committees/Pages/Committees.aspx?CTId=3&CId=282     

Child sexual abuse in Lebanon during war and peace

Purpose Child sexual abuse (CSA) is rarely addressed in the Arab world. This study examined the prevalence, risk factors and consequences associated with CSA in Lebanese children before, during and after the 2006 Hezbollah‐Israeli war. Method A total of 1028 Lebanese children (556 boys; 472 girls) were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire. Results In total, 249 (24%) children reported at least one incident of CSA; 110 (11%) occurred before the war, 90 (8%) took place in the 1‐year period after the war to the time of the data collection and 49 (5%) occurred during the 33‐day war. There were no gender differences in CSA reports before or after the war, but boys reported more incidents during the war than did girls. Girls who reported CSA had higher trauma‐related symptoms for sleep disturbance, somatization, Post Traumatic Stress Disorder (PTSD) and anxiety than did boys. There were geographic differences in the reports of abuse that may be associated with poverty and living standards. Logistic regression analyses correctly classified 89.9% of the cases and indicated that children's age, family size, fathers' education level and family functioning significantly predicted CSA during the period following the war. Conclusions The prevalence of CSA in the current study is within the reported international range. Given the increase in the incidents of CSA during the war and the significant findings for family‐related risk factors, there is an urgent need to provide multi‐component culturally appropriate interventions that target the child and the family system in times of peace and conflict.     

Long-term health outcomes of childhood sexual abuse and peer sexual contact among an urban sample of behaviourally bisexual Latino men

While previous research indicates high rates of childhood sexual abuse among Latino men who have sex with men, few studies have examined the long-term health outcomes of childhood sexual abuse specifically among behaviourally bisexual Latino men. In a sample of 148 behaviourally bisexual Latino men in New York City, we examined associations between childhood sexual abuse and multiple dimensions of adult health: sexual risk behaviours; sexually transmitted infections incidence; polydrug use; depressive symptoms; and perceived stress. We compared outcomes between those with histories of childhood sexual abuse, those reporting peer sexual contact prior to age 13 and those with no sexual contact prior to age 13. Over one-fifth (22.3%) reported a history of childhood sexual abuse, which was significantly associated with engaging in receptive condomless anal intercourse (aOR = 3.59, p < .01, SE = 2.0), high perceived stress (aOR = 2.48, p < .06, SE = 1.13) and clinically significant depressive symptoms (aOR = 2.7, p < .05, SE = 1.25). Across all variables, peer sexual contact did not impact these outcomes, underscoring a key distinction between abusive and non-abusive early sexual experiences. We recommend that sexual abuse prevention policies and programmes better engage Latino youth, and that practitioners serving this population across diverse areas of practice incorporate childhood sexual abuse screening and culturally appropriate treatment and care into practice.     

Child sexual abuse treatment: misinterpretation and mismanagement of child sexual behavior

OBJECTIVE: The purpose of the study was to examine caregiver understanding of the impact of child sexual abuse and the management of abused children in residential treatment. METHODS: A purposive sample of 20 registered nurses and child care workers were interviewed about their experiences working in residential treatment and their knowledge about child development and child sexual abuse and its application to practice. Data from interviews and field notes were analysed using dimensional analysis. FINDINGS: Caregivers had limited knowledge of the sequelae of child sexual abuse. Developmentally appropriate behaviour of sexually abused children, as well as behavioural manifestations of child sexual abuse, were often misinterpreted and mismanaged. CONCLUSION: Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity.