Sexual assault and abuse of children

Testing for sexually transmitted infections (STIs) in children presents a number of problems for the practitioner that are not usually faced when testing adults for the same infections. The identification of an STI in a child can have, in addition to medical implications, serious legal implications. The presence of an STI is often used to support the presence or allegations, or, in some cases, may prompt an investigation of possible abuse. The purpose of this paper is to review the recent data on the epidemiology of child sexual abuse including the epidemiology of major STIs (Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, herpes simplex virus, Trichomonas vaginalis, and human papillomavirus) and summarize the current recommendations for diagnostic testing in this population.     

Sexual abuse and the outcome of addiction treatment

The objective of this prospective follow-up study was to examine the effects of sexual abuse on substance use disorder patients' clinical presentation and course in treatment. Consecutive admissions to the MUHC's Addictions Unit were assessed at intake (N=206) and six-month follow-up (n=172). Assessments evaluated socio-demographic and psychiatric characteristics, addiction severity, and physical and/or sexual abuse histories. Upon entering treatment, 23% reported prior sexual abuse with or without physical abuse. Patients with a sexual abuse history had higher rates of psychological problems, stronger family histories of substance use disorders, and more impaired family relationships. At six months, there were no differences between patients with and without sexual abuse histories in their response to treatment, or their utilization of treatment services. The current study failed to show that prior sexual abuse compromised short-term treatment outcomes.     

Sexual abuse and alcoholism in a female population

Abstract Aims. (1) To study the prevalence of childhood sexual abuse before the age of 18 years (CSA) and life-time sexual abuse (LSA) in a Swedish female, general population, (2) to analyse associations between CSA and life-time alcohol dependence or abuse (ADA), and (3) to identify possible confounding factors . Design and participants. The study was conducted in two phases. Phase 1: an alcohol problem screening questionnaire was sent to 3130 women aged 25-65. The answers were scored. Phase 2: based on the questionnaire scores, a randomly selected stratified sample of 479 women was invited for an interview. Of these, 316 women participated in a structured face-to-face interview . Setting. A sector of Goteborg city with 100 000 inhabitants . Measurements. The interviews focused on substance use and on social, psychological and behavioural characteristics, including experiences of sexual abuse. Clinical psychiatric diagnoses were made according to DSM-III-R. Bivariate analyses and multivariate logistic regression analyses were performed . Findings. The prevalence of CSA and LSA was 9.8% and 13.9%, respectively. CSA increased the risk for life-time ADA and anxiety, but not for depression. When potential confounding factors (e.g. early background factors, depression and anxiety) were adjusted for, CSA under 13 years of age still predicted ADA in multivariate analyses, but CSA under 18 years of age did not . Conclusions. LSA, and especially CSA under 13 years of age, are factors that should be considered in treatment of women with ADA and in psychiatric treatment of women.     

Sexual abuse history and women’s medical problems

Received from the Department of Medicine, Stanford University School of Medicine, Stanford, California.     

Sexual and physical abuse in women with fibromyalgia syndrome

Objective. To determine the prevalence of sexual and physical abuse in female patients with fibromyalgia syndrome (FMS), as compared with rheumatic disease control patients. Methods. Eighty-three female FMS patients and 161 consecutive female rheumatology (non-FMS) control patients answered a standardized confidential questionnaire recording previous sexual and physical abuse, drug and alcohol abuse, and eating disorders. Demographic information was collected on age, education, economic status, and cultural group. Results. Overall abuse was greater in FMS patients than in control patients (53% versus 42%; P not significant). Significant differences were observed for lifetime sexual abuse (17% versus 6%), physical abuse (18% versus 4%), combined physical and sexual abuse (17% versus 5%), and drug abuse (16% versus 3%). There was a trend toward a higher incidence of childhood sexual abuse (37% versus 22%) and of eating disorders (10% versus 3%) in the FMS patient group. Conclusion. A high frequency of sexual abuse was identified both in control patients and in FMS patients. A statistical association was demonstrated between FMS and the frequency and severity of sexual abuse, and the frequency of physical abuse and drug abuse. These results raise the possibility that abuse may have an effect upon the expression and perpetuation of FMS in adult life.     

Sexual abuse of older adults: APS cases and outcomes

PURPOSE: The purpose of this study was to develop a profile of sexual abuse cases among adults aged 60 and older receiving attention from Adult Protective Services units in Virginia over a 5-year period. DESIGN AND METHODS: We used bivariate analysis to characterize older adults (n = 82) experiencing sexual abuse and the circumstances of the abuse. We used multiple correspondence analysis, a multivariate method, to explore relationships between characteristics of the older adults and the type of sexual abuse experienced. RESULTS: Most victims of sexual abuse were women, between the ages of 70 and 89, residing in a nursing home. Typically, sexual abuse involved instances of sexualized kissing and fondling and unwelcome sexual interest in the person's body. The majority of perpetrators were nursing home residents who were 60 years of age and older. In most situations, witnesses to the sexual abuse were facility residents. IMPLICATIONS: Orientation affects the invasiveness of the sexual abuse experienced by older adults. Our data reveal a small but persistent number of cases identifying individuals who are especially vulnerable to this form of abuse. These findings establish a baseline for future research and set the stage for further examination in both domestic and institutional settings as well as possible interventions and staff training.     

Sexual and physical abuse are not associated with rectal hypersensitivity in patients with irritable bowel syndrome

BACKGROUND: Patients with irritable bowel syndrome (IBS) have reduced pain thresholds for rectal distension. In addition, the prevalence of sexual/physical abuse in referred IBS patients is high and is associated with greater pain reporting, poorer health status, and poorer outcome. This lead to a hypothesis that abuse history may sensitise patients to report pain at a lower threshold. AIM: To compare rectal pain thresholds in women with IBS who had a history of severe abuse to IBS women with no history of abuse. METHODS: We studied 74 IBS patients with a history of severe physical and/or sexual abuse and 85 patients with no history of abuse. Abuse history was assessed by a previously validated self-report abuse screening questionnaire. Rectal sensory thresholds were assessed using an electronic barostat and determined by the ascending method of limit (AML) and by the tracking technique. RESULTS: IBS patients with a history of severe abuse had significantly higher rectal pain thresholds, as measured by AML (F (1, 111) = 6.06; p = 0.015) and the tracking technique (F (1, 109) = 5.21; p = 0.024). Patients with a history of severe abuse also reported a significantly higher threshold for urgency to defecate (F (1, 113) = 11.23; p =.001). CONCLUSION: Severe sexual/physical abuse is associated with higher urge and pain thresholds for rectal distension in IBS patients. This suggests that the greater pain reporting and poorer health status in IBS patients with abuse history are not related to increased rectal pain sensitivity. Further studies are needed to determine the causes of these findings.     

Actions hormonales sur les cellules germinales femelles de Carassius auratus L., en culture organotypique. Renversement sexuel et ovogenése in vitro

We have studied the effects of hormones (carp pituitary extract, human chorionic gonadotropin, FSH, estradiol, testosterone) and of parabioses (hypophysis, testis) on fragments of adult ovaries of Carassius auratus L., and cultured in vitro on a gelified seminatural medium. Oogonial mitoses and the previtellogenic stages of oogenesis did not seem to require any hormonal stimulation in vitro. Survival of vitellogenic oocytes was improved by hypophysis (parabiosis or carp pituitary extract) and, to a lesser extent, HCG and testosterone. In no case was induction of vitellogenesis observed. Estradiol showed no activity on female germ cells.Abnormal oogonial differentiation occurred in explants from maturing ovaries: increased numbers of gonial mitoses were seen, as were figures similar to the first premeiotic steps of spermatogenesis, up to pachynema. Such pictures were more numerous in the presence of testosterone, but not in the presence of a testicular explant.     

Major depression in patients with HIV/AIDS and substance abuse

Previous research has been inconsistent in documenting a strong relationship between depression and HIV/AIDS, although a recent meta-analysis of studies examining this issue indicates that rates of depression are modestly higher for this population. For the current study, conducted from 2001-2004, we sought to examine rates and types of depressive symptoms in a cohort of patients receiving HIV care at two urban medical centers. These patients were participants in an intervention study examining adherence and mental health in persons triply diagnosed with psychiatric disorders, substance use disorders, and HIV/AIDS. Nearly three quarters of these participants were people of color, two thirds described their sexual orientation as heterosexual, and the vast majority were unemployed. We sought to examine the relationship of depression to patients' adherence to antiretroviral medication regimens (highly active antiretroviral therapy [HAART]). Results obtained from structured clinical interviews and self-report questionnaires indicated that study participants experienced high rates of depressive symptoms, and that 72.9% of participants met criteria for major depressive disorder (MDD). The results of this study offer a detailed view of the incidence and nature of MDDs and depressive symptoms for an urban sample of substance-abusing adults with HIV/AIDS. Given the degree to which depressive symptoms and MDD appear to be prevalent for this group, as well as the observation that these symptoms are amenable to treatment, future research should focus on identifying helpful strategies and interventions for treating these symptoms, effective ways of providing linkages to care, and ways in which standardized assessment and treatment protocols might be adapted to better suit this population.     

Sexual and physical abuse in women with functional or organic gastrointestinal disorders

STUDY OBJECTIVES: To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization. DESIGN: A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire. MEASUREMENTS: The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused. RESULTS: Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01). CONCLUSIONS: We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.     

Sexual dysfunction in fibromyalgia patients

OBJECTIVE:To investigate the prevalence of sexual dysfunction in female patients with fibromyalgia (FM), the impact of FM on sexual activity and the factors associated with sexual dysfunction in these patients.METHODS:Thirty-one consecutive women with FM were enrolled; two groups of 20 aged-matched healthy women and 26 patients with rheumatoid arth-ritis (RA) were used as controls. Demographic features were recorded in all patients. A cross-sectional analysis of pain (100-mm VAS scale), anxiety and depression (as determined by the STAI and Beck Depression Inventory scales, respectively) was performed. Sexual function was assessed by the Changes in Sexual Functioning Questionnaire (CSFQ).RESULTS:FM and RA patients showed a significantly higher rate of sexual dysfunction compared to healthy controls. Sexual dysfunction was more frequent among FM patients (97%) than in RA patients (84%) but without statistical differences. A univariate analysis showed that age (p=0.0002), marital (p=0.036) and work status (p=0.048), pain intensity (p=0.007), level of anxiety (p=0.002), level of depression (p=0.0005), were significantly associated with sexual dysfunction in FM. However, only the intensity of depression was associated with the sexual dysfunction in patients with FM in the multivariate analysis (p=0.012).CONCLUSIONS:Sexual function was very frequently and severely affected in patients with FM and this impairment appeared to be particularly associated with the degree of depression. The recognition of this dysfunction and its inclusion for the multidisciplanary management of FM may contribute to improve quality of life of these patients.     

Sexual activity in cardiac patients]

The question "extents of sexual activity", especially for a cardiac patient, seems enigmatic for patient himself and his physician. Cardiac patient's prejudice is that limitation of sexual activity is necessary to avoid complications like myocardial infarction. This misconception worsens quality of life of patient which is already limited. In this kind of situations, a physician is supposed to answer lots of questions. Patient's risk status should be interpreted and stratified by further examinations, before deciding to treat. Pharmacological and rehabilitative modalities can be applied when indicated, on the other hand, majority of the patients are classified as low risk status that are assumed to be safe. A routine follow- up is recommended for this kind of patients by 6 months intervals, regardless the patient is under medication or not.     

Sexual dysfunction in patients with fibromyalgia

Several studies have investigated sexual function in patients with fibromyalgia (FM). All reports agree that sexual function seems frequently impaired in this condition. This dysfunction is usually severe and may affect all domains of sexuality. Given the complexity of factors involved in human sexual function and the intricacy of the physiopathology of FM, many factors and mechanisms have been implicated. Per our literature review, depression may be the main contributing factor to FM-related sexual dysfunction. However, prospective studies are needed, as reports have lacked sufficient quality to draw definitive conclusions. Recognition of sexual dysfunction and its inclusion in multidisciplinary management are needed to improve quality of life for patients with FM.     

Sexual dysfunction among patients with arthritis

Summary The relationship of arthritis and sexual dysfunction was investigated among 169 patients with rheumatoid arthritis, osteoarthritis and spondyloarthropathy, 130 of whom were pair-matched to controls. Assessments of marital happiness and depressed mood were also made using the CES-D and the Azrin Marital Happiness Scale (AMHS). Sexual dysfunctions were found to be common among patients and controls, the majority in both groups reporting one or more dysfunctions. Impotence was more common among male patients than controls and was found to be associated with co-morbidity and the taking of methotrexate. Depressed mood was more common among patients and was associated with certain sexual difficulties, but not with impotence. Marital unhappiness as indicated by AMHS scores, was not associated with arthritis but was associated with sexual dysfunction, sexual dissatisfaction and being female.