Adriana Pinho

Violence against women: a study in a primary healthcare unit

OBJECTIVES There is scarce information on violence against women in the Brazilian society. This fact is rarely reported in medical records as part of the diagnosis and case management, despite evidence showing the significant impact of violence on the populations health. The study aim was to estimate the occurrence of violence against women, and to determine the nature and magnitude of the violent action and the relationship between women and her aggressors. METHODS The study was conducted among women seen in a primary care unit of the city of São Paulo, Brazil, in a two-month period in 1998. The occurrence of violence cases was ascertained using standardized interviews to all women aged 15 to 49 years who sought health care during the study. Three-hundred and twenty-two women were interviewed. RESULTS Of the participants, 143 (44.4%; IC95%=38.9-49.8%) reported at least one episode of physical violence in their adult life, 110 of those perpetrated by their partners or family members (34.1%; IC95%=28.9-39.3%). Thirty-seven women (11.5%; IC95%=8.0-14.9%) reported at least one episode of sexual violence in their adult life, 23 of those perpetrated by their partners or family members (7.1%; IC95%=4.3-9.9%). CONCLUSIONS As reported in other countries, physical and sexual violence is highly frequent among women seen in primary care services. In most cases their partners and family members are the perpetrators and the episodes are mostly serious and recurrent.

Cobertura e motivos para a realização ou não do teste de Papanicolaou no Município de São Paulo

Investigou-se a prevalencia da realizacao do teste de Papanicolaou alguma vez na vida e nos ultimos tres anos entre mulheres de 15 a 49 anos, o recebimento do resultado do ultimo teste realizado e os motivos relatados para a realizacao ou nao do exame. Um inquerito domiciliar foi realizado no Municipio de Sao Paulo em 2000, com uma amostra representativa de 1.172 mulheres selecionadas aleatoriamente em seus domicilios. Das mulheres que ja tinham iniciado a vida sexual (n = 1.050), 86,1% (932) realizaram o teste alguma vez na vida e 77,3 % (839) nos ultimos tres anos. Das que ja realizaram o teste, 806 (87,0%) receberam o resultado do ultimo exame. Os principais motivos para a realizacao do ultimo teste foram: demanda espontânea (55,5%), recomendacao medica (25%) e presenca de queixas ginecologicas (18,2%). As principais razoes para a nao realizacao do exame foram: ausencia de problemas ginecologicos, vergonha ou medo e dificuldades de acesso. A despeito do relativo aumento na cobertura do teste de Papanicolaou e de mais da metade das mulheres demandarem espontaneamente pelo exame, sua realizacao foi menor entre aquelas com as piores condicoes socio-economicas e, portanto, de maior risco para o câncer cervical.This study estimated Pap smear coverage (at least one test in the lifetime and one in the last three years) among women aged 15 to 49 years old. The study also discusses whether the women received the results of their last test, as well as self-reported reasons for and against submitting to the test. A population-based survey was conducted in the city of Sao Paulo in 2000 with a randomly selected representative sample of 1,172 women. Among the women who were already sexually active (n = 1,050), 86.1% reported having had at least one Pap smear during their lifetime, and 77.3% had undergone the test in the previous 3 years. Among those who reported having had at least one Pap smear, 87.0% had received the result of the last test. The main reasons reported for having had the last test were: spontaneous demand (55.5%), medical referral (25%), and gynecological complaints (18.2%). The main reasons for never having had a Pap test were: no gynecological problems, embarrassment or fear, and difficulties in accessing health services. Despite high coverage of the Pap test and the fact that the majority of the women had self-reported a spontaneous demand, use of the Pap test was less prevalent among women with the lowest socioeconomic level (and consequently at greater risk of cervical cancer).This study estimated Pap smear coverage (at least one test in the lifetime and one in the last three years) among women aged 15 to 49 years old. The study also discusses whether the women received the results of their last test, as well as self-reported reasons for and against submitting to the test. A population-based survey was conducted in the city of Sao Paulo in 2000 with a randomly selected representative sample of 1,172 women. Among the women who were already sexually active (n = 1,050), 86.1% reported having had at least one Pap smear during their lifetime, and 77.3% had undergone the test in the previous 3 years. Among those who reported having had at least one Pap smear, 87.0% had received the result of the last test. The main reasons reported for having had the last test were: spontaneous demand (55.5%), medical referral (25%), and gynecological complaints (18.2%). The main reasons for never having had a Pap test were: no gynecological problems, embarrassment or fear, and difficulties in accessing health services. Despite high coverage of the Pap test and the fact that the majority of the women had self-reported a spontaneous demand, use of the Pap test was less prevalent among women with the lowest socioeconomic level (and consequently at greater risk of cervical cancer).

Violência vivida: a dor que não tem nome

E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece. Palavras-chave: Comunicacao; violencia; invisibilidade da violencia; violencia domestica; mulheres maltratadas. ABSTRACT The account of the violence that women undergo is a difficult one. One is dealing with the invisibility of violence affecting users of care services and professionals, which gives rise to communication impasses. The authors attempted to characterize this silence by studying users of primary care in the Sao Paulo public network as regards the prevalence of violence, the perception of having suffered violence, the definition of violence in general and the designation given by the person who experienced violence. 322 users aged 15 to 49 were interviewed concerning physical, sexual and/or psychological aggression, the aggressor, and the perception of having suffered violence. The interviewees were asked to tell the interviewer about a striking episode, as well as what they would call it and what their definition of violence would be. 69.6% of the interviewees referred to some physical, psychological or sexual aggression; of these, 63.4%% did not consider that they had undergone violence in life; 64.3% told of some striking episode and 46.5% of them gave a name to the experience. The most common definition of violence was physical aggression (78.8%), followed by psychological aggression (39.7%) and sexual aggression (24.2%). One concludes that most women that referred to some aggression did not consider that they had suffered violence in life. They had great difficulty in narrating their episodes and giving them names and, even though most of these episodes had taken place within the domestic sphere, in the definition of violence this reference was omitted. Key words: Communication; violence; invisibility of violence; domestic violence; violence against women. RESUMEN Es dificil el relato de violencia sufrida por mujeres. Se trata de la invisibilidad de la violencia que afecta las relaciones usuarias - profesionales, creando impasses comunicacionales. Se trato de caracterizar este silencio, estudiando usuarias de atencion primaria en la red publica de Sao Paulo, respecto a predominancia de violencia, a percepcion de haber sufrido violencia, a definicion de violencia en general y al nombre dado por quien la sufrio. Se entrevistaron 322 usuarias de 15 a 49 anos, sobre agresiones fisica, sexual y/o psicologica, el agresor y la percepcion de haber sufrido violencia, solicitando el relato de un episodio marcante, el nombre que daria a este y la definicion de violencia en general. De las entrevistadas, 69,6% refirieron alguna agresion fisica, psicologica o sexual y, de estas, 63,4% no consideraron haber sufrido violencia en la vida; 64,3% relataron algun episodio marcante y 46,5% atribuyeron un nombre a lo vivido. La definicion de violencia mas comun fue la de agresion fisica (78,8%), seguida por la psicologica (39,7%) y sexual (24,2%). Se concluye que la mayoria de las mujeres que refirio alguna agresion no considero haber sufrido violencia en la vida. Hubo gran dificultad en contar episodios y nombrarlos y, a pesar de que la mayoria de esos episodios sean do ambito domestico, en la definicion de violencia esta referencia no aparece. Palabras clave: Comunicacion; violencia; invisibilidad de la violencia; violencia domestica; violencia contra la mujer.E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece.

Prevenção do câncer de colo do útero: um modelo teórico para analisar o acesso e a utilização do teste de Papanicolaou

Several studies have indicated that the prevailing high incidence and mortality rates of cervical cancer, mainly in developing countries, are due to the low quality and coverage of the cervical smear or Papanicolaou (Pap) test. This article intends to analise some aspects related to measures of control and prevention of cervical cancer, such as the effectiveness of the Pap test, the operational and scientific rationale of public health policies for the prevention of cervical cancer and coverage of the Papanicolaou test in many countries. It also intends to review the explanatory models that have been proposed to analyze access to this service. For this latter objective, we investigated the factors associated to the use of the Pap test described within the epidemiological literature and we proposed a new approach in the investigation of these factors, incorporating social, cultural and organizational aspects in the analysis of access to and use of this practice so that measures of prevention and control may be more coherent with the needs and the rights of women.

Validade da citologia cervicovaginal na detecção de lesões pré-neoplásicas e neoplásicas de colo de útero

Background: The cervicovaginal cytology or Papanicolaou (Pap) test allows the early diagnosis of cervical cancer. Success of cervical cancer screening depends, among other factors, on the diagnostic accuracy of Pap test. Objectives: To evaluate the diagnostic accuracy of cervicovaginal cytology in the detection of cervical lesions through cito-histopathological correlation. Methods: We evaluated the degree of correlation between the cytological results and cervical biopsies from 373 patients assisted at a university hospital in the period from 1990 through 1997. The indicators: sensitivity, specificity, positive and negative predictive values and false positive and false negative rates for cervicovaginal cytology diagnosis were calculated. Results: The crude rate of cito-histopathological correlation was 65.1%. The sensitivity of the Pap test was high (96%); its specificity, however, was low (51.5%), resulting in the inclusion of many false positive results. The rate of false positive results was 48.4%, whereas the rate of false negative results was 4%. Discussion: Despite the higher sensitivity of the test, its specificity is low, meaning that a lot of women would be falsely diagnosed as ill, resulting in a high number of false positive results and unnecessary costs, in addition to the potential iatrogenic character of this preventive practice. However, a highly sensitive test is the test of choice for the screening of cervical cancer among the female population. Conclusions: In order to guarantee the diagnostic accuracy of the Pap test, it is imperative to establish quality control activities for colpocytological and histopathological procedures, thus allowing success in early detection and treatment of cervical lesions.

Violencia vivida: el dolor sin nombre

E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece. Palavras-chave: Comunicacao; violencia; invisibilidade da violencia; violencia domestica; mulheres maltratadas. ABSTRACT The account of the violence that women undergo is a difficult one. One is dealing with the invisibility of violence affecting users of care services and professionals, which gives rise to communication impasses. The authors attempted to characterize this silence by studying users of primary care in the Sao Paulo public network as regards the prevalence of violence, the perception of having suffered violence, the definition of violence in general and the designation given by the person who experienced violence. 322 users aged 15 to 49 were interviewed concerning physical, sexual and/or psychological aggression, the aggressor, and the perception of having suffered violence. The interviewees were asked to tell the interviewer about a striking episode, as well as what they would call it and what their definition of violence would be. 69.6% of the interviewees referred to some physical, psychological or sexual aggression; of these, 63.4%% did not consider that they had undergone violence in life; 64.3% told of some striking episode and 46.5% of them gave a name to the experience. The most common definition of violence was physical aggression (78.8%), followed by psychological aggression (39.7%) and sexual aggression (24.2%). One concludes that most women that referred to some aggression did not consider that they had suffered violence in life. They had great difficulty in narrating their episodes and giving them names and, even though most of these episodes had taken place within the domestic sphere, in the definition of violence this reference was omitted. Key words: Communication; violence; invisibility of violence; domestic violence; violence against women. RESUMEN Es dificil el relato de violencia sufrida por mujeres. Se trata de la invisibilidad de la violencia que afecta las relaciones usuarias - profesionales, creando impasses comunicacionales. Se trato de caracterizar este silencio, estudiando usuarias de atencion primaria en la red publica de Sao Paulo, respecto a predominancia de violencia, a percepcion de haber sufrido violencia, a definicion de violencia en general y al nombre dado por quien la sufrio. Se entrevistaron 322 usuarias de 15 a 49 anos, sobre agresiones fisica, sexual y/o psicologica, el agresor y la percepcion de haber sufrido violencia, solicitando el relato de un episodio marcante, el nombre que daria a este y la definicion de violencia en general. De las entrevistadas, 69,6% refirieron alguna agresion fisica, psicologica o sexual y, de estas, 63,4% no consideraron haber sufrido violencia en la vida; 64,3% relataron algun episodio marcante y 46,5% atribuyeron un nombre a lo vivido. La definicion de violencia mas comun fue la de agresion fisica (78,8%), seguida por la psicologica (39,7%) y sexual (24,2%). Se concluye que la mayoria de las mujeres que refirio alguna agresion no considero haber sufrido violencia en la vida. Hubo gran dificultad en contar episodios y nombrarlos y, a pesar de que la mayoria de esos episodios sean do ambito domestico, en la definicion de violencia esta referencia no aparece. Palabras clave: Comunicacion; violencia; invisibilidad de la violencia; violencia domestica; violencia contra la mujer.E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece.

Violence experienced: the nameless pain

E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece. Palavras-chave: Comunicacao; violencia; invisibilidade da violencia; violencia domestica; mulheres maltratadas. ABSTRACT The account of the violence that women undergo is a difficult one. One is dealing with the invisibility of violence affecting users of care services and professionals, which gives rise to communication impasses. The authors attempted to characterize this silence by studying users of primary care in the Sao Paulo public network as regards the prevalence of violence, the perception of having suffered violence, the definition of violence in general and the designation given by the person who experienced violence. 322 users aged 15 to 49 were interviewed concerning physical, sexual and/or psychological aggression, the aggressor, and the perception of having suffered violence. The interviewees were asked to tell the interviewer about a striking episode, as well as what they would call it and what their definition of violence would be. 69.6% of the interviewees referred to some physical, psychological or sexual aggression; of these, 63.4%% did not consider that they had undergone violence in life; 64.3% told of some striking episode and 46.5% of them gave a name to the experience. The most common definition of violence was physical aggression (78.8%), followed by psychological aggression (39.7%) and sexual aggression (24.2%). One concludes that most women that referred to some aggression did not consider that they had suffered violence in life. They had great difficulty in narrating their episodes and giving them names and, even though most of these episodes had taken place within the domestic sphere, in the definition of violence this reference was omitted. Key words: Communication; violence; invisibility of violence; domestic violence; violence against women. RESUMEN Es dificil el relato de violencia sufrida por mujeres. Se trata de la invisibilidad de la violencia que afecta las relaciones usuarias - profesionales, creando impasses comunicacionales. Se trato de caracterizar este silencio, estudiando usuarias de atencion primaria en la red publica de Sao Paulo, respecto a predominancia de violencia, a percepcion de haber sufrido violencia, a definicion de violencia en general y al nombre dado por quien la sufrio. Se entrevistaron 322 usuarias de 15 a 49 anos, sobre agresiones fisica, sexual y/o psicologica, el agresor y la percepcion de haber sufrido violencia, solicitando el relato de un episodio marcante, el nombre que daria a este y la definicion de violencia en general. De las entrevistadas, 69,6% refirieron alguna agresion fisica, psicologica o sexual y, de estas, 63,4% no consideraron haber sufrido violencia en la vida; 64,3% relataron algun episodio marcante y 46,5% atribuyeron un nombre a lo vivido. La definicion de violencia mas comun fue la de agresion fisica (78,8%), seguida por la psicologica (39,7%) y sexual (24,2%). Se concluye que la mayoria de las mujeres que refirio alguna agresion no considero haber sufrido violencia en la vida. Hubo gran dificultad en contar episodios y nombrarlos y, a pesar de que la mayoria de esos episodios sean do ambito domestico, en la definicion de violencia esta referencia no aparece. Palabras clave: Comunicacion; violencia; invisibilidad de la violencia; violencia domestica; violencia contra la mujer.E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece.

Violence experienced: the nameless pain - - - Violência vivida: a dor que não tem nome

E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece. Palavras-chave: Comunicacao; violencia; invisibilidade da violencia; violencia domestica; mulheres maltratadas. ABSTRACT The account of the violence that women undergo is a difficult one. One is dealing with the invisibility of violence affecting users of care services and professionals, which gives rise to communication impasses. The authors attempted to characterize this silence by studying users of primary care in the Sao Paulo public network as regards the prevalence of violence, the perception of having suffered violence, the definition of violence in general and the designation given by the person who experienced violence. 322 users aged 15 to 49 were interviewed concerning physical, sexual and/or psychological aggression, the aggressor, and the perception of having suffered violence. The interviewees were asked to tell the interviewer about a striking episode, as well as what they would call it and what their definition of violence would be. 69.6% of the interviewees referred to some physical, psychological or sexual aggression; of these, 63.4%% did not consider that they had undergone violence in life; 64.3% told of some striking episode and 46.5% of them gave a name to the experience. The most common definition of violence was physical aggression (78.8%), followed by psychological aggression (39.7%) and sexual aggression (24.2%). One concludes that most women that referred to some aggression did not consider that they had suffered violence in life. They had great difficulty in narrating their episodes and giving them names and, even though most of these episodes had taken place within the domestic sphere, in the definition of violence this reference was omitted. Key words: Communication; violence; invisibility of violence; domestic violence; violence against women. RESUMEN Es dificil el relato de violencia sufrida por mujeres. Se trata de la invisibilidad de la violencia que afecta las relaciones usuarias - profesionales, creando impasses comunicacionales. Se trato de caracterizar este silencio, estudiando usuarias de atencion primaria en la red publica de Sao Paulo, respecto a predominancia de violencia, a percepcion de haber sufrido violencia, a definicion de violencia en general y al nombre dado por quien la sufrio. Se entrevistaron 322 usuarias de 15 a 49 anos, sobre agresiones fisica, sexual y/o psicologica, el agresor y la percepcion de haber sufrido violencia, solicitando el relato de un episodio marcante, el nombre que daria a este y la definicion de violencia en general. De las entrevistadas, 69,6% refirieron alguna agresion fisica, psicologica o sexual y, de estas, 63,4% no consideraron haber sufrido violencia en la vida; 64,3% relataron algun episodio marcante y 46,5% atribuyeron un nombre a lo vivido. La definicion de violencia mas comun fue la de agresion fisica (78,8%), seguida por la psicologica (39,7%) y sexual (24,2%). Se concluye que la mayoria de las mujeres que refirio alguna agresion no considero haber sufrido violencia en la vida. Hubo gran dificultad en contar episodios y nombrarlos y, a pesar de que la mayoria de esos episodios sean do ambito domestico, en la definicion de violencia esta referencia no aparece. Palabras clave: Comunicacion; violencia; invisibilidad de la violencia; violencia domestica; violencia contra la mujer.E dificil o relato de violencia sofrida por mulheres. Trata-se da invisibilidade da violencia que afeta as relacoes usuarias - profissionais, criando impasses comunicacionais. Buscou-se caracterizar este silencio, estudando usuarias de atencao primaria na rede publica de Sao Paulo, quanto a prevalencia de violencia, a percepcao de ter sofrido violencia, a definicao de violencia em geral e a nomeacao dada por quem a experimentou. Entrevistaram-se 322 usuarias de 15 a 49 anos, sobre agressoes fisica, sexual e/ou psicologica, o agressor, e a percepcao de ter sofrido violencia, solicitando-se o relato de um episodio marcante, o nome que daria a este e a definicao de violencia em geral. Das entrevistadas, 69,6% referiram alguma agressao fisica, psicologica ou sexual e, destas, 63,4% nao consideraram haver sofrido violencia na vida; 64,3% relataram algum episodio marcante e 46,5% atribuiram um nome ao vivido. A definicao de violencia mais comum foi a de agressao fisica (78,8%), seguida pela psicologica (39,7%) e sexual (24,2%). Conclui-se que a maioria das mulheres que referiu alguma agressao nao considerou haver sofrido violencia na vida. Houve grande dificuldade em contar episodios e nomea-los, e apesar de a maioria desses episodios serem do âmbito domestico, na definicao de violencia esta referencia nao aparece.