Katarina Swahnberg

Emotional, physical, and sexual abuse in patients visiting gynaecology clinics : a Nordic cross-sectional study

BACKGROUND Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearsons chi(2) test. FINDINGS The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

A history of sexual abuse and health : A Nordic multicentre study

Objectives  To determine if a history of sexual abuse is associated with objective and subjective indicators of health and if certain abusive incidents had a stronger impact on health than others.

Are sociodemographic and regional and sample factors associated with prevalence of abuse

Background.  The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables.

Patients’ experiences of abuse in health care: a Nordic study on prevalence and associated factors in gynecological patients

Background. In an earlier Swedish study conducted with The NorVold Abuse Questionnaire, we found that one‐third of female patients who had experienced adult abuse in health care (AAHC) had a background of childhood emotional, physical and/or sexual abuse (EPSA) (‘revictimised’). But since the majority of women with AAHC were ‘new victims’ without such a background, there might be other factors associated with AAHC. The present study aimed to map prevalence of abuse in health care (AHC), and associated variables among new victims and revictimised patients. Methods. We carried out a cross‐sectional questionnaire study at 5 Nordic gynecological clinics. Associations between AAHC and other variables were tested in a multivariate model in 4 groups of women with adult EPSA, childhood EPSA, childhood and adult EPSA, and no EPSA. Results. The response rate was 77% (n = 3,641). The overall prevalence of any lifetime experience of AHC was 13–28%. High educational level, physical complaints, post‐traumatic stress symptoms, and sleeping problems were associated with AAHC in women without EPSA (new victims). Poor self‐rated health was strongly associated with AAHC in the 3 groups of women with EPSA. Conclusion. AHC is commonly reported by gynecological patients in the Nordic countries, but not yet properly explored or understood. The most important factors associated with AAHC were high educational level and poor self‐rated health.

Nullified: Women's perceptions of being abused in health care

Objective. In a study performed with The NorVold Abuse Questionnaire (NorAQ) among Nordic gynecological patients, the prevalence of lifetime abuse in health care (AHC) was 13 – 28%. In the present study we chose a qualitative approach. Our aim was to develop a more in-depth understanding of AHC; as experienced by female Swedish patients. Study design. Qualitative interviews with 10 Swedish gynecological patients who had experienced AHC. The interviews were analyzed through Grounded Theory. Results. Saturation was reached after six interviews. In the analyses four categories emerged which explain what AHC meant to the participating women: felt powerless, felt ignored, experienced carelessness, and experienced non-empathy. To be nullified is the core category that theoretically binds the four categories together. The womens narratives described intensive current suffering even though the abusive event had taken place several years ago. Conclusions. The fact that AHC exists is a critical dilemma for an institution that has the societys commission to cure and/or to alleviate pain and suffering. In their narratives, women described the experience of ‘being nullified’, a core category that embodies AHC.

Experiences of physical and sexual abuse and their implications for current health

OBJECTIVE: To estimate the prevalence of a history of physical and sexual abuse in adulthood among gynecological patients and the association with general and reproductive health. METHODS: A cross-sectional questionnaire study on abusive experiences of gynecologic outpatients in a tertiary hospital. The total sample size was 691. RESULTS: Of all women, 42.4% had experienced moderate or severe physical or sexual abuse as an adult. One hundred forty-seven (21.6%) women reported physical abuse, 84 (12.3%) sexual abuse, and 58 (8.5%) both. The abused and nonabused women did not differ in mean age, education, or parity. Sexually abused women and those who were both sexually and physically abused reported poor general health significantly more often (P=.005 and P=.001, respectively) than the nonabused. They also rated their sex life as significantly worse than the nonabused women (P=.002 and P=.012, respectively). Over half of abused women had experienced common physical complaints during the previous 12 months compared with one third of the nonabused (P<.001). Two thirds of both the abused and the nonabused women preferred that their gynecologist not ask directly about abuse. CONCLUSION: Abusive experiences were common in gynecologic outpatients. Women with abusive experiences had ill health and poor sexual life more often than the controls. In contrast to the results of previous studies, most of the women did not want to be asked about abuse by their gynecologist. LEVEL OF EVIDENCE: II

Prevalence of perceived experiences of emotional, physical, sexual, and health care abuse in a Swedish male patient sample

The aim of the present study was to estimate the prevalence of and current suffering from emotional abuse (EA), physical abuse (PA), and sexual abuse (SA) and abuse in health care (AHC) among male Swedish patients and compare prevalences of abuse between female and male patients at a Swedish university hospital. For data collection we used the NorVold Abuse Questionnaire, which has been validated in a female sample and in the present study. The lifetime prevalences were EA = 12.8%, PA = 45.7%, SA = 3.8%, and AHC = 8.1%. Current suffering from abuse among participants was 1% to 9%. The women reported higher rates than men of current suffering from all kinds of abuse and more severe forms of abuse, such as life-threatening PA. Health care staff should be aware of the documented high prevalences of abuse and learn to make good judgments as to when to ask male as well as female patients about experiences of abuse.

Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse

Abstract The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18–22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22 and 33%, respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy – prioritizing the partner’s enjoyment before their own – and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.

Women's perceived experiences of abuse in the health care system : their relationship to childhood abuse

Objectives  The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non‐victims did.

Young Swedish women's experience of pain and discomfort during sexual intercourse

Objective. To study experience and prevalence of (1) pain related to first sexual intercourse; (2) pain and/or discomfort associated with sexual intercourse during the previous month; and (3) associations between these experiences. Design. Cross‐sectional study. Setting. A youth center in southeast Sweden. Sample. Three hundred consecutive women, aged 13–21 (response rate 98%). Method. During a two‐month period, women consulting a youth center, participated in a questionnaire study. Main outcome measures. Pain and/or discomfort during sexual intercourse. Results. The majority of the participants, 98%, had had sexual intercourse and of those, 65% reported pain related to first sexual intercourse. Forty‐nine percent (99/203) of those who reported sexual intercourse during the previous month had experienced coital pain and/or discomfort during that period, and for almost every second woman (46/99), those experiences constituted a problem. We found no association between experience of pain during first sexual intercourse and pain and/or discomfort during the previous month. Conclusions. Prevalence of pain and/or discomfort associated with sexual intercourse is high among women visiting a youth center. Our results show that coital pain in young women is a problem which needs to be further explored.