#metoo? The association between sexual violence history and parturients' gynecological health and mental well-being

Adverse life events among bedouin and jewish women and the risk for postpartum depressive symptoms

PURPOSE

Postpartum depression (PPD) affects 10-15% of postpartum women with increased risk among women with trauma history. The purpose of this study was to investigate the relationship between adverse life events and postpartum depressive symptoms among Bedouin and Jewish women.

METHODS

A cross-sectional study was performed in a tertiary hospital in the southern district of Israel on women with singleton deliveries between November 2021 and March 2022. Eligible women completed two questionnaires to determine exposure to childhood trauma (CT) and other potentially traumatic events (PTE), including the Childhood Trauma Questionnaire (CTQ), and Lifetime Events Checklist questionnaire (LEC). To measure risk for PPD we used the Edinburgh Postnatal Depression Scale (EPDS). The associations between CT, PTE, and risk for PPD were analyzed and multivariable logistic regression models were constructed to control for potential confounders.

RESULTS

A total of 201 women were included, 120 Bedouin (59.7%) and 81 Jewish (40.2%). In the entire study population, both CT and PTE were independently associated with risk for PPD (adjusted OR = 2.13, 95% CI 1.02-4.44, p = 0.043 and adjusted OR = 3.42, 95%, CI 1.46-8.00, p = 0.004, respectively). While among Bedouin women, PTE was independently associated with PPD risk (adjusted OR = 4.83, 95% CI 1.66-14.05, p = 0.004), no significant association was found among Jewish women.

CONCLUSION

Both CT and PTE were associated with increased PPD risk in Bedouin and Jewish women. Only PTE, and not CT, was associated with PPD among Bedouin women. Understanding risk factors for PPD, and differences among minority groups, could promote prevention efforts for PPD.

Experience of Pelvic Examination and Uptake of Gynecological Care Following Domestic or Sexual Violence: a Systematic Review

Pelvic examination, a routine practice for gynecological care, can cause anxiety and be considered traumatic. This study aimed to define the association between domestic or sexual violence and the experience of pelvic examination, as well as the uptake of gynecological care following domestic or sexual violence. Pubmed, Cochrane Library, ScienceDirect, and Google Scholar were searched, up to April 30, 2023. Cohort, cross-sectional, case-control studies and controlled trials assessing perception of pelvic examination or the use of gynecological care for women with a history of violence were selected and analyzed. Each study underwent a descriptive analysis and was assessed for bias using the Newcastle-Ottawa scale and the RoB2 tool. Twenty-three articles met the inclusion criteria. Eleven studies, including 7,329 women, investigated the experience of pelvic examination following lifetime or childhood sexual violence. Most reported an association between violence and adverse experiences of pelvic examination, such as discomfort, anxiety, distress, and pain perceptions. Ten studies, including 9,248 women, investigated the uptake of gynecological care following domestic or sexual violence and reported mixed results, such as a decreased or an increased uptake, particularly for acute symptoms. Two studies, including 1,304 women, examined both outcomes. The present study highlights the association between violence and adverse experiences of pelvic examination, as well as mixed results on the uptake of gynecological care. It argues for the necessity to screen for violence in consultations, particularly when considering a pelvic examination, to guarantee the utility of pelvic examinations, and to consider the traumatic impact of sexual violence in care.

Uptake of gynecological consultation following domestic or sexual violence: A case-control study in the context of induced abortion

OBJECTIVE

The aim of this study was to determine the prevalence of domestic and sexual violence and to characterize the association between exposure to domestic and sexual violence and low uptake of gynecological care, in the context of induced abortion.

STUDY DESIGN

We conducted a case-control study among women seeking abortion care, in mother and child centers and sexual health centers in the Paris, France area (April 2022-March 2023).

RESULTS

A total of 103 women were included in the study during induced abortion care. Physical, psychological or sexual domestic violence was reported by 48.5 % and sexual violence, whoever the perpetrator, was reported by 23.3 %. In the bivariate analysis, a history of physical, psychological or sexual domestic violence was not associated with the absence of a gynecological consultation in the past two years, compared with no history of intimate partner violence (p = 0.09). After adjustment for regular pelvic pain, dysmenorrhea, vulvodynia and dyspareunia, there was no association between a history of sexual violence and the absence of a gynecological consultation in the past two years (OR 1.05; CI95% 0.27-4.13, p = 0.93).

CONCLUSION

Violence was a common finding among women seeking abortion care. We did not find any association between a history of sexual violence and the absence of a gynecological consultation in the past two years. We suggest investigating multiple or frequent use of gynecological care following violence. The combination of ethical, moral, and psychological constraints associated with violence screening and abortion care is a challenge to patient recruitment in future studies.

Risk of adverse perinatal outcomes with violence in pregnancy

PURPOSE

To examine the association between physical, sexual, or physiological harm in pregnancy and perinatal outcomes in a large, contemporary birth cohort.

METHODS

This retrospective cohort study used California-linked vital statistics and hospital discharge data from 2016 to 2020. We included singleton, non-anomalous births with a gestational age of 23-42 weeks. Violence in pregnancy was identified using International Classification of Disease, Tenth Revision (ICD-10) codes. Chi-square tests and multivariable Poisson regression models were used to evaluate associations of violence in pregnancy with perinatal outcomes.

RESULTS

A total of 1,728,478 pregnancies met inclusion criteria, of which 3,457 (0.2%) had reported violence in pregnancy. Compared to those without violence in pregnancy, individuals who experienced violence had an increased risk of non-severe hypertensive disorders (aRR = 1.36, 95% CI 1.22, 1.51), preeclampsia with severe features (aRR = 1.34; 95% CI 1.11, 1.61), chorioamnionitis (aRR = 1.68; 95% CI 1.48, 1.91), anemia (aRR = 1.59; 95% CI 1.50, 1.68), antepartum hemorrhage (aRR = 2.17; 95% CI 1.19, 3.95), and postpartum hemorrhage (aRR = 1.65; 95% CI 1.48, 1.85). Violence in pregnancy was also associated with increased risk of Apgar score < 7 at 5 min (aRR = 1.37; 95% CI 1.11, 1.71) and neonatal hypoglycemia (aRR = 1.26; 95% CI 1.07, 1.48).

CONCLUSION

Violence experienced in pregnancy is associated with an increased risk of adverse perinatal outcomes. Understanding how universal screening and early recognition of violence in pregnancy may reduce disparities in maternal morbidity for this understudied population is critical.

Wellbeing and illbeing in women exposed to physical and sexual violence during peripregnancy: a population-based longitudinal study

Background: Physical and sexual violence against pregnant women have been associated with detrimental mental health outcomes for victims. Few studies have examined both positive (wellbeing) and negative (illbeing) mental health indicators in the same sample. Additionally, the literature assessing mental health based on different forms of violence is limited.Objective: To compare both wellbeing (life satisfaction) and illbeing (anxiety and depression) trajectories between non-victimized and victims of physical, sexual and both forms of violence that occurred during or shortly before pregnancy. Further, we analyse whether social support moderates these trajectories.Method: This longitudinal study is based on the Norwegian Mother, Father and Child Cohort, including the period from early pregnancy to toddlerhood (3 years). We compared wellbeing and illbeing trajectories of non-victims (n = 73,081), victims of physical abuse (n = 1076), sexual abuse (n = 683), and both forms of abuse (n = 107) using Growth Curve Modelling. Finally, social support was included as a moderator of wellbeing and illbeing trajectories.Results: Results indicated that victims scored systematically lower in wellbeing and higher in illbeing. Exposure to violence did not significantly change the wellbeing trajectory, pointing to similar developments in wellbeing among victims and non-victims for the considered period. On the other hand, different trajectories in illbeing occurred between victims and non-victims, as well as between victimized groups. Victims experienced greater change in illbeing scores, with a steeper decrease in illbeing compared to non-victims. Both victims and non-victims returned to respective baseline scores 3 years after birth. All women benefited from social support, but victims of physical abuse were particularly protected by social support.Conclusions: There is an alarming persistence of mental health problems in women exposed to violence during peripregnancy. Different forms of violence differentially impact women's mental health. Social support is beneficial among all pregnant women.

Low uptake of gynecological consultation following domestic or sexual violence: A case-control study during pregnancy follow-up

OBJECTIVE

The aim of this study was to examine the association between exposure to domestic and sexual violence and low uptake of gynecological consultation.

STUDY DESIGN

Between October 2021 and October 2022, a case-control studywas conducted in mother andchild centers and sexual health centers in the Paris, France area. The case group included pregnant women who did not have a scheduled gynecological consultation in the past two years. The control group included pregnant women who had a scheduled gynecological consultation in the past two years. Pregnant women were interviewed using a standardized questionnaire about a history of domestic and sexual violence, the date of their last gynecological consultation and the gynecological health.

RESULTS

A total of 405 pregnant women were included in the case group (n = 129) or in the control group (n = 276). After adjustment for age, couple, social security, supplementary health insurance, dyspareunia, abnormal vaginal discharge, dysmenorrhea, regular pelvic pain, mastodynia, vulvodynia and history of difficult delivery, a history of intimate partner violence was associated with the absence of a gynecological consultation in the past two years (OR 2.13; CI95% 1.21-3.73, p = 0.008). A history of sexual violence, regardless of age, was associated with the absence a gynecological consultation in the past two years (OR 1.92; CI95% 1.05-3.49, p = 0.03). The absence of a gynecological consultation was associated with dyspareunia and domestic or sexual violence (p < 0.0001 and p < 0.0001, respectively).

CONCLUSIONS

This study highlighted the association between domestic and sexual violence and the absence of gynecological consultations in the past two years. It underlines the importance of screening for domestic and sexual violence during gynecological consultations and its impacts on mental health, in particular psychotraumatic symptoms, and on gynecological health, in particular dyspareunia.

Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter

BACKGROUND

Domestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations.

METHODS

We analyzed the data following inductive thematic analysis methods.

RESULTS

Between April 2022 and January 2023, we conducted 25 semi-structured interviews, lasting on average 90 min (range: 45-180), with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. The women described physical and psychological violence mainly in the domestic sphere, their altered gynecological and mental health and their perception of gynecological care. The levels of uptake of gynecological care were related to the characteristics of the violence and their consequences. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied.

CONCLUSION

This study can help question the appropriateness of professional practices related to the prevention of violence against women and gynecological examination practices. Any gynecological examination should be carried out within the framework of an equal relationship between caregiver and patient, for the general population and for women with a history of violence. It participates in preventing violence in the context of care, and more widely, in preventing violence against women.

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]

OBJECTIVE

To provide guidelines for the pelvic clinical exam in gynecology and obstetrics.

MATERIAL AND METHODS

A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

RESULTS

The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature.

CONCLUSIONS

The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

BACKGROUND

Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals' perspectives with the patients' to determine how sexual violence conversations should occur in these environments.

METHODS

Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 (n = 22) living in Indiana who sought community-based or private healthcare for women's reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization.

RESULTS

There were three resulting themes: (1) healthcare professionals' approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize.

CONCLUSIONS

Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women's reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

[Gynecological care among women reporting sexual violence: a qualitative study]

INTRODUCTION

Sexual violence can be followed by different levels of gynecological care. Our objective was to characterise gynecological care and to identify the related factors among women who had reported sexual violence.

METHODS

Twenty-five semi-structured interviews were conducted among adult women who reported sexual violence during childhood or as adults. Topics addressed included gynecological health, gynecological care and experienced violence, RESULTS: Interviewed women, aged 20-60, had a good professional integration and a high level of education. The violence had often been committed by a relative or acquaintance. For the women interviewed, the least use of gynecological care was motivated by a desire to avoid the gynecological examination. Among women who had regular check-ups, the desire to conform to the norm explained their need for gynecological check-ups, which was similar to that of women who had never been subjected to violence. Lastly, some care pathways were characterised by multiple recourse of gynecological care for complaints with identical motives. The women interviewed expected professionals to spontaneously identify the violence they had suffered and the gynecological consequences attributed to such violence.

CONCLUSION

Individual and interpersonal differences in levels of gynecological care use were related to the characteristics of the violence and its perceived effects on gynecological health. It would be interesting to extend this research by examining the care pathways of women with other socioeconomic characteristics. A quantitative study would measure the association between violence and the use of gynecological care.

"The Global Sense of Disaster was Synchronized With my Own Disaster": Implications of the COVID-19 Crisis on the Wellbeing of Survivors of Sexual Violence

The present study is designed to improve our understanding of the impact of the COVID-19 pandemic, as collective trauma, on the wellbeing of survivors of sexual violence (SV). The data are based on an online qualitative survey about the experiences of 39 survivors and a thematic analysis of ten in-depth interviews with service providers in Israel. The findings reveal that the pandemic and restrictive measures are associated with increased risk for participants' wellbeing, caused directly by pandemic characteristics, as well as indirectly through the denial of access to coping resources. Paradoxically, the pandemic also offers relief, given the widespread restrictions imposed on the entire population and the general crisis atmosphere. The service providers' perspective indicates an increased demand for services as well as for their adjustment. These findings highlight the vulnerability of individuals with a history of SV and the need for accommodation of frontline SV services for health crises.