The effects of forced sexual intercourse on white female adolescents

Prevalence of Sexual Abuse Among Secondary School Students in Saudi Arabia

Child sexual abuse (CSA) is a public health problem that has been found to be linked to negative health outcomes. Data on CSA in Saudi Arabia are limited, and there are many gaps in research in this field. The aim of this study is to examine the prevalence of sexual abuse among children in Saudi Arabia. A cross-sectional, national survey (N = 16,010) utilizing International Society for Prevention of Child Abuse and Neglect Child Abuse Screening Tool Children's Version was conducted at secondary high schools in Saudi Arabia. Participant's mean age was 16.8 ± 0.9 years, and 50.8% were boys. Sixteen percent of the participants reported exposure to any type of CSA during their lives. Boys and those who lived with step-parent were more likely to be sexually abused compared to those who didn't (p < .05). Ordinary least squares regression analysis revealed that gender was the predictor significantly associated with CSA. Evidence-based prevention programs targeting mainly the high-risk groups should be implemented.

Intimate violence as it relates to risky sexual behavior among at-risk females

OBJECTIVE

Rates of sexually transmitted infections (STIs) among adolescents are on the rise. The majority of adolescents who contract STIs do so through risky sexual behavior. Previous literature has identified multiple correlates of risky sexual behaviors among adolescents, including physical and sexual victimization, mental health concerns, and substance use. Few studies, however, have examined these relationships together in a comprehensive model. The primary purpose of this study was to examine whether relationship violence was related to risky sexual behavior, and whether mental health symptoms and substance use mediated this relationship.

METHOD

A cross-sectional design was used, and adolescent females (N = 179), recruited from social service agencies, were 18.9 years old on average and were 37.2% White, 19.3% Black, 37.9% multiracial, and 5.6% other.

RESULTS

Regression results revealed that females who were physically assaulted and sexually victimized by their intimate partners did engage in more sex without condoms. Mediational analyses indicated that PTSD symptoms significantly influenced the relationship between (1) physical assault and risky sexual behavior and (2) sexual victimization and risky sexual behavior.

CONCLUSION

Contrary to expectations, PTSD may act to reduce risk perhaps by reducing interest in sex. It is important to address victimization, PTSD, and sexual risk in young women. More work is needed to understand these complex relationships using longitudinal designs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

Care of the Adolescent After an Acute Sexual Assault

Sexual violence is a broad term that encompasses a wide range of sexual victimizations. Since the American Academy of Pediatrics published its last policy statement on sexual assault in 2008, additional information and data have emerged about sexual violence affecting adolescents and the treatment and management of the adolescent who has been a victim of sexual assault. This report provides new information to update physicians and focuses on the acute assessment and care of adolescent victims who have experienced a recent sexual assault. Follow-up of the acute assault, as well as prevention of sexual assault, are also discussed.

Acute Sexual Assault in the Pediatric and Adolescent Population

Children and adolescents are at high risk for sexual assault. Early medical and mental health evaluation by professionals with advanced training in sexual victimization is imperative to assure appropriate assessment, forensic evidence collection, and follow-up. Moreover, continued research and outreach programs are needed for the development of preventative strategies that focus on this vulnerable population. In this review we highlight key concepts for assessment and include a discussion of risk factors, disclosure, sequelae, follow-up, and prevention.

Adolescent Risk Factors for Sexual Victimization

Longitudinal data were used to examine riskfactors for sexual victimization among 237 young adult rural women. In this sample, 8% reported experiencing forced sex (i.e., physically violent experiences) and a separate 22% reported experiencing coerced sex(i.e., external psychological manipulation, substance-related coercion, or internal psychological pressure.) Women who had more educated mothers had a greater probability of reporting forced sex. In addition, mothers’ education moderated the relationship between individual riskfactors and the probability of reporting forced sex. For women with less educated mothers, higher frequency of sexual activity during adolescence was related to an increased probability of reporting forced sex. For women with more educated mothers, higher frequency of sexual activity was related to a decreased probability of reporting forced sex. Frequency of sexual activity during adolescence was also related to coerced sex, with higher frequency of sexual activity predicting a greater probability of reporting coerced sex.

Sexual Issues in Treating Trauma Survivors

The effect of interpersonal trauma on sexuality can be profound. The field of sexual trauma is complex empirically and clinically, with contradictory theories and conflicting data. Research definitions and treatment protocols for child sexual abuse are very imprecise. There are no firm, empirically proven guidelines for treating men and women who have been sexually abused as children or adolescents. Overt sexual abuse (OSA) in children and adolescents is defined here as molestation, rape, or incest. Research has shown that OSA may, but does not necessarily, lead to sexual dysfunction in adulthood. The effects of OSA are worsened by concurrent types of family of origin abuse, such as emotional abuse or physical abuse. One factor that seems related to the varying impact of OSA on adult sexuality is the patients’ family of origin experience with nonsexual Milestones of Sexual Development. Without positive experiences with touch, trust and empathy, the ability to relax and be soothed, and power, the effects of OSA are potentiated and complicated. Sexuality is embodied, so experiences with touch are particularly important when working with OSA. A three-color Body Map technique which assesses stored associations to touch is provided. The concept of developmental sexual trauma (DST) is introduced as a way to label traumagenic family events which potentiate OSA or negatively effect sex but which are not explicitly sexual in origin. Strategies to assess and treat OSA are reviewed. Body Maps are recommended to assess and treat sexual trauma.

The role of ethnicity, sexual attitudes, and sexual behavior in sexual revictimization during the transition to emerging adulthood

An experience of child sexual abuse (CSA) substantially increases women's risk of adult sexual assault (ASA), but the mechanisms underlying this relationship are unclear. Previous research often has not examined the full range of ASA experiences or included the influence of ethnicity, sexual behavior, and sexual attitudes on CSA and severity of ASA. The current study utilized path analysis to explore the relationships among ethnicity, sexual attitudes, number of lifetime sexual partners, CSA, and severity of ASA in emerging adult women. Results indicated a significant relationship between CSA and more severe ASA that was partially explained by having more lifetime sexual partners. Additionally, European American women, relative to Hispanic women, reported more severe victimization, which was fully explained by more positive attitudes toward casual sex and having more lifetime sexual partners. These results have implications in the design and implementation of universal and selective prevention programs aimed at reducing ASA and revictimization among emerging adult women.

Really not even a decision any more: Late adolescent narratives of implied sexual consent

Sexual activity without clear consent, as one aspect of violence against women, is a significant global issue, especially during adolescence when young people are developing their values and beliefs about sexual activity and sexual norms. This narrative inquiry was performed to investigate influences on the sexual decision-making of late adolescents. Ten late adolescent females between the ages of 18 and 22 comprised the final sample. The results included the main finding that in the majority of these adolescents' sexual encounters, sexual consent was implied by the situation instead of being clearly stated. Inability to communicate with partners and the influence of alcohol were identified as contributing factors to implied sexual consent. Additionally, there was a pervasive normalization and acceptance of this type of nonconsensual sexual activity, and no one labeled these actions as rape or assault.

IMPLICATIONS

Providers who work with adolescents need to assess sexual behaviors in greater detail and recognize that complex social factors and individual characteristics may contribute to an environment in which adolescents are at risk for nonconsensual sexual activity. Sexual violence education programs need to include information on negotiation and communication skills that will help adolescents mediate complicated interpersonal situations.

Sexual self-schemas of female child sexual abuse survivors: relationships with risky sexual behavior and sexual assault in adolescence

Childhood sexual trauma has been demonstrated to increase survivors' risk for engaging in unrestricted sexual behaviors and experiencing adolescent sexual assault. The current study used the sexual self-schema construct to examine cognitive representations of sexuality that might drive these behavioral patterns. In Study 1 (N = 774), we attempted to improve the content validity of the Sexual Self Schema Scale for child sexual abuse (CSA) survivors, introducing a fourth sexual self-schema factor titled the "immoral/irresponsible" factor. In Study 2 (N = 1150), the potential differences in sexual self-views, as assessed by the four sexual self-schema factors, between CSA survivors and non-victims were explored. In addition, Study 2 evaluated how these sexual self-schema differences may contribute to participation in unrestricted sexual behaviors and risk for sexual assault in adolescence. Results indicated that a history of CSA impacted the way women viewed themselves as a sexual person on each of the four factors. CSA survivors were found to view themselves as more open and possessing more immoral/irresponsible cognitions about sexuality as compared to women who did not have a CSA history. In addition, the CSA survivors endorsed less embarrassment and passionate/romantic views of their sexual selves. The interaction of CSA severity and the sexual self-schemas explained variance in adolescent sexual assault experiences above and beyond the severity of CSA history and participation in risky sexual behaviors. The findings suggest that sexual self-views may serve to moderate the relationship between CSA and adolescent sexual assault. Implications of these findings and directions for future research are discussed.

Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression

Potential pathways from childhood sexual abuse (CSA) to subsequent romantic intimacy problems were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8-15 years of age, and again 1-6 years later. Stigmatization (abuse-specific shame and self-blame) and internalizing symptoms (posttraumatic stress and depressive symptoms), more than abuse severity, explained which youth with CSA histories experienced more sexual difficulties and dating aggression. Stigmatization was found to operate as a predictive mechanism for subsequent sexual difficulties. Internalizing symptoms were not predictive of romantic intimacy problems, although they did show correlational relations with sexual difficulties and dating aggression. Early interventions such as trauma-focused cognitive-behavioral therapy that target stigmatization may be important for preventing the development of sexual difficulties in CSA youth.

Care of the adolescent sexual assault victim

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations including rape. Since the American Academy of Pediatrics published its last policy statement on sexual assault in 2001, additional information and data have emerged about sexual assault and rape in adolescents and the treatment and management of the adolescent who has been a victim of sexual assault. This report provides new information to update physicians and focuses on assessment and care of sexual assault victims in the adolescent population.

Sexual victimization and health-risk behaviors: a prospective analysis of college women

The present study utilizes the National College Health Risk Behavior Survey to examine the relationship between health-risk behaviors and sexual victimization among a sample of college women. A prospective design is utilized to examine the relationship between health-risk behaviors as measured at baseline and sexual victimization during a 3-month follow-up period. After controlling for age and parents' education, a history of adolescent sexual victimization was associated with the following health-risk behaviors as measured at pretest: increased likelihood of cigarette smoking, marijuana use, suicidal ideation, experience of physical violence within a dating relationship, use of diet pills and vomiting or laxatives to lose weight, multiple sexual partners, and early sexual intercourse. Prospectively, women's history of adolescent sexual victimization was the strongest predictor of sexual victimization during the 3-month follow-up. Implications of univariate associations between early sexual intercourse, suicidal ideation, and problematic weight loss behaviors and subsequent experience of sexual victimization are discussed.

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.

A cross-national comparison of youth risk behaviors in Latino secondary school students living in El Salvador and the USA

OBJECTIVES

As Latin Americans' exposure to the USA increases through migration patterns and US political and economic ties to their countries of origin, they become susceptible to adopting not only the cultural expressions of the USA such as fashion, but also the health-related behaviors of the US population. In assessing potential health risks for Salvadoran youth that may result from the connection between Latin Americans and the USA, this study compared the prevalence of health risk behaviors from four behavior domains (aggression and victimization, depression and suicidal ideation, substance use, and sexual behavior) between Salvadoran and US Latino secondary school students aged 14-17 years.

DESIGN

A secondary analysis was performed on two 1999 cross-sectional survey data. In the USA, results were based on 1,063 Latino high school students who answered the nationally representative Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention. In El Salvador, results were based on 793 public secondary school students who answered a local YRBS survey conducted in coordination with the Ministry of Education of El Salvador.

RESULTS

The prevalence rates for aggression/victimization and for depression and suicidal ideation behaviors were similar between Salvadoran and US Latino adolescents. Substance use prevalence, however, was 10-40% higher for US Latino adolescents. While the prevalence of sexual intercourse was higher among US Latino youth (between 13 and 27% higher, depending on age), the prevalence of condom use was lower among sexually active Salvadoran youth (between 11 and 42% lower, depending on age).

CONCLUSIONS

In the context of the transnationalization of the Salvadoran population, with potential for increased influence of the USA in Salvadoran culture, these differences in risk behavior are important for targeting effective interventions for Latino adolescents in El Salvador and in the USA.

Does childhood sexual abuse set in motion a cycle of violence against women?: what we know and what we need to learn

This article reviews evidence for the deleterious effects of childhood sexual abuse on female development in both the acute and long-term phases. Taken in aggregate, there is evidence to suggest a persistent cycle of violence perpetrated against women that begins in childhood in the form of sexual abuse, reemerges later in adolescence and early adulthood in the form of physical assault or sexual revictimization, and ultimately places the next generation at considerable risk for victimization. The differential effect of the characteristics of sexual abuse and the wide variation in the onset and developmental course of symptoms are underscored. The need for adequate models elucidating mechanisms behind this continued cycle of violence is discussed.

Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls

OBJECTIVE

The main objective of this study is to better understand the associations between forced sex history and history of sexually transmitted disease (STD) infection. Three research questions are investigated. Is history of forced sex associated with risk-taking behaviors? Are these risk-taking behaviors associated with history of STD? Is history of forced sex independently associated with history of STD?

METHODS

Information on the sexual and STD histories is obtained from 3,579 sexually active adolescent girls using data from the National Longitudinal Study of Adolescent Health. Weighted logistic and OLS regressions are employed, using techniques that account for the complex sampling design.

RESULTS

Girls with a history of forced sex are significantly more likely to have a greater number of sexual partners, be younger at first sex, and be more likely to use alcohol or drugs at last sex; there is no difference in condom use at last sex. These factors, in turn, are significantly associated with a positive STD history. Condom use at last sex is negatively associated with ever having had an STD. When all five sexual and protective practices are investigated simultaneously, history of forced sex remains significantly associated with STD history (odds ratio [OR] = 1.39, p =.014); number of sexual partners and early onset of sex remain significant. Condom use and substance use at last sex reduce to marginal significance.

CONCLUSIONS

These results suggest that a history of forced sex is independently associated with a history of STD among sexually active adolescent girls. Programmatic strategies aimed at reducing STDs through encouraging responsible sexual behavior would potentially benefit from also including a component that addresses sexual victimization.

The role of childhood sexual abuse sequelae in the sexual revictimization of women: an empirical review and theoretical reformulation

There is now widespread empirical evidence that child sexual abuse (CSA) survivors are at greater risk for sexual revictimization in adulthood, but less is known of the mechanisms underlying this relationship. Despite the lack of a conceptual framework to guide research, there has been a recent influx of studies examining explanatory variables, with most focusing on the psychological sequelae of CSA: alcohol and drug use, sexual behavior, dissociation, posttraumatic symptomatology, poor risk recognition, and interpersonal difficulties. With the exception of sexual behavior, the studies reviewed here provide limited or mixed support for the role of intrapersonal factors in revictimization. Future research may benefit from a focus on the function of psychological distress that is expressed as psychological vulnerability, as opposed to individual forms of psychopathology or maladaptive behavior. An ecological framework may be useful as a guide to future investigations, as this model focuses on factors outside of the victim, including childhood factors such as family environment, contextual factors including the behavior of the perpetrator, and societal and cultural factors that impact revictimization. Future investigations should focus on the interaction between victim vulnerability and perpetrator behavior. Implications for prevention programming, clinical intervention, and future research are discussed.

A prospective investigation of the impact of childhood sexual abuse on the development of sexuality

The sexual attitudes and activities of 77 sexually abused and 89 comparison women (mean age = 20.41, SD = 3.38) were assessed 10 years after disclosure in a longitudinal, prospective study of the long-term effects of childhood sexual abuse. Abused participants were more preoccupied with sex, younger at first voluntary intercourse, more likely to have been teen mothers, and endorsed lower birth controlefficacy than comparison participants. When psychological functioning earlier in development was examined, sexual preoccupation was predicted by anxiety, sexual aversion was predicted by childhood sexual behavior problems, and sexual ambivalence (simultaneous sexual preoccupation and sexual aversion) was predicted by pathological dissociation. Findings also indicate that biological father abuse may be associated with greater sexual aversion and sexual ambivalence.

Family influences on adolescent sexual and contraceptive behavior

Studies of adolescent pregnancy risk are relevant to understanding responsible adolescent sexual behavior because most investigators have focused on the key proximal determinants of pregnancy--sexual intercourse and contraceptive use--rather than analyzing pregnancy status per se. Lesser pregnancy risk is associated with teens remaining sexually abstinent, postponing onset of intercourse, and having intercourse less often or with fewer partners, as well as by using contraception at first or most recent intercourse and by using contraception consistently over time. Living with a single parent, in a lower SES family, having older sexually active siblings or pregnant/parenting teenage sisters, being a victim of sexual abuse, and residing in disorganized/dangerous neighborhoods all place teens at elevated risk of adolescent pregnancy. Parent-child closeness or connectedness, and parental supervision or regulation of children, in combination with parents values against teen intercourse (or unprotected intercourse), decrease the risk of adolescent pregnancy. Studies about parent-child sexual communication and adolescent pregnancy risk are less conclusive, largely because of methodological complexities.

Psychological functioning and family discord among African-American adolescent females with and without a history of childhood sexual abuse

OBJECTIVES

The aim was to examine the rate of childhood sexual abuse along with the factors (age of abuse onset, type of perpetrator, and duration of the abuse), as well as the relationship of these factors to psychological functioning among females with a history of childhood abuse. Second, to determine whether levels of psychological functioning and family discord differ among females with and without a history of childhood sexual abuse.

METHOD

A cross-sectional design was used. Two hundred and forty-nine adolescent females were recruited from a community-based health program. Two trained female interviewers administered an anonymous survey that assessed childhood sexual abuse, psychological functioning, and family environment.

RESULTS

Fifty-seven (22.9%) of those surveyed reported childhood sexual abuse, of which 44.3% were intrafamilial and 55.7% were interfamilial. Age at onset ranged from 3 years to 17 years; 62.5% reported that the sexual abuse occurred 1 to 4 times; 27.9% reported a duration ranging from 1 year to 13 years; and 9.6% reported a duration of 1 month to 7 months. Multiple regression analysis revealed that a greater duration predicted higher levels of depression and lower levels of self-esteem among females with a history of sexual abuse. Females with a history of childhood sexual abuse scored significantly lower on measures of self-esteem and mastery, and significantly higher on measures of physical and emotional abuse.

CONCLUSIONS

Results indicate that adolescent females with a history of childhood sexual abuse suffer an array of negative sequelae that include psychological and family distress.

Care of the adolescent sexual assault victim

Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.

Sexuality, contraception, and the media. Committee on Public Education

Early sexual intercourse among American adolescents represents a major public health problem. Although early sexual activity may be caused by a variety of factors, the media are believed to play a significant role. In film, television, and music, sexual messages are becoming more explicit in dialogue, lyrics, and behavior. In addition, these messages contain unrealistic, inaccurate, and misleading information that young people accept as fact. Teens rank the media second only to school sex education programs as a leading source of information about sex. Recommendations are presented to help pediatricians address the effects of the media on sexual attitudes, beliefs, and behaviors of their patients.

Repeated SUICIDE Attempts: ANALYZED AS ADDICTIVE BEHAVIORS

Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.

Social network constellation and sexuality of sexually abused and comparison girls in childhood and adolescence

This longitudinal study examines how childhood and early adolescent (age 6 to 15) peer and nonpeer social networks relate to sexual attitudes and behaviors in adolescence and young adulthood (age 12 to 25) for sexually abused and comparison girls. A large number of male peers in childhood is related to heightened sexual activity, sexual preoccupation, increased sexual pressure, and risky sexual behavior in adolescence. High-quality, female, nonpeer relationships have a positive effect on attitudes toward casual sex. Multiple group models illuminate several cross-lag group moderators: (a) Abused girls who are happier with male nonpeers are less preoccupied with sex; (b) abused girls who are happier with male peers are more likely to use birth control; and (c) abused girls who have early physical relationships are more likely to engage in risky sexual behavior. Treatment implications include monitoring the effects of low-status peer groups, encouraging contact with female role models, and encouraging the formation of high-quality relationships with male peers and nonpeers.

Sexual violence and reproductive health

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.

Do physicians have adequate knowledge of child sexual abuse? The results of two surveys of practicing physicians, 1986 and 1996

The objective of this study was to to determine if physician knowledge of and biases regarding child sexual abuse (CSA) have changed since 1986. A questionnaire, previously used in 1986, was mailed to 370 physicians who see children in Columbus, Ohio. More respondents in 1996 correctly denied an association between specific sociologic factors and the likelihood of CSA. Seventy-two percent of physicians indicated that they check the genitalia of prepubescent females more than 50% of the time, versus 77% in 1986. Physicians who see more than 25 pediatric patients per week were significantly more likely to check the genitalia (p < .001), whereas physicians with more than 10 years experience were less likely to check genitalia (p < .05). Physicians surveyed in 1996 were more knowledgeable about socioeconomic and behavioral aspects of CSA but continued to be deficient in identifying prepubescent female genital anatomy and in reporting suspected abuse. Education is necessary to correct these deficits.

Partner condom use among adolescent girls with sexually transmitted diseases

PURPOSE

To explore associations of self-reported condom use with sexual risk knowledge and behaviors, perceptions of peer condom use, and communication with sexual partners about condom use among adolescent girls with sexually transmitted diseases (STDs).

METHODS

Adolescent girls with cervicitis or pelvic inflammatory disease (PID) completed a 62-item self-administered questionnaire on sexual risk knowledge and behaviors, condom use, perceptions of peer condom use, and condom use negotiation with partners. Associations with frequency of condom use and condom use at last sexual intercourse were analyzed.

RESULTS

A total of 24 girls were enrolled: 13 with cervicitis and 11 with PID; 22 had complete data for analysis. Compared with girls who reported low frequency of condom use, girls who reported condom use all or most of the time were younger (16.7 vs. 19.5 years; p = .008), were less likely to have a prior history of STD (67% vs. 0%; p = .03), and were more likely to think that all or most of their friends use condoms (72% vs. 0%; p = .02). Compared with girls who had not used a condom with last sexual intercourse, girls who had used a condom were younger (16.2 vs. 17.9 years; p = .04), had fewer lifetime partners (2.7 vs. 8.4; p = .03) and had higher mean scores in condom use negotiation (29.1 vs. 24.4; p = .02), and were more likely to think that all or most of their friends used condoms (100% vs. 31%; p = .001). Knowledge about condoms and STD prevention was high (mean 14.3 +/- 2.3 of 16) but was not associated with condom use.

CONCLUSIONS

STD interventions for partner condom use among high-risk adolescent girls must recognize the decrease in condom use with increasing age and focus on maintaining safer sex behaviors, building condom use negotiation skills, and promoting the perception of condom use by friends.

Childhood sexual abuse and revictimization in adolescence

OBJECTIVE

The aim of this study was to examine the link between childhood experiences of sexual abuse and subsequent revictimization in adolescence.

METHOD

A sample of 281 female adolescents between 17-20 years of age, who participated in a prevalence survey of unwanted sexual contacts, completed the Sexual Experiences Survey as a measure of unwanted sexual contacts in adolescence and indicated whether or not they had experienced childhood sexual abuse.

RESULTS

Childhood experiences of sexual abuse were reported by 8.9% of the respondents, a further 8.5% indicated they were not sure if they had been sexually abused as children. Both abused women and women uncertain about their victimization status were significantly more likely to report unwanted sexual contacts as adolescents than women who did not state abuse. The link between childhood abuse and subsequent victimization was mediated by a higher level of sexual activity among the abuse victims.

CONCLUSIONS

The results support existing evidence on the impact of childhood sexual abuse on sexual relationships in subsequent developmental stages and underline the need to consider childhood sexual abuse as a risk factor of adolescent sexual victimization.

Sexual assault: the role of the advanced practice nurse in identifying and treating victims

Sexual assault is the fastest growing crime in the United States with an estimate that one in four women will be sexually assaulted before she reaches 18 years of age. Nevertheless, only 1 in 10 rapes is reported to law enforcement authorities. Although victims face cross-generational and long-term physical, emotional, cognitive, sexual, and spiritual damage, they seldom share this history unless directly questioned by a clinician. This article reviews the rapidly growing body of literature on sexual assault and the negative health effects on female victims and their families. Sexual assault is defined, incidence is discussed, the aftermath is explored, and the roles of advanced practice nurses are examined.

The pediatrician and the sexually active adolescent. Sexual activity and contraception

Sexuality and its resultant consequences continue to be major issues for adolescents and for those who provide their health care. This article discusses current sexual behavior in adolescents and describes the various forms of hormonal contraception that sexually active adolescents should use.