Hello. I would like to discuss with you a very serious topic, intimate partner violence and sexual assault.
While I don’t think you’ll have many questions on your USLME, it’s important to note these things
that I’m going to review just now. Let’s now talk about the patterns of assaultive behavior
and coercive behavior. Women may actually not disclose that they have physical injury
but they may sometimes tell you they have psychologic abuse, sexual assault, or progressive isolation
from friends and family. This is typical in an abusive pattern that they may have
from their intimate partner. Stalking is also common, deprivation of money and resources,
and frank intimidation or talking down to the patient. Women may also experience reproductive coercion.
That essentially means is that they don't have the choice to have a child or not have a child.
Intimate partner violence is very common in the US. One in three women have experienced rape,
physical violence, or stalking by an intimate partner during their lifetime.
In the US, 4.8 million women have actually reported incidence of physical or sexual assault annually.
The true prevalence though is unknown as many women are afraid to disclose
their personal experiences of violence. Let’s now talk about reproductive coercion.
Approximately 20% of women seeking care in family planning clinics had a history of abuse
and also experienced pregnancy coercion and 15% reported birth control sabotage.
Why do you think the partner would do that? Well, if you have more children, you might be more reliant
on a partner. So, this is a form of abuse. Now, I’d like to discuss sexually transmitted infections.
Patients who have been exposed to intimate partner violence were more likely to respond
by saying that STI notification would actually subject them to being accused by their partner of cheating.
So, they’re very, very fearful of disclosing the STI diagnosis to their partner.
Some women reported threats of harm or actual harm in response to notifying their partners
about their sexually transmitted infection. I would now like to discuss special populations that are at risk
for intimate partner violence. This is particularly true in the adolescent as she may not yet realize
the normal boundaries and context of a healthy relationship. Therefore, it’s important to screen
these patients for intimate partner violence. Another population are immigrant women.
These women may have their immigration status tied to their partner. Therefore, they’re less likely
to report him or her if they’re subjected to abuse. Women with disabilities may rely on individuals
who take care of them or assist them in their daily activities of living. Therefore, they're vulnerable
to abuse not only from family members and friends but also caretakers. It’s important to screen them.
Older women similarly may also be subjected to abuse in care facilities, in hospitals, and at home.
So, remember to screen all women but especially these populations for intimate partner violence.
Let’s now review the important points of intimate partner violence screening.
We should always use language that does not convey judgment. Intimate partner violence
can happen to anyone. It’s not restricted to certain socioeconomic classes, ethnicities, or countries.
Screen in private. You should not ask a patient if they feel safe if someone else is around.
They may feel uncomfortable disclosing in front of someone else. Use professional language with interpreters.
If a patient does not primarily speak English, do not assume that you can communicate well with them
and employ an interpreter. Also, the interpreter should not be a family member
or someone who knows the patient. Preferably, they should be employed by the hospital
or by an agency that contracts with the hospital. You should clearly explain to the patient
that screening is done universally and that you're not singling her out for any specific reason.
Confidentiality is very important and you should not discuss things with patients
unless it’s germane to their care. However, remember that each state law may actually have
specific disclosure recommendations. It’s really important to remember that intimate partner
violence screening should occur at each point of care. This is helpful if you do it in the form
of a questionnaire so patients think that it’s universally done. This can be done through intake forms.
There are different resources that you can provide to patients in the US. Here are some of the organizations
and the contact information that you can actually give to patients that will assist women
who may be trying to get out of relationships that are plagued by intimate partner violence.