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INTRODUCTION

Domestic violence and sexual assault are widespread public health concerns. They are of special concern to women because most domestic abuse and sexual assault victims are women. Obstetrician-gynecologists and primary care physicians are often the first professionals to offer care to these victims. Health care providers play a vital role in providing assistance to abuse and assault victims though screening, intervention, support, and treatment.

DOMESTIC VIOLENCE

ESSENTIALS OF DIAGNOSIS

  • Chronic pelvic pain

  • Sexual dysfunctions, such as decreased interest or arousal, dyspareunia, or anorgasmia

  • Chronic or recurrent vaginitis

  • Anxiety or tears before or during the pelvic examination

  • Persistent multiple bodily complaints, such as chronic headaches, palpitations, abdominal complaints, or sleep and appetite disturbances

  • Eating disorders

  • Somatoform disorder

  • Depressed or suicidal

  • Anxiety or sleep disorders

  • Alcohol or substance abuse

  • Posttraumatic stress disorder

  • Personality disorders characterized by maladaptive character traits

  • Multiple personality disorder

Domestic or intimate partner violence (IPV) is a pattern of behavior that may include physical injury, psychological abuse, sexual assault, and reproductive coercion. It typically refers to violence perpetrated against adolescent and adult females within the context of family or intimate relationships. Although victims of domestic violence may be male or female, 90–95% of the victims are women.

The abuser uses the behavior to establish and maintain domination and control over the victim. Because abuse is usually accompanied by shame and guilt, the victim often does not report the abuse. As a result of significant underreporting, data on domestic violence are only estimates. It is estimated that about 20% of sexual assaults and 25% of physical assaults are reported. In the United States, approximately 4–5 million women are believed to be battered by their intimate partners annually. Violence by an intimate partner accounts for approximately 21% of all the violent crime experienced by women. More than 40% of all female homicide victims are murdered by their husbands, boyfriends, or ex-partners. It is estimated that at least one-third of all American women have experienced rape, physical assault, or stalking by a partner or ex-partner during their lifetime.

Physical abuse may include threats, throwing objects, pushing, kicking, hitting, beating, sexual assault, and threatening with or using a weapon. Domestic violence frequently includes verbal abuse, intimidation, progressive social isolation, and deprivation of things such as food, money, transportation, or access to health care. The violence typically occurs in a predictable, progressive cycle. The tension-building phase is characterized by blaming and threats of violence as anger intensifies. This leads to the battering phase, which may involve verbal threats, sexual abuse, physical battering, and use of weapons. The battering phase is followed by a honeymoon phase during which the abuser may deny the violence, make excuses for battering, apologize, buy gifts, and promise never to do it again, until the next cycle begins. Domestic violence often occurs within a framework of family violence that can include child abuse, elder abuse, or ...

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