Sexual and physical abuse

Child sexual or physical abuse may be an antecedent for CPP but many individuals have suffered such abuse without this or other consequence in later life and the research literature is beset with the problem of appropriate comparison groups. Individual judgement is needed about whether to ask directly about sexual or physical abuse during a gynaecological consultation. Important considerations are the setting and plans for follow-up and support that are available to women following such disclosure. Sometimes such a history may be volunteered by the patient unprompted, especially so during a follow-up consultation when rapport has been established. Some women may even find it easier to raise the subject with an unfamiliar hospital specialist than with a general practitioner with whom they have regular consultations for other matters. It may be useful to incorporate questions on abuse into a self-completion questionnaire, such as that provided by the International Pelvic Pain Society, or in a multidisciplinary clinic to address the topic during a consultation with the nurse or psychologist. We have found it appropriate not to include those items in the package of questionnaires sent to patients for self-completion before the initial consultation.

In a study from a tertiary referral multidisciplinary pain clinic, 40% of those with CPP reported sexual abuse compared to 5(17%) in each of two comparison groups. In women with pelvic pain, abuse histories were evenly distributed among those with and without identified pelvic pathology such as endometriosis, but somatization scores were higher among those with identified pathology [10]. It has been suggested that the potential link between sexual abuse and pelvic pain might be that abuse is an observable marker for childhood neglect in general [11] and this might explain the association in some studies with physical rather than sexual abuse [12].

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