Screening for Sexual Violence: Gaps in Research and Recommendations for Change

Data show that the majority of completed and attempted sexual assaults against women are not reported to the police. In addition, resources that may be thought of as refuges for survivors, such as rape crisis centers, are often not accessed by them. In fact, most women who are victims of childhood or adult sexual violence do not go to hospitals, do not tell their families, and are hesitant to speak to their friends about it.

But survivors of sexual violence do make frequent visits to health care services. Often these women go to health care providers because they are experiencing the physical and psychological effects of sexual violence, which can manifest as headaches, gastrointestinal distress and/or the physical effects of the vio lence such as Pelvic Inflammatory Disease (PID) and Sexually Transmitted Infections (STI's) or Human Immunodeficiency Virus (HIV).

It is clear that health care visits are the gateway to care for many survivors of sexual violence and that providers could be central in improving the outcomes of survivors of violence if they screened, educated and referred their patients. The American Medical Association, the World Health Organization, American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatricians, and the Ameri- can Nurses Association are amongst the health care groups who recommend that providers screen their women patients for violence. ACOG specifically recommends that obstetricians/gynecologists screen women at each visit and include inquiry about sexual violence.

Yet often when providers do screen their female patients for violence, the focus of the screening is on assessing women for domestic violence. This type of screen usually covers physical, emotional/psychological and possibly financial abuse of a woman by her partner, but not sexual violence. But research shows an overlap between types of violence, so that women who are beaten by their partners are often also the victims of sexual violence as well (and visa versa).

There is a critical gap in the level of knowledge we have about sexual violence in this context. The existing domestic violence research gives us the opportunity to learn from the research and to develop a research agenda that asks important questions specifically related to sexual violence. This future agenda includes questions about: inclusive and effective screening tools; types of referrals survivors need; the development and testing of health care outcome measures; development and implementation of program models that work within the health care system, are cost effective and are adaptable to different types of sites; and how screening for sexual violence affects health care usage, the quality of survivors' lives and health care savings.

We need to focus on identifying and assisting survivors of sexual violence, and help them to let go of the shame of silence and isolation related to their experiences of sexual violence. One way to do this is to no longer weigh them with the burden of finding a person to tell or a place to get help. We need to offer comprehensive care and services where women already go, and make sexual violence screening a clear and integrated part of women's health care.