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For many victims of domestic violence and sexual assault, the first contact with the health care system is with the obstetrician-gynecologist or primary care doctor. Consequently, it is critical that these physicians be knowledgeable in the identification, evaluation, and treatment of such patients.

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
  • May self-medicate with alcohol or other substances
  • Posttraumatic stress disorder
  • Personality disorders characterized by maladaptive character traits
  • Multiple personality disorder

Although the home is often thought of as a safe haven, it is the site of the most common manifestations of violence in our society today. Domestic or intimate partner violence 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. Domestic violence is characterized by a behavior pattern manifested in physical and sexual attacks, as well as psychologic and economic coercion.

The abuser uses the behavior in order 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, it is difficult to compile exact data on the incidence of domestic violence. Every year, approximately 4–5 million women are believed to be battered by their intimate partners. Violence by an intimate partner accounts for approximately 21% of all the violent crime experienced by women. More than 40% of all female murder victims are murdered by their husbands, boyfriends, or ex-partners. It is estimated that at least one-fifth of all American women will be physically assaulted by a partner or ex-partner during their lifetime.

Violent acts 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 arguing and blaming as anger intensifies. This leads to the battering phase that 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. Although unemployment, poverty, and alcohol and substance abuse increase the likelihood of abuse, domestic violence cuts across all racial, ethnic, religious, educational, and socioeconomic lines. Domestic violence often occurs within ...

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