Urologists should ask patients about sexual abuse
Victims of sexual abuse often avoid gynaecological examinations, but they do go to urologists, is what Leiden PhD candidate Jack Beck has discovered. Knowing about abuse can help provide better diagnosis and treatment. 'It should be standard practice for urologists to ask about abuse, but this by no means happens in every case.' PhD defence 25 April.
Several Dutch and international studies have shown that victims of sexual abuse often do not dare to visit a gynaecologist because they are unwilling to undergo an internal examination. Beck wondered whether they also avoided urologists. He was working as a trainee urologist at the LUMC when, during a physical examination, one of his patients had a flashback to an instance of abuse in the past. Beck: 'The patient reacted very emotionally, which made a great inpression on me. I decided after that to find out what was known about urology patients and sexual abuse, and I found very few Dutch and English studies. That was a reason for me to look further.'
Beck studied the experiences of 845 adult patients. Of the men, 2 per cent had experienced sexual abuse in the past, and among the women, this figure was 13 per cent. In the majority of cases, the abuse had taken place in their childhood or teenage years. Beck also had 180 urologists complete questionnaires. On average they estimated that 10 per cent or fewer of their patients have a pre-history of abuse. Beck was interested to find out whether it was standard practice for them to ask their patients about negative sexual experiences. Almost 70 per cent of the urologists say that they do pose this question. However, Beck suspected that this was not actually the correct figure in practice. He therefore asked 32 patients with a pre-history of abuse whether their urologist had asked them about their past history. Only 1 out of the 32 confirmed this was the case.
Beck does not believe that this question is omitted because of any feelings of embarrassment. 'I think that many urologists do want to ask the question, but time constraints mean they don't get around to it.' The question is whether patients want to be asked these kinds of difficult questions. Beck looked at this, too, and found a clear response: more than 70 per cent of victims are happy for their urologist to ask them about this. Beck suspects that the physical examination is less difficult for them if the urologist already knows about the abuse and takes this into account, for example, by offering the patient a doctor of the same sex as the patient.
Beck also looked at the degree to which sexual abuse influences the nature and seriousness of urology complaints. There seems to be a clear connection. At the academic pelvic treatment centres that he studied, where cases of more serious and multiple pelvic complaints are treated, 23 per cent of the patients report sexual abuse. They have not only bladder complaints, but also, for example, difficult bowel movements and pain with intercourse. At urology clinics in general hospitals, that tend to treat less complex problems, 13 per cent of patients report experiences of sexual abuse.
According to Beck: ‘Knowledge of sexual abuse helps urologists make a clearer diagnosis and can be specially useful with bladder complaints where there is no known cause. Victims of sexual abuse often suffer from tense pelvic muscles that cause all kinds of problems. 'I hope that my researech will encourage urologists to ask this important question more frequently. It is relevant information for choosing the best treatment. These patients need not only medication and pelvic physiotherapy, but sometimes also appropriate psychological support.'
J.J.H. Beck - Sexual abuse evaluation in urological practice
Date: Thursday 25 April 2013
Time: 13:45 hrs
Location: Academy Building
2311 GJ Leiden
Supervisor: Professor R.C.M. Pelger
(15 April 2013 )