Overcoming the legacy of childhood sexual abuse: the role of caregivers and childbirth educators.

Long-term effects of childhood sexual abuse jre varied, complex, and often devastating. Many obstetrician-gynecologists knowingly or unknowingly provide care to abuse survivors and should screen all women for a history of such abuse. Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse. Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, nonspecific vaginitis, and gastrointestinal disorders are common diagnoses among survivors. Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care. Obstetrician-gynecologists can offer support to abuse survivors by giving them empowering messages, counseling referrals, and empathic care during sensitive examinations. Women who are survivors of childhood sexual abuse often present with a wide array of symptoms. Frequently, the underlying cause of these symptoms is unrecognized by both the physician and patient. The obstetrician-gynecologist should have the knowledge to screen for childhood sexual abuse, diagnose disorders that are a result of abuse, and provide support with interventions. Adult childhood sexual abuse survivors disproportionately use health care services and incur greater health care costs compared with adults who did not experience abuse (1).