Most people are relieved when they aren’t asked many questions on an intake form or by their doctor.
I’m not one of them.
Yes, I hate questions about goiters and gas like you do. Topics that seem irrelevant or too personal are a turn-off for everyone. Similarly, questions that feel like a waste of time (“how many glasses of alcohol do you drink in a setting?” Um, 4? Scratch that. Let’s say 2.) are simple to fudge. It’s easy to add extra time on the elliptical or omit those several months in our 20’s when we smoked with a new partner. We often fill out intake paperwork without much thought. Does our embellishing or omission matter? It doesn’t seem to. But what does matter is what we are not being asked.
What every healthcare professional — from doc to dentist- should ask about is sexual abuse.Talk about a personal question! I get it but hear me out.
About 33% of women and almost 16% of men are survivors of some form of contact sexual violence. That’s abuse involving touch only. Forcing someone to watch pornography, peeping on someone and unwanted sexting- none of that counts. But if everyone exposed to any form of sexual violence — from catcalls to rape — counted as a survivor, numbers would be higher than 1 in 3 and almost 1 in 6.
Not only are the numbers high but sexual abuse is rarely over when it’s over. The effects can last a lifetime, impacting physical and emotional health. Adults exposed to sexual abuse as a child are particularly susceptible. In one ongoing study, sexually abused girls were more likely to suffer from a host of different health challenges including obesity, propensity to become a teen mom, depression, PTSD and more. These girls were also almost twice as likely to be re-victimized later, both physically and sexually.
But sexual abuse doesn’t only happen to girls and women. The rates of sexual violence among trans people is higher than it is for cis gender people. 50% of transgender people experience sexual violence but experts believe that number is likely too low, given the barriers of reporting.
While you might be surprised to read the almost 16% statistic, the actual rates for boys and men is likely higher. Adult men tend to disclose either publicly (see Junot Diaz and Terry Crews most recently) or privately to their partner. There is less urgency, too, for men to report as there is for women, for whom rape could mean pregnancy. The stigma of being a male survivor, especially strong in some communities, also influences disclosing abuse.
With so many survivors, then, why don’t more providers ask about sexual abuse?
Sexual abuse is an uncomfortable topic for everyone. This fact alone is a huge challenge because we expect the healers and fixers to know everything. But the reality is few providers are taught how to respond to a disclosure of sexual abuse or how to sit with something painful. Healthcare providers don’t ask and patients don’t say.
Recently, I asked one doctor how often he connects past trauma to the conditions or concerns of his patients. He told me “not nearly enough,”. That’s common. Many providers don’t think past trauma, like sexual abuse, even when they see heart disease or diabetes. And yet, the more bad events in your childhood, the higher your risk for a host of seemingly unrelated health conditions.
Healthcare providers, like many of us, also tend to marginalize sexual abuse as something that happens to other people. As a result, they are often unaware of the prevalence of sexual abuse. You also may not “look” like an abuse survivor. Why, then, would your doctor risk offending you by asking about something personal? Something they imagine they probably don’t need to know about?
With so many people affected by sexual abuse, we need healthcare providers to be pro-active in asking about our whole health history, including sexual abuse. Collecting the right information can help them not only provide better care but also cut stress, build trust and save time…for them and for us. Asking the right questions means asking about sexual abuse. The wrong questions are not only a waste of time but a missed opportunity.