Am Fam Physician. 2011 Feb 15;83(4):352-359.
to the editor: This well-written article provides a useful outline for evaluating acute pelvic pain in women; however, it does not cover the topic of sexual violence as a potential contributing factor. Pregnancy, sexually transmitted infections, vaginal bleeding, and abdominal or pelvic pain can all be the result of sexual violence. Health care professionals should use the presentation of acute pelvic pain in women as an opportunity to ask about sexual violence.
A comprehensive evaluation of pelvic pain should begin with a complete history and physical examination. This history, which may help to prioritize the differential diagnosis, must include a sexual history. Although direct questioning about contraception use, sexual activity, and previous sexually transmitted infections can offer clues to stratify the patient's risk of pregnancy and pelvic inflammatory disease, health care professionals must remember to also ask about potential sexual violence. This is especially true for women with high-risk sexual behavior. The Centers for Disease Control and Prevention reports that one in six women have experienced rape or attempted rape at some point during their lives, and that approximately 32,000 pregnancies per year occur as a result of rape.1 Early recognition of sexual violence can enhance comprehensive medical care and allow for timely referral for psychological support.2
1. Centers for Disease Control and Prevention. Understanding sexual violence. Fact sheet 2007. http://www.cdc.gov/ncipc/pub-res/images/SV%20Factsheet.pdf. Accessed July 26, 2010.
2. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report on violence and health. Geneva, Switzerland: World Health Organization; 2002. http://www.who.int/violence_injury_prevention/violence/world_report/en/full_en.pdf. Accessed July 26, 2010.
in reply: We thank Dr. DiPlacido for highlighting sexual violence as a possible etiology for acute pelvic pain in women. One-third of women are exposed to sexual violence during their lifetime.1 We agree, therefore, that sexual violence should be explored when taking a history in patients with acute pelvic pain.
1. Tavara L. Sexual violence. Best Pract Res Clin Obstet Gynaecol. 2006;20(3):395–408.
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