The impact of sexual abuse in patients undergoing colonoscopy.
BACKGROUND
Sexual abuse has been linked to strong effects on gastrointestinal health. Colonoscopy can provoke intense emotional reactions in patients with a sexual abuse history and may lead to avoidance of endoscopic procedures.


OBJECTIVE
To determine whether care around colonoscopy needs adjustment for patients with sexual abuse experience, thereby exploring targets for the improvement of care around colonoscopic procedures.


METHODS
Questionnaires were mailed to patients (n = 1419) from two centers within 11 months after colonoscopy. Differences in experience of the colonoscopy between patients with and without a sexual abuse history were assessed and patients' views regarding physicians' inquiry about sexual abuse and care around endoscopic procedures were obtained.


RESULTS
A total of 768 questionnaires were analyzed. The prevalence of sexual abuse was 3.9% in male and 9.5% in female patients. Patients born in a non-western country reported more sexual abuse (14.9%) than those born in a western country (6.3%; p = 0.008). Discomfort during colonoscopy was indicated on a scale from 0 to 10, mean distress score of patients with sexual abuse was 4.8(± 3.47) compared to 3.5(± 3.11) in patients without a sexual abuse history (p = 0.007). Abdominal pain was a predictor for higher distress during colonoscopy (β = -0.019 (SE = 0.008); p = 0.02, as well as the number of complaints indicated as reason for colonoscopy (β = 0.738 (SE = 0.276); p = 0.008). Of patients with sexual abuse experience, 53.8% believed gastroenterologists should ask about it, 43.4% said deeper sedation during colonoscopy would diminish the distress.


CONCLUSIONS
Sexual abuse is prevalent in patients presenting for colonoscopy. Patients with a sexual abuse history experience more distress during the procedure and indicate that extra attention around and during colonoscopy may diminish this distress.
Department of Urology, Leiden University Medical Center, Leiden, the Netherlands.
Melianthe P J
MP
Nicolai
Department of Gastroenterology, HAGA Teaching Hospital, The Hague, the Netherlands.
Josbert J
JJ
Keller
Department of Urology, Westeinde Hospital, The Hague, the Netherlands.
Lieke
L
de Vries
Department of Gastroenterology, Leiden University Medical Center, Leiden, the Netherlands.
Andrea E
AE
van der Meulen-de Jong
Department of Gastroenterology, HAGA Teaching Hospital, The Hague, the Netherlands.
Jan J
JJ
Nicolai
Department of Gastroenterology, Leiden University Medical Center, Leiden, the Netherlands.
James C H
JC
Hardwick
Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands.
Hein
H
Putter
Department of Urology, Leiden University Medical Center, Leiden, the Netherlands.
Rob C M
RC
Pelger
Department of Urology, Leiden University Medical Center, Leiden, the Netherlands.
Henk W
HW
Elzevier
D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012742:Sex Offenses / Q000523:psychology; D011795:Surveys and Questionnaires