title: Dealing with patients facing a history of sexual abuse: A cross-sectional survey among Dutch general practitioners.
abstract: BACKGROUND
  Sexual abuse (SA) is a common problem. As the primary confidant, the general practitioner (GP) has a valuable role in identifying a history of abuse, specifically with regard to the commonly performed pelvic examination for cervical cancer screening.
  
  
  OBJECTIVE
  This study focused on GPs' practice patterns, knowledge, training need and barriers concerning asking patients about SA. Furthermore, it was investigated who performs the cervical smear within the practice and if SA is taken into consideration.
  
  
  METHODS
  The authors constructed a 31-item questionnaire, which was sent to a group of 730 Dutch GPs in September 2012.
  
  
  RESULTS
  The response rate was 49.3%. Half of the 357 responding GPs asked their patients about SA sometimes. The majority (76.2%) stated they had some knowledge of SA. The most important barriers for not asking were 'no angle or motive for asking' (81.6%), 'presence of third parties' (73.1%), and 'not enough training' (54.1%). In most practices (84.3%), the nurse practitioner (NP) was assigned to perform the cervical smears, of which 34.8% presumably never ask about SA in advance. Additional training was in need according to 68.6%. GPs desired a clinical practice guideline regarding the counselling of SA (83.5%).
  
  
  CONCLUSIONS
  This study showed SA is an under-evaluated problem in general practice, yet GPs are motivated to improve knowledge and counselling skills. NPs perform most of the cervical smears, but the majority never or rarely asked about SA in advance. Educational training and a clinical guideline regarding SA would be appreciated and hence recommended.
authors.affiliation: a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
authors.forename: Eleonore M L
authors.initials: EM
authors.lastname: Birkhoff
authors.affiliation: a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
authors.forename: Esmée M
authors.initials: EM
authors.lastname: Krouwel
authors.affiliation: a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
authors.forename: Melianthe P J
authors.initials: MP
authors.lastname: Nicolai
authors.affiliation: b General practitioner and sexologist, Maarsen , The Netherlands ;
authors.forename: Bert-Jan
authors.initials: BJ
authors.lastname: de Boer
authors.affiliation: c Department of Urology , St. Antonius Hospital Nieuwegein, Utrecht and Zuwe Hofpoort Hospital Woerden , The Netherlands ;
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Beck
authors.affiliation: d Department of Medical Statistics , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
authors.forename: Rob C M
authors.initials: RC
authors.lastname: Pelger
authors.affiliation: a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
authors.forename: Henk W
authors.initials: HW
authors.lastname: Elzevier
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003376:Counseling / Q000592:standards; D019548:Crime Victims; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000458:organization & administration* / Q000706:statistics & numerical data; D058869:Gynecological Examination / Q000379:methods*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012742:Sex Offenses; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000379:methods
keywords: General practitioners; cross-sectional survey; practice patterns; sex offenses; vaginal smears