Domestic and Sexual Violence __________________________________________________________________
Domestic violence can consist of any of many behaviors or combination of behaviors, falling under physical, psy- chological, verbal, sexual, and financial/economic abuse ( Table 1 ). It is important for healthcare professionals to understand that domestic violence, in the form of emotional and psychological abuse and physical violence, is prevalent in society. Unfortu- nately, domestic violence and abuse has become a fact of life for many Americans. This course will use the terms “domestic violence” and “IPV” interchangeably. DEFINING SEXUAL VIOLENCE According to the Massachusetts Coalition Against Sexual Assault and Domestic Violence, sexual violence is defined as “a multi-layered oppression that occurs at the societal and individual level and is connected to and influenced by other forms of oppression, in particular, sexism, racism, and het- erosexism…On an individual level, sexual violence is a wide range of sexual acts and behaviors that are unwanted, coerced, committed without consent, or forced either by physical means or through threats” [3]. The Association of American Universi- ties (AAU) defines it as “nonconsensual penetration or sexual touching by force or incapacitation” [4]. Whether out of impulse, compulsion, anger, or the assertion of power, sexual assault is a criminal act of violence imposed on the vulnerable and the innocent, causing immediate physical and emotional suffering and often having long-lasting adverse psychological effects. Rape is the legal term for a sexual assault during which there is penetration of a body orifice (vagina, anus, or mouth) involving force, the threat of force, or incapac- ity and nonconsent of the victim. It is important to consider that there is a wide range of sexual violence that can manifest in many different ways and set- tings/situations. For example, it can entail forced marriage and child marriage, forced lack of precautions to prevention sexually transmitted infections, and/or reproductive coer- cion (e.g., forced abortion, forced pregnancy) is considered a form of sexual violence [3; 5]. It is estimated that 35.6% of the global population have experienced sexual violence. It is important to note that men can be victims of sexual violence, although it is more challenging to obtain prevalence rates for this population [5]. CONTRACEPTIVE COERCION Control of reproductive or sexual health is also a recognized trend in IPV. This type of abuse includes trying to impregnate or become pregnant against a partner’s wishes, refusal to use birth control (e.g., condoms, oral contraceptives), manipulating a contraceptive so it becomes ineffective, preventing or forcing abortion, or stopping a partner from using birth control [6; 7]. It does not necessarily involve physical force, and it ultimately undermines the autonomy of the individual in regard to their reproductive health [7].
INTRODUCTION Domestic violence continues to be a prevalent problem in the United States today. Because of the number of individu- als affected, it is likely that most healthcare professionals will encounter patients in their practice who are victims. Accord- ingly, it is essential that healthcare professionals are taught to recognize and accurately interpret behaviors associated with domestic violence. It is incumbent upon the healthcare profes- sional to establish and implement protocols for early identifica- tion of domestic violence victims and their abusers. In order to prevent domestic violence and promote the well-being of their patients, healthcare professionals in all settings should take the initiative to properly assess all patients for abuse during each visit and, for those who are or may be victims, to offer education, counseling, and referral information. Victims of domestic violence suffer emotional, psychological, and physical abuse, all of which can result in both acute and chronic signs and symptoms of physical and mental disease, illness, and injury. Frequently, the injuries sustained require abused victims to seek care from healthcare professionals immediately after their victimization. Subsequently, physicians and nurses are often the first healthcare providers that victims encounter and are in a critical position to identify domestic violence victims in a variety of clinical practice settings where victims receive care. Accordingly, each healthcare professional should educate himself or herself to enhance awareness of the presence of abuse victims in his or her particular practice or clinical setting. Specifically, healthcare professionals should be aware of the signs and symptoms associated with domestic violence. In addi- tion, when family violence cases are identified, there should be a plan of action that includes providing information on, and referral to, local community resources related to legal aid, sheltering, victim counseling, batterer counseling, advocacy groups, and child protection.
AN OVERVIEW OF THE ISSUE
DEFINING DOMESTIC VIOLENCE Domestic violence, termed spousal abuse, battering, or inti- mate partner violence (IPV), refers to the victimization of an individual with whom the abuser has or has had an intimate or romantic relationship. The Centers for Disease Control and Prevention (CDC) defines IPV as, “physical violence, sexual violence, stalking, and psychological aggression (including coercive tactics) by a current or former intimate partner (i.e., spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner)” [1]. The World Health Organization defines intimate partner violence as “behaviour by an intimate partner or ex- partner that causes physical, sexual, or psychological harm, including physical aggression, sexual coercion, psychological abuse, and controlling behaviours” [2].
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MDCT2026
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