• Eleonore M L Birkhoff, Esmée M Krouwel, Melianthe P J Nicolai, Bert-Jan de Boer, Jack J Beck, Hein Putter, Rob C M Pelger, and Henk W Elzevier.
• a Department of Urology , Leiden University Medical Centre , Leiden , The Netherlands ;
• Eur J Gen Pract. 2016 Jun 1; 22 (2): 126-33.

BackgroundSexual 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.ObjectivesThis 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.MethodsThe authors constructed a 31-item questionnaire, which was sent to a group of 730 Dutch GPs in September 2012.ResultsThe 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%).ConclusionThis 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.

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