The Monday Memo
October 14, 2019 PITT DPT STUDENTS
We Need to Talk About Sexual Assault
A recent study by Hawks, et. al, published in JAMA Internal Medicine indicated that 1 in 16 women in the United States report rape as their first sexual encounter. This number may be astonishing, but the true number is likely much higher since the study only surveyed women ages 18-44. The study was also completed before the #MeToo movement began, so Hawks et. al. believe the number would increase if the study was repeated today. Women may feel more comfortable saying that they were sexually assaulted following the rise of the #MeToo movement.
You may be wondering how this relates to physical therapy. Well, Hawks, et.al. found that the women whose first sexual encounter was rape were more likely to suffer from health problems later in life. These health problems include an increased risk of endometriosis, pelvic pain, and psychiatric issues. Not only do physical therapists help treat patients with pelvic pain, but we are a very hands-on profession. We are often touching patients in intimate places and spend a lot of time in a patient’s personal space. Being aware of a patient’s past traumas, especially sexual assault, can make us better clinicians and provide better patient care.
Trauma-informed care is often taught extensively in medical school but is not emphasized as much in physical therapy school. The CDC states that one in five women and one in 71 men have experienced rape at some point in their life. This is an extremely important fact to know as a health professional. People who have been sexually assaulted often have post-traumatic stress and can be triggered by even the lightest touch. Whether a PT is working in an outpatient or inpatient setting, we are often placing our hands in sensitive areas. For example, an outpatient PT may palpate a patient’s gluteal muscles to see it they are activating appropriately. An inpatient PT may place their hands on a patient’s ischial tuberosities to do a transfer.
Trauma-informed care suggests that practitioners should be thorough in our exam, explaining every step of the way, and always ask consent before touching a patient. We need to do everything we can to make our patients feel comfortable before beginning an exam. This may include having a family member nearby or letting the patient ask as many questions as they would like. We need to be compassionate and understanding and accept the fact that not everyone is as comfortable with physical touch as we are. Not everyone has had the same experiences or is from the same background, so being able to adapt to each patient’s needs will show excellence as a professional.
Dr. Lincoln, a primary care physician at MGH, suggests that health professionals ask their patients “Is there anything in your history that makes seeing a practitioner or having a physical examination difficult?” or “is there anything I can do to make your visit and exam easier?” These questions can easily be integrated into our physical therapy examination. Similar to how it’s important to know about a patient’s history of hypertension or COPD, it’s important to know about a patient’s past psychological traumas as they can all equally affect their care.
Sexual assault should not be a taboo topic that we feel uncomfortable talking about. It is unfortunately not uncommon, and it not only affects the survivors, but it affects their partners, their family, and their friends as well. Since more physical therapists are obtaining direct access, now is the perfect time for PTs to become more educated in trauma-informed care and the long-term health deficits associated with sexual assault.
-Kara Kaniecki, SPT
Hawks, L., Woolhandler, S., Himmelstein, D., Bor, D., Gaffney, A., & McCormick, D. (2019). Association Between Forced Sexual Initiation and Health Outcomes Among US Women. JAMA Internal Medicine.
Tello, M. (2018, October 16). Trauma-informed care: What it is, and why it’s important. Retrieved from Harvard Health Publishing.