Mentioning the unmentionable

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Many of the questions we ask patients in our clinical practice are fairly routine things, topics of conversation that wouldn't be all that unusual in a social setting: “How are you feeling today?” “What brings you in to see me?” Even the questions we ask our adolescent patients aren't all that different from what they might talk about with their friends: “Who lives at home with you?” “What's school like?”  “Do you ever smoke cigarettes?”

Intimate partner violence (IPV), on the other hand, is never an easy thing to bring up: “Is anyone hurting you?”  “Have you ever been forced to have sex when you didn't want to?”

How often do these topics come up in cocktail party conversation? Probably not much. As a consequence, many of us neglect to ask them in clinical practice. We feel awkward; we're afraid of what the answers might be and that we won't know what to say, what resources to offer, what answers to provide. Despite clinical guidelines urging us to screen patients routinely, how many of us do?

To add greater clarity and urgency to the task of asking about IPV, the Family Violence Prevention Fund has been conducting research in conjunction with Planned Parenthood about the relationship between IPV and unintended pregnancy. The connection might not seem obvious at first, but think about a woman whose partner is controlling or threatening -- or outright abusive -- toward her. Reproductive coercion is often an extension of or a prelude to these behaviors. Many women, adolescents especially, may experience birth-control sabotage and/or forced intercourse at the hands of an abusive partner. And teens may experience violence or harassment in ways (texting?!) we providers may never imagine.

A June editorial in the journal Contraception highlights current research in this corner of the women's health world.  Review the editorial and see what you think. And then see whether you can start asking some basic questions to your adolescent patients. You may save them years of hurt.

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