Anyone can experience sexual or physical assault or abuse. When taking a client-centered sexual history, consider asking questions regarding sexual assault and/or domestic violence in a sensitive manner, when appropriate.
What is sexual assault?
Sexual assault is any form of unwanted sexual activity without a person’s consent (i.e. voluntary agreement). This can include, but is not limited to, forced sexual intercourse (rape), sexual abuse, childhood sexual abuse, incest, sexual harassment, and any other unwelcome sexual activity, such as kissing, fondling, touching, oral sex, or threatening to do any of these things.
Sexual assault is a common occurrence and can happen to peoples of all genders. Many people experience sexual assault in their own homes by their partners, family members, friends, co-workers, or acquaintances. How a person is dressed, where a person goes, or what a person does are not reasons to be sexually assaulted. Survivors are never to blame.
What is domestic violence?
Domestic violence is sometimes called intimate partner violence (IPV). It is violence or abuse in a domestic setting, such as in an intimate relationship or marriage. Domestic abuse and violence are used for one purpose — To gain and maintain control and power over one’s partner.
Domestic abuse is not always physical. It can be verbal, emotional, psychological, spiritual, or financial in nature. Domestic violence happens in all racial and cultural groups, in all social classes, and at all educational and income levels.
Abusive behaviour is never acceptable. All peoples deserve to feel safe, respected, and valued.
Trauma-informed approaches with different populations:
Trauma can be experienced differently by different groups of people, including immigrants and refugees, Indigenous peoples, and other populations. Healthcare providers should make every effort to tailor their care to the varying experiences of their patients.
One key consideration is our increasing understanding of the impacts of historical and intergenerational trauma for Indigenous peoples. Between the 1860’s and 1990’s, First Nations, Inuit, and Métis peoples were forced to leave their families and homes and attend residential schools instead. In these schools, Indigenous children experienced loss of language, culture, and support and were subjected to extreme forms of neglect and physical, sexual, and emotional abuse and torture. Residential schools were supported by aggressive assimilation policies. The harms these policies inflicted on Indigenous peoples continue to affect the health and well-being of many communities today and help explain the lack of trust some groups have in the Canadian healthcare and governmental systems.
To ensure culturally competent care, providers should take active steps to understand Canada’s colonial history and build their self-awareness and skills in this area.
General tips for history taking:
- It is incredibly important to build rapport with patients BEFORE asking them about sexual assault and relationship violence
- Restate the parameters of confidentiality before you ask personal questions
- Use open-ended questions when possible
- Beware of judgemental questions (e.g. “Your partner doesn’t hit you, do they?”) and behaviours (shaking your head)
- Do not make assumptions based on one’s ethnicity, appearance, and/or language/speech
Suggested questions on history:
- Have you ever been hurt in a sexual way or forced to have sex when you didn’t want to?
- Have you ever traded sex for money, drugs, a place to stay or other things that you need?
- Do you feel safe in your relationships?
Authors | Ishita Aggarwal, Carly Alfano, Balsam Arwini (Sexual Health Portfolio)
References
- https://www.arc-c.ca/about-sexual-assault–domestic-violence-c27.php
- https://www.aacap.org/App_Themes/AACAP/Docs/member_resources/SOGIIC/AHWG-Taking-a-sexual-history.pdf
- https://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf