Research on childhood sexual abuse (CSA) shows a range of emotional, psychological and physical effects in adulthood. For many women, post-traumatic stress disorder symptoms, interpersonal problems, self-abuse, chronic pain, gastrointestinal and respiratory conditions, and other complaints are associated with a history of CSA (Bala, 1994; Roy, 1998). The effects of CSA may influence current encounters between survivors and health care providers without the awareness of one or both parties. Health promotion policies and programs have not considered the implications of these findings, nor has the delivery of health care services taken into account the needs of CSA survivors. Thus, many women avoid routine and preventive services, particularly those experienced as invasive; or when they do obtain care, they suffer in silence.

In a previous study by several members of this research team, specific recommendations about ways to improve the organization and quality of care provided by health practitioners were given (Heinonen, Merrett-Hiley, McClure, Tudiver & Kreklewetz, 1997). The former study was the basis for the most recent research, which explored practitioners': 1) level of knowledge and training about CSA; 2) experiences with patients who have CSA histories; and 3) recommendations for appropriate care for women patients with such histories. The aims of the study were to raise awareness about women survivors' needs in the health care system and to highlight practitioners' concerns about health care provision for women survivors of CSA. The research team hoped that professional bodies and individuals would be encouraged to develop referral networks, appropriate curricula, policies, and practice guidelines to better meet the needs of these women.

Through purposive, snowball sampling among clinic and hospital staff, interviews with 25 health care professionals in urban Manitoba (including four physicians, seven nurses, five mammographers, five sonographers, three dentists, and one dental hygienist), were arranged. Participants all provided health care services to women which involved invasive procedures (i.e., observing, touching, probing, or otherwise manipulating parts of a woman's body during examination or treatment).

Within each practitioner category, there was variation in awareness and knowledge about CSA and its physical and emotional effects, and in experience with CSA survivors as patients. Some had encountered many clients with CSA histories. Others admitted that they had never considered the significance of CSA in their professional work before the interview. Few practitioners routinely asked patients about CSA due to personal discomfort, a hesitancy to "open up a can of worms," and inadequate training. Obstacles in medical environments included limited time, lack of privacy, language barriers, staff shortages, and preoccupation with equipment, technologies, and procedures over psychosocial concerns. All participants wanted more information about CSA and how their practice could be adapted to better meet the needs of all women.