Diverse and Special Patient Populations

Rape and other forms of sexual assault are highly prevalent in society and are problems of significant medical, public health, and criminal importance. Sexual assault is often a component of abusive relationships, although underreporting due to embarrassment, self-blame, and fear make accurate prevalence and figures difficult to obtain.

The prevalence of IPV in GSM relationships appears to be equal to or greater than that reported in heterosexual relationships. Many lesbian, gay, bisexual, transgender, gender nonconforming, and other GSM individuals do not feel comfortable disclosing their sexual orientation or gender identity to their health care provider and are thus unlikely to disclose abuse. Barriers to inquiry include gender-related myths - for example, men cannot be victims of abuse, women are never batterers, and same sex relationships are inherently "equal" because parties are of the same sex.

Adolescents can be subject to an array of abusive behaviors, ranging from verbal and emotional abuse to physical abuse, rape, reproductive coercion, and even homicide. Some teens are battered  by people with whom they are in a dating relationship, while others are adolescent victims of parental abuse. Teens typically lack experience in defining a healthy dating relationship and are reluctant to seek help from authority figures and healthcare providers.

IPV is associated with a range of specific reproductive health risks such as restricted access to contraception, unintended and even coerced pregnancy; rapid repeat pregnancy; late or sporadic access to prenatal care; spontaneous abortion; unexplained pain, low birth weight and much more. IPV against pregnant women is more prevalent than preeclampsia, gestational diabetes, and placenta previa.

Immigrants and other members of visible and non-visible minority cultures are likely to face extra hurdles as they attempt to access available healthcare services to achieve safety for themselves, their children, and other dependents. Some survivors may adhere to belief systems and traditions that make it harder for them to perceive their own danger, understand their right to live in safety, and know their legal rights and options. These barriers are even greater for non-English speaking immigrants.  Fear is often overwhelming and is associated with being "turned in" to law enforcement (even if they are here legally), loss of custody of their children, fear of police, fear of deportation of the perpetrator who is also the economic provider, and much more. It is important for health care professionals to establish a trusting and confidential relationship with these patients.