Sexual Dysfunction with a Patient with a Past History of Violence

Authors: Stuart Weisberg, M.D. and Joseph B. Layde, M.D., J.D.
Medical College of Wisconsin

I. Sexual Dysfunction in a Patient with a Past History of being a Victim of Sexual Assault - Sexual History Taking Videotaped Exercise

II. Synopsis
A. Audience: M-II students in the Human Sexuality Course
B. Mode of Education: Role-playing by medical students, one of whom portrays a general internist and one of whom plays a 22 year-old woman with a prior history as a victim of sexual assault. A third student operates a video camera and videotapes the sexual history taking, which is then critiqued by small group students and a small group leader in the M-II Human Sexuality Course in Psychiatry.

III. Objectives
A. At the conclusion of this module, the learner will be able to:
B. Describe the typical sequence of sexual violence in a young woman.
C. Competently obtain a sexual history from a victim of domestic violence.
D. Explain the psychosocial context of date rape and similar forms of domestic violence.

IV. Key Definitions and Concepts
A. Victims of domestic violence in the past may feel inhibited in sexual behavior later in life.
B. Some victims of domestic violence are amnestic about the history of assault, sometimes as a result of ingesting surreptitiously altered drinks containing pharmaceutical intoxicants.
C. Sexual assault can occur in the context of date rape or a similar circumstance, such as at a fraternity party.

V. Relationship to Human Sexuality Course
A. Knowledge base: Students learn about the relationship of some cases of sexual dysfunction to earlier sexual assault, as well as about contraception and sexually transmitted diseases.
B. Clinical skills and methods: Students learn to empathetically interview and obtain a sexual history from a patient with a prior history of sexual assault.
C. Physician's professional role: Students have the opportunity to role play a general internist caring for a patient who presents seeking contraception, but who later in the course of the visit reveals a history of sexual assault.

VI. Linkages to other MCW curriculum
A. Horizontal links to other courses: M-II Psychopathology-Domestic Violence, M-II Pharmacology, M-II Microbiology (Sexually Transmitted Diseases).
B. Vertical links: M-I Foundations of Human Behavior, M-III Psychiatry, M-III OB-GYN, M-IV Women's Reproductive Health

VII. References
A. For faculty:
Understanding Sexuality, 3rd Edition, Haas and Hass, St. Louis, Mosby, 1993: "Sexual Intercourse", pgs. 154-171; "Birth Control", pgs. 193-208; "Yeast Infections", pg. 444; "Sexual Problems and the Solutions", pgs. 492-512; "Sexual Coercion and Violence", pgs. 558-578.

B. For students:
Understanding Sexuality, 3rd Edition, Haas and Hass, St. Louis, Mosby, 1993: "Sexual Intercourse", pgs. 154-171; "Birth Control", pgs. 193-208; "Yeast Infections", pg. 444; "Sexual Problems and the Solutions", pgs. 492-512; "Sexual Coercion and Violence", pgs. 558-578.

Assessing Patients for Family Violence: A guide for health care providers. Climbing the "ALPS", Violence Assessment Workgroup, Sinai Samaritan Medical Center, 1999 pamphlet

C. For patient education:
"Sexual Assault: Where to go for help", Sexual Assault Treatment Center of greater Milwaukee, Sinai Samaritan Medical Center, 1994 pamphlet

VIII. Evaluation Strategies:
A. The "Sexual Dysfunction with a Past History of Violence" case

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