Sexual Abuse and the Primary Care Doctor

The importance of identifying a history of sexual abuse is now well recognized by doctors who know that the problem may lie behind a presentation of physical illness, relationship problems, unhappiness or sexual and psychological difficult- ies. It is, however, impossible to say accurately how often sexual abuse is a factor, because in so many cases it is not acknowledged consciously, or is hidden away where it is inaccessible without skilled help. The majority of the books on sexual abuse have been written from particular standpoints. There are now many such books for social workers who are called in because of revelations by children. Stories are written by those who have suffered in order to help themselves overcome their difficulties and help others to do the same. There are accounts of how to detect the signs of abuse for police surgeons, forensic psychiatrists or paediatricians which spell out the unpleasant and distressing nature of the work. There are examinations of the family interactions by family thera- pists, accounts of individual long-term psychotherapy with victims by adult or child psychotherapists and advice on group therapy methods for lay or professional workers. All of these deal with the problem after it has been exposed and Preface xi after it has been referred for specialist help. There was no book, however, to illuminate the skills, attitudes and knowledge needed by the doctor (or nurse) of first contact.