The sequelae of childhood sexual abuse: a primary care focus for adult female survivors.

Researchers have increasingly demonstrated that 15% to 30% of all women have been sexually abused as children. Information on the emotional, behavioral, and cognitive sequelae of this abuse has been available. Most recently, a literature on the somatic and medical sequelae has developed. This article reviews this literature and discusses its implications for primary care providers. Survivors are likely to suffer from insomnia, gastrointestinal problems, obesity, chronic pain, headache, and somatization, and they are frequent utilizers of primary care services. Specific suggestions about history taking, physical examination, and referrals are given to ensure that survivors receive care that is sensitive, supportive, and competent. The article also discusses the dynamics of abuse and how they relate to the ongoing relationship between the primary care provider and the survivor of sexual abuse.