Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter

Abstract

Abstract Background Domestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations.Methods Between April 2022 and January 2023, we conducted 25 semi-structured interviews with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. We analyzed the data following inductive thematic analysis methods.Results The majority of women described physical and psychological violence mainly in the domestic sphere. When questioned about domestic sexual violence, they denied its existence. However, as they were asked to qualify their intimate and sexual life, they described it as forced or coerced, without referring to it as sexual violence. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied.Conclusion We assumed that perceptions of domestic sexual violence and violence in gynaecological care are likely to vary according to a number of related factors. This study can help question the appropriateness of professional practices related to the prevention of violence against women and those of gynecological examination practices.