Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program

Women who have experienced sexual assault

Page last updated: 17 November 2019 (this page is generated automatically and reflects updates to other content within the website)

Barriers to screening
Engagement strategies
Healthcare provider resources
Consumer resources

Sexual assault is common in Australia, with 19% of women having experienced some form of sexual violence since the age of 15.

Sexual assault includes any unwanted sexual act or behaviour which is threatening, violent, forced or coercive and to which a person has not given consent or was not able to give consent.

Women who have experienced sexual assault are often reminded of the experience by gynaecological procedures and are less likely to attend for cervical screening. If they do screen, they are more likely to have a negative experience during the procedure.

Women who have experienced sexual assault are also more likely to have higher levels of gynaecological problems and cervical neoplasia.

Barriers to screening

In addition to the general barriers women may face in participating in cervical screening, the following barriers have been identified as common for women who have experienced sexual assault.

Barriers to screening
  • Feelings of anxiety, shame, embarrassment, fear and vulnerability
  • Avoidance as a way to cope with trauma (i.e. avoiding a gynaecological examination as a way to control or avoiding triggers of trauma response)
  • Reluctance to disclose sexual assault to a healthcare provider
  • Parallels with the abuse situation/reminder of the sexual assault – for example, perceived loss of control, the power disparity between healthcare providers and patients, feeling exposed and the physical sensation of the examination. The gynaecological procedure may feel threatening and re-traumatising.
  • Lack of trust, feeling unsafe
  • Availability of a female doctor or nurse
  • Physical pain/discomfort during examination
  • Healthcare providers’ lack of knowledge about the impact of sexual assault
  • Insensitivity of healthcare providers

Engagement strategies

The following strategies have been shown to be effective in engaging women who have experienced sexual assault in cervical screening.

Strategy

Detail

Staff training

Encourage all healthcare providers to undertake training about sexual assault, supporting women to participate in cervical screening, managing disclosure and making referrals to specially trained cervical screening providers. This training should build knowledge and skills in order to feel more confident to meet the needs of women.

Appropriate communication

Present opportunities for disclosure of sexual assault (e.g. including questions during history taking).
Offer more than one appointment and/or longer appointment times (e.g. the first visit to familiarise the women with healthcare providers, procedure and instruments and the second for the test itself). This strategy will also help build rapport and trust.
Ask women for their consent before undertaking the procedure.
Acknowledge the difficulties that screening poses for these women and your willingness to support these women through the procedure.
Provide women with control over their appointment (e.g. they are able ask to stop the procedure at any time.

Make the procedure as comfortable as possible

Offer women the opportunity to perform the test in a different position (e.g. on their side rather than their back, letting them have their hands and arms free during the examination).
Consider use of a smaller speculum.
In some cases it may be appropriate to offer self-collection.

Supportive environment

Place relevant posters or pamphlets in your practice to indicate an awareness and willingness to discuss sexual assault and support women to undertake cervical screening.
Encourage the woman to bring a friend or support person to the appointment.
Offer and/or advertise the availability of counsellors and provide contact details.

Patient records

If sexual assault is disclosed, flag this in medical records so healthcare providers are aware for future visits.

Choice of cervical screening provider

Ensure female cervical screening providers are available.
Refer women to a cervical screening provider who is experienced in working with women who have experience sexual assault.
If sexual assault is disclosed, provide additional support and referrals as required.

Healthcare provider resources

Consumer resources