Clinical audit of referrals for sexual abuse among females ages 13–19 years attending the Agape Family Medicine Clinic, Nassau, Bahamas, 2011–2015

OBJECTIVE: To evaluate the adequacy of the documentation of referrals for sexually abused females ages 13–19 years directed to the Agape Family Medicine Clinic for interim management. SUBJECTS AND METHODS: An approved review was performed on 123 referral forms regarding sexually abused females 13–19 years old who attended Agape’s Sexual Assault Follow-up and Evaluation (SAFE) clinic, Nassau, Bahamas. The exercise focussed on documentation adequacy based on a scoring system developed by the researchers: > 50% was assessed to be adequate, and recording disposition, date of incident and sexually transmitted infection (STI) screening was considered vital for adequacy. A current version of Statistical Package for the Social Sciences (IBM SPSS, v 21) generated descriptive and inferential statistics. RESULTS: Participants’ median age was 14 (IQR: 13, 15) years old. Of 63.4% (n = 78) with documented nationality, 88.5% (n = 69) were Bahamian and 11.5% (n = 9) Haitian. Documentation status did not differ statistically significantly by nationality. Regarding documentation, 74% (n =91) recorded school, 59.3% (n = 73) recorded knowing the assailant and 17.9% (n = 22) indicated not knowing. Approximately two-thirds (65.9%; n = 81) indicated penetration type; 18.7% recorded disposition, 29.8% (n =36) incident date and 60.2% STI screening; 7.3% (n = 9) documented all three and 22.8% (n = 28) two. Among public health clinics (PHCs), 45.3% (n = 29) did not indicate any of the three vital variables versus 7.8% (n = 4) for Accident and Emergency (A&E) referrals. Mean percent documentation for vital variables was 49.3 (± 3.6)%for A&E versus 30.5 (± 4.0)% for PHCs (p = 0.001). CONCLUSION: The deficient documentation status of referral forms demands the need for reform. Complete, consistent documentation is required.

Sexual dysfunction among females on anti-hypertensive treatment - abstract

Sexual dysfunction is a common finding among males treated for essential hypertension, and is frequently cited as a cause of non-compliance with a therapeutic regimen. Reports of sexual dysfunction among treated women have been few, and there is little appreciation of how this problem affects the female patient. The present paper focusses on 112 pre-menopausal females, age 23 to 45 years, referred for evaluation of essential hypertension either as part of a pre-immigration physical examination or for management in a general medical out-patient clinic. Seventy-five women had been on anti-hypertensive treatment in the past or were on treatment at the time of evaluation. Previously treated women were kept on their old regime, and the others were put on a stepped-care protocol. After stabilisation of their blood pressure, all patients were questioned about sexual function while on treatment. Twenty-four women admitted to some degree of sexual dysfunction, loss of libido being the most significant problem. Twelve said they would enjoy sex after activity was initiated by their consorts, but thought their pleasure was considerably diminished by treatment. Four found that sex had become distasteful but continued to please their partners. Sixteen patients reported virtually complete loss of orgasm, and eight cited failure of lubrication as a significant problem. Eleven women admitted to more than one sexual problem. Only one admitted to pre-treatment sexual dysfunction. Four patients were thought to be depressed, by the medical attendant, and three of these responded to anti-depressant therapy plus a change of anti-hypertensive drugs. Of fourteen patients followed by the same physician for more than one year, eleven considered themselves restored to normal, or near normal, sexual function by a change of drug regimen but, in all cases, 2 or more different drugs had been tried before this was achieved. Only two women admitted to discontinuing drugs because of sexual difficulties. Sexual dysfunction in treated hypertensive females would therefore appear to be a significant problem. The present study may actually underestimate its extent, as there was a preponderance of middle-class women among those admitting to dysfunction: these females are presumably more educated and articulate and perhaps less embarrassed at discussing sexual matters (AU)