Low uptake of gynecological consultation following domestic or sexual violence: A case-control study during pregnancy follow-up.

OBJECTIVE: The aim of this study was to examine the association between exposure to domestic and sexual violence and low uptake of gynecological consultation. STUDY DESIGN: Between October 2021 and October 2022, a case-control studywas conducted in mother andchild centers and sexual health centers in the Paris, France area. The case group included pregnant women who did not have a scheduled gynecological consultation in the past two years. The control group included pregnant women who had a scheduled gynecological consultation in the past two years. Pregnant women were interviewed using a standardized questionnaire about a history of domestic and sexual violence, the date of their last gynecological consultation and the gynecological health. RESULTS: A total of 405 pregnant women were included in the case group (n = 129) or in the control group (n = 276). After adjustment for age, couple, social security, supplementary health insurance, dyspareunia, abnormal vaginal discharge, dysmenorrhea, regular pelvic pain, mastodynia, vulvodynia and history of difficult delivery, a history of intimate partner violence was associated with the absence of a gynecological consultation in the past two years (OR 2.13; CI95% 1.21-3.73, p = 0.008). A history of sexual violence, regardless of age, was associated with the absence a gynecological consultation in the past two years (OR 1.92; CI95% 1.05-3.49, p = 0.03). The absence of a gynecological consultation was associated with dyspareunia and domestic or sexual violence (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: This study highlighted the association between domestic and sexual violence and the absence of gynecological consultations in the past two years. It underlines the importance of screening for domestic and sexual violence during gynecological consultations and its impacts on mental health, in particular psychotraumatic symptoms, and on gynecological health, in particular dyspareunia.

[Forensic medical examination of adolescent and adult victims of sexual assault or intimate partner violence who do not complain to the police - An observational study in Seine-Saint-Denis, France]. / Accueil en médecine légale des adolescents et adultes victimes de violences sexuelles ou de violences dans le couple n'ayant pas déposé plainte ­ étude observationnelle en Seine-Saint-Denis.

OBJECTIVES: to identify characteristics of victims of sexual assault or domestic violence who consulted in a Department of Forensic Medicine without a formal complaint to the police. METHODS: observational study (03/01/2014-08/31/2015) of individuals (age>15years) consulting in a Department of Forensic Medicine near Paris, France, after a sexual assault or domestic violence. Among the individuals who were examined in the department of Forensic Medicine, we compared the individuals who had not complained to the police to those who had complained to the police. RESULTS: A hundred and nine individuals have consulted without a prior complaint to the police, including 73 persons after domestic violence (i.e. 4% of all persons examined with or without a complaint to the police) and 36 persons after a sexual assault (i.e. 8% of all persons examined). Regarding domestic violence, the proportion of persons presenting recent traumatic injuries was lower among those who did not complain to the police than among those who did (64% vs. 78%, P=0.008). Regarding sexual violence, the persons who did not complain to the police were more frequently uncertain about the assault (42% vs. 13%, P<0.001), reported more frequently a recent alcohol or drug intake (42% vs. 26%, P=0.039) and less frequently showed extragenital traumatic injuries than the persons who did complain to the police (22% vs. 43%, P=0.016). CONCLUSION: the persons examined who had not complained to the police accounted for less than one in 20. The extension of the activity of a Department of Forensic Medicine to persons who do not want to be involved in a judicial process is not sufficient for the majority of victims to consult a forensic physician.

Social vulnerabilities and health conditions of arrestees in the Greater Paris area, France, in 2013: a multicentre cross-sectional study.

OBJECTIVE: The aim of this study was to describe the health and social conditions of arrestees, as compared to the general population. METHODS: We studied a sample of 600 adult arrestees in three locations in the Greater Paris area, prospectively included (February-May 2013). A descriptive analysis has been performed, then prevalence was estimated using an indirect standardisation according to age, based on data from a population-based, representative survey in the same area. RESULTS: Arrestees had a median age of 31 years; 92% were males. As compared to the general population, arrestees had a lower level of education (8.6 vs. 7.6%, p < 0.001), were more frequently unemployed (42.0 vs. 11.9%, p < 0.001) and in a difficult financial situation (43 vs. 11%, p < 0.001) and had less significant social support (48.1 vs. 87.9%, p < 0.001). They reported also more frequently a chronic health condition (54 vs. 36%, p < 0.001) and a limited health insurance coverage (36 vs. 15%, p < 0.001). CONCLUSION: Comparative analysis of male arrestees and males from the general population showed that the former had worse social and health conditions. These results argue for widespread medical interventions on all arrestees. Medical examination during detention could act as a gateway to health care and social support.

[Physicians attending detainees in police custody: an improved format of the doctor's opinion]. / Intervention du médecin en garde à vue : proposition d'un certificat médical amélioré

OBJECTIVE: Physicians attending detainees in police custody should decide whether the detainee's health status is compatible with detention in a police station. According to a recent French law on police custody (April 14, 2011), the physician is expected to make any useful observations. Standard documents have been proposed since 2004. They have not been extensively used so far. Our objective was to analyze the content and the limitations of such documents and to elaborate a new model. METHODS: We analyzed available models, studied how they fit to national guidelines, and proposed a new model which was more in accordance with the existing guidelines. RESULTS: Recommended format of the doctor's opinion consists in two parts: a standard medical certificate to be sent to the authority who requested the doctor's attendance and a confidential medical record, which is not sent to the requesting authority. Some guidelines were not followed, e.g. detection of psychiatric illnesses and addictive behaviours, and a systematic record of traumatic injuries. The new model has been tested for 18 months by a group of 25 forensic physicians. It includes the description of traumatic injuries and suggests that the doctor systematically assesses a duration of total incapacity to work, even if an extensive description is not requested by the authority. The confidential medical record mentions psychiatric history and addictive behaviours. CONCLUSION: The proposed model could help detainees to assert their rights. It could also take part in characterizing health hazards to which detainees can be exposed.

[Doctor's attendance in police custody]. / Intervention du médecin en garde à vue.

Medical examination is a right for every person detained in police custody in France. Examination of detainees usually takes place in the police station so that the doctor can assess the conditions in which the detainee is being held. In some cases, such as type I diabetes care, detainees need to be examined and treated in a hospital. Doctors are subject to a duty of care and prevention. Description of recent traumatic injuries is part of the doctor's mission. They should prescribe any ongoing treatment which needs to be continued, as well as any emergency treatment required. Custody officers may monitor the detainee and administer medication. Doctor's opinion should be given in a national standard document. If the doctor considers that the custody conditions are disgraceful, they may refuse to express an opinion as to whether the detainee is fit for custody.