The prevalence of sexually stressful events among females in the general population.

Five hundred sixteen adult females were administered a questionnaire inquiring into the nature of sexually stressful events in their lives. There were 500 responses, and, of those, 298 (59.9%) had experienced an event of this type. A total of 416 different incidents were reported. They were categorized by the authors as either noninvasive (harassment, obscene calls, exposures, "peepers") or invasive (fondling, attempted rape, rape). The invasive incidents were most often initiated by a friend, acquaintance, or relative. The noninvasive events were almost always perpetrated by strangers. The subjects were asked to report the emotional impact of the events. All were reported to be stressful, with rape being the most stressful event. Regardless of whether formal therapy was sought, all victims reported lowered stress levels over time. There were 98 incidents reported when the subjects were 13 years of age or younger. There were 45 invasive events, including 9 rapes. All the rapes were committed by acquaintances or relatives. Only one victim of childhood rape received professional attention. Of the 41 women who were raped, nearly 75% were raped by acquaintances or relatives. This does not parallel existing emergency room data, suggesting that the group of patients who report to medical authorities may be a skewed sample of rape victims. Only four victims reported their rapes to either legal or medical authorities.

Assessing continuing medical education needs in New Mexico.

In 1981 a decision was made by the University of New Mexico School of Medicine to create a new Office of Community Professional Education whose primary function was to create continuing medical education programs tailored to its constituency. To accomplish this, a needs assessment survey was distributed to a stratified random sample of members of the New Mexico Medical Society practicing throughout the state to determine preferred learning styles, locations of programs and times of year, as well as other determinants for attending such programs. The survey was received by 647 physicians and 469 returned them-a response rate of 72.4 percent. Conclusions reached as a result of the needs assessment will serve as a basis of policy formation for the delivery of continuing medical education at the University of New Mexico School of Medicine.

Suicide potential: evaluation by nonpsychiatrists.

Since most people who commit suicide visit a physician in the week to year preceding the act, the physician is in a unique position to intervene before it is too late. If the patient has already made an attempt or gesture, the physician must evaluate the risk of suicide by inquiring into the patient's situation and state of mind and the circumstances of the act. The most common types of psychopathology in those who make a suicide attempt or gesture are depression and borderline personality. To detect suicidal patients who have not yet made an attempt or gesture, the physician must be alert to subtle cues, particularly somatic complaints.

The interrelationship of sex guilt, sex behavior, and age in an adult sample.

Sexual guilt is defined as a generalized expectancy for self-mediated punishment for violating or anticipating violating internalized standards of proper sexual conduct. Previous studies have focused on the relationship between sexual guilt and sexual behavior in college students. The relationship has been shown to be inverse and quite strong. The present study employed a sample of males, ages 27 to 73. The instruments used were the Sexual Guilt Subscale of the Mosher Forced Choice Guilt Scale and the Bentler Heterosexual Behavior Assessment Scale. As in prior studies, it was found that there was a significant inverse correlation between sexual guilt and sexual behavior. In addition, there was found to be an inverse correlation between sexual behavior and age. A significant positive correlation was found between sexual guilt and age. When age was held constant, it was found that there was a highly significant inverse correlation between sexual guilt and sexual behavior. This factoring out of age clarifies the relationship between these variables. The clinician should be aware that the age of a patient may not be a factor in his/her sexual behavior.

Male rape victims: noninstitutionalized assault.

Fourteen male rape victims treated in a county hospital emergency room over a 30-month period are compared with 100 randomly selected female victims treated over the same period. The male victims as a group sustained more physical trauma, were more likely to have been a victim of multiple assaults from multiple assailants, and were more likely to have been held captive longer. They were more reluctant to reveal initially the genital component of their assault and were more likely to use denial and control their emotions in reaction to the assault. Proper diagnosis and treatment of male rape victims requires a high index of suspicion and sensititivty to the likelihood of major, hidden trauma.

Caring for rape victims: its impact on providers.

Students in the health professions are working with a variety of anxiety-provoking patients, such as victims of child abuse or sexual assault, suicidal and terminally ill patients. Faculty have a responsibility to assist these students in maximizing the growth potential of the experience. This study, involving 22 female and three male students at the University of New Mexico Colleges of Nursing and Medicine, examines the effects of such an experience. Each participant worked on a Sexual Assault Response Team at the Bernalillo County Medical Center for an average of 8.6 months; each saw an average of 16 rape victims for whom they provided counseling services and assisted in medical care and gathering evidence. All of the students reported heightened awareness of their own vulnerability. They began to develop cognitive and behavioral strategies to cope with the possibility of being raped. Approximately one third of the subjects developed symptoms similar to those experienced by rape victims. Those who did not develop symptoms attributed it to being able to work through their feelings at team meetings. Students became more aware of their attitudes toward rape victims, both positive and negative. Moreover, the most significant change they experienced was in their own perception of themselves as care givers; they felt more confident and competent, both in medical and counseling areas. Faculty are encouraged to meet weekly with students involved in such experiences.

A framework for the emergency evaluation of the suicidal patient.

With increasing frequency, emergency room personnel face the anxiety of assessing suicide potential. The authors have developed and present here a mnemonic (SAD CHILDREN) which should facilitate the evaluation of potential in attempted or threatened suicide patients.

Follow-up of rape victims in a family practice setting.

Health care for rape victims traditionally has been crisis oriented, focused solely upon the victim, and provided either by a gynecologist or psychiatrist. A family practice health team, working in a county hospital, offered rape victims and their families crisis counseling in the emergency room, and follow-up care in a family practice clinic. Follow-up of victims markedly increased from 8% before initiation of the program to 86% afterward. Family members of more than half of the victims seen on follow-up received treatment. A wide range of health needs of both victims and their families, not identified in the emergency room, was identified on follow-up visits. In this way emergency care of the rape victim often became an entry point into the health care system. Rape must be viewed as a family's as well as victim's health problem, often demanding a broader service than can be offered by a gynecologist or psychiatrist alone.

Diethylstilbestrol in the treatment of rape victims.

Despite growing controversy surrounding its use as a "morning after pill," diethylstilbestrol (DES) is prescribed liberally for rape victims. Guidelines for its use in these patients is lacking. Of 150 consecutive rape victims treated at a university medical center, 63 (42 percent) received prescriptions for DES. Of the 55 (87 percent) on whom follow-up was obtained, in 40 (73 percent) there were substantial side effects-nausea or vomiting, or both. At least six (11 percent) did not complete therapy because of these side effects. The authors offer guidelines for use of DES for rape victims and a plan for patient education and follow-up.