RE: Incidence of diseases in male survivors of csa

[Lisa Amaya-Jackson <laj@xxxxxxxxxxxxxx>]

 I think the study would miss a lot of their GI problems if the questions were limited to only anal sex. As an MD, we see rampant GI problems in patients (children/adults) with histories of abuse .  So I think Randy's point would be well taken in the context: Does anal sex, above and beyond other forms of maltreatment predict GI disorders (controlling for other important variables including psychiatric disorders, stressors)?  I think the stress/trauma he mentions (with clear psychophysiological implications) is important to consider.  You motivated me to pull an old article I had on file by Drossman that showed abuse was quite prevalent (but often hidden) in women referred for GI problems esp. those with functional GI disorders (like Irritable bowel etc)--he was asking the question in the reverse direction:

  Drossman, D, Leserman, J, Nachman et al.  (1990). Sexual and physical abuse in women with functional or organic GI disorders. Annals of Internal Medicine, Vol. 113; 828-33.

In a GI clinic sample of 206 patients, 44% reported sexual or physical abuse and all but 1 of the physically abused had been sexually abused.  (1/3 had neverl discussed their experiences with anyone).  Patients with functional disorders were more likely than those with organic disease dxes to report a hx of forced intercourse ( OR=2.1); frequent physical abuse (OR=11.4); chronic or recurrent abdominal pain (OR=2.1) . Abused patients were more likely than nonabused patients to report pelvic pain (OR=4), multiple somatic symptoms; and more lifetime surgeries. The question didn't differentiate vaginal vs anal penetration. The study's in women,but I think makes a good point for the researcher to consider. I know these and other researchers have followed up with more sophisticated studies since this one. 

Clinically-I have an adolescent male patient, with a significant abuse history--with horrific encopresis (and very impairing psychiatric illness) but no abnormal colon/anal findings.  But his GI symptoms have reduced his psychosocial functioning to nil. 

Lisa  a-j
-----Original Message-----
From:	J. Randall Webber [SMTP:rwebber@chestnut.org]
Sent:	Thursday, May 10, 2001 4:16 PM
To:	Child Maltreatment Researchers
Subject:	RE: Incidence of diseases in male survivors of csa

Ms. Hollows-Your inquiry appears to put all male survivors of CSA in one
category. If your student is interested in the incidence of colon/bowel
disease in male victims of CSA, wouldn't s/he do better to ask about males
who have endured abuse involving anal sex? Perhaps I'm missing something,
but would being subject to exhibitionism, unwanted genital touch or oral sex
tend to increase the physiologically-based incidence of colon/bowel
disorders? I think that including ALL male survivors of CSA may contaminate
your student's data as only some of these individuals have an increased risk
of large bowel disorders as the result of their abuse. For those who have
survived less invasive forms of CSA or coerced oral sex, the issue of
colon/bowel disease is moot unless it is related to stress/trauma.  The
latter is certainly a possibility.

Perhaps we would be better off if we thought of sexual abuse as being a
continuum ranging from verbal abuse to abuse that produces life-threatening
or chronic conditions (e.g., severe damage to the GI system and subsequent
infection and/or persistent dysfunction).  That way, we could focus in more
precisely on a particular subgroup. On that topic, a recent study published
in the American Journal of Public Health found that among female CSA
victims, those who 1) had been raped (vs being "molested"), 2) knew the
perpetrator, and 3) were subject to chronic abuse (vs an isolated
incident)showed a higher incidence of psychiatric disease than those who did
not have those variables as part of their CSA history.

Molnar, B, Buka, S, & Kessler, R (2001).  "Child Sexual Abuse and Subsequent
Psychopathology."  AJPH, 91:5, 753-760.

-Randy Webber

J. Randall (Randy) Webber, M.P.H. rwebber@chestnut.org
Director of Training and Publications
Chestnut Health Systems
Lighthouse Institute
720 W. Chestnut Street
Bloomington, IL  61701
(309) 829-1058 Ext 3411
<http://www.chestnut.org/li/>

"All people are equal, it is not birth, it is virtue alone that makes
the difference. "
- Voltaire



-----Original Message-----
From: owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
[mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu]On Behalf Of
Anne E. HOLLOWS(HSC)
Sent: Thursday, May 10, 2001 9:57 AM
To: Child Maltreatment Researchers
Subject: Incidence of diseases in male survivors of csa



A research student undertaking a qualitative study of experience of services
for adult male survivors has asked me to enquire :
a)whether there is a higher prevalence of colon/bowel disease among male csa
survivors (in a small qual. study he has found that a quarter of the
respondents have bowel disease or malfunction) and
b) whether anyone is aware of protocols available within hospital services
examining such patients. In his cases they had recognised potential
difficulties in undergoing rectal examination and had written to hospitals
asking that this be disclosed to and noted by staff who would undertake the
exam. In each case the letters never reached their destination leading to
speculation about where they had ended up.

Anne Hollows
Principal Lecturer in Social Work
School of Health and Community Studies
Sheffield Hallam University
Collegiate Crescent Campus
Sheffield S10 2BA

tel  +44 (0) 114 225 2369
fax+44 (0) 114 225 2430