Urological Complaints and Sexual Abuse: A Case Control Study Identifying Multiple Urological Complaints in Relation to Sexual Abuse History

Jack Beck, Melianthe Nicolai, Hein Putter, Rob Pelger, Henk Elzevier

Leids Universitair Medisch Centrum, Leiden, The Netherlands.

DOI: 10.4236/asm.2013.32008                

Abstract

Introduction: The relationship between sexual abuse and urinary tract symptoms has been described for urgency, frequency and nocturia. Aims: To investigate if other urological complaints in females, like urinary tract infections, incontinence, voiding complaints and lower abdominal pain are also correlated with a history of sexual abuse (SA) and to measure the prevalence of sexual abuse in our urological patient population, using a clinical case control study. Methods: 1383 female patients of 18-year-old or older visiting our outpatient urological university clinic were asked to fill out a questionnaire evaluating referral indications and urological complaints. The questionnaire consisted out of two parts. The first part was designed characteristics and medical history. The second part included referral indications, the urological complaints and a possible history of SA. The sample was divided into two groups: those with and those without a history of SA. The Outcome Measures: 1) The comparison of the frequency of voiding complaints, urinary tract infections (UTI’s), lower abdominal pain, hematuria and incontinence in respondents with and without SA; 2) The prevalence of SA in female patients presenting at our university urological outpatient clinic; 3) The number of urological symptoms presented at the time of referral by respondents with a history of SA compared the non-abused. Results: 436/1383 (32%) patients were willing to participate. 304 (70%) questionnaires were properly filled in. The reported prevalence of sexual abuse was 17% (51/304). More than half of the females with a history SA presented with voiding complaints (32/51 p = 0.18), incontinence (31/51 p = 0.10) and urinary tract infections (27/51 p = 0.22). However, comparing the data of respondents without SA we found no significant differences with regards specific complaints. Patients with SA report more symptoms than those without (Armitage’s trend test 0.14 (p = 0.004) for 4 complaints or more). Conclusions: No significant correlation between SA and voiding complaints, incontinence nor lower abdominal pain was found. The prevalence rate of SA in female patients visiting our university urological outpatient clinic was 17%. These abused females mentioned more synchronous complaints as reason for referral at their first visit than the non-abused.

Keywords

Sexual Abuse; Abuse

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	K. M. Gorey and D. R. Leslie, “The Prevalence of Child Sexual Abuse: Integrative Review Adjustment for Potential Response and Measurement Biases,” Child Abuse & Neglect, Vol. 21, No. 4, 1997, pp. 391-398. doi:10.1016/S0145-2134(96)00180-9
[2]	N. Kellogg, “The Evaluation of Sexual Abuse in Children,” Pediatrics, Vol. 116, No. 2, 2005, pp. 506-512. doi:10.1542/peds.2005-1336
[3]	C. L. Link, K. E. Lutfey, W. D. Steers and J. B. Mc-Kinlay, “Is Abuse Causally Related to Urologic Symptoms? Results from the Boston Area Community Health (BACH) Survey,” European Urology, Vol. 52, No. 2, 2007, pp. 397-406. doi:10.1016/j.eururo.2007.03.024
[4]	A. B. Hill, “The Environment and Disease: Association or Causation?” Proceedings of the Royal Society of Medicine, Vol. 58, No. 5, 1965, pp. 295-300.
[5]	M. A. Reinhart and R. Adelman, “Urinary Symptoms in Child Sexual Abuse,” Pediatric Nephrology, Vol. 3, No. 4, 1989, pp. 381-385. doi:10.1007/BF00850210
[6]	J. L. Klevan and A. R. De Jong, “Urinary Tract Symptoms and Urinary Tract Infection Following Sexual Abuse,” American Journal of Diseases of Children, Vol. 144, No. 2, 1990, pp. 242-244.
[7]	P. I. Ellsworth, P. A. Merguerian and M. E. Copening, “Sexual Abuse: Another Causative Factor in Dysfunctional Voiding,” The Journal of Urology, Vol. 153, No. 3, 1995, pp. 773-776. doi:10.1016/S0022-5347(01)67716-4
[8]	H. Fenster and B. Patterson, “Urinary Retention in Sexually Abused Women,” The Canadian Journal of Urology, Vol. 2, No. 4, 1995, pp. 185-188.
[9]	G. W. Davila, F. Bernier, J. Franco and S. L. Kopka, “Bladder Dysfunction in Sexual Abuse Survivors,” The Journal of Urology, Vol. 170, No. 2, 2003, pp. 476-479. doi:10.1097/01.ju.0000070439.49457.d9
[10]	K. Jundt, I. Scheer, B. Schiessl, K. Pohl, K. Haertl and U. M. Peschers, “Physical and Sexual Abuse in Patients with Overactive Bladder: Is There an Association?” International Urogynecology Journal and Pelvic Floor Dysfunction, Vol. 18, No. 4, 2007, pp. 449-453. doi:10.1007/s00192-006-0173-z
[11]	C. DeLago, E. Deblinger, C. Schroeder and M. A. Finkel, “Girls Who Disclose Sexual Abuse: Urogenital Symptoms and Signs after Genital Contact,” Pediatrics, Vol. 122, No. 2, 2008, pp. 281-286. doi:10.1542/peds.2008-0450
[12]	K. M. Peters, D. J. Carrico and A. C. Diokno, “Characterization of a Clinical Cohort of 87 Women with Interstitial Cystitis/Painful Bladder Syndrome,” Urology, Vol. 71, No. 4, 2008, pp. 634-640. doi:10.1016/j.urology.2007.11.013
[13]	J. Pannek, E. M. Einig and W. Einig, “Clinical Management of Bladder Dysfunction Caused by Sexual Abuse,” Urologia Internationalis, Vol. 82, No. 4, 2009, pp. 420-425. doi:10.1159/000218531
[14]	M. A. Reinhart, “Urinary Tract Infection in Sexually Abused Children,” Clinical Pediatrics, Vol. 26, No. 9, 1987, pp. 470-472. doi:10.1177/000992288702600907
[15]	J. J. Beck, H. W. Elzevier, R. C. Pelger, H. Putter and P. J. Voorhamvan der Zalm, “Multiple Pelvic Floor Complaints Are Correlated with Sexual Abuse History,” The Journal of Sexual Medicine, Vol. 6, No. 1, 2009, pp. 193-198. doi:10.1111/j.1743-6109.2008.01045.x
[16]	M. D. Bekker, J. J. H. Beck, H. Putter, M. van Driel, R. C. M. Pelger, A. A. B. Lycklama à Nijeholt and H. W. Elzevier, “The Place of Female Sexual Dysfunction in the Urological Practice: Results of a Dutch Survey,” The Journal of Sexual Medicine, Vol. 6, No. 11, 2009, pp. 2979-2987. doi:10.1111/j.1743-6109.2009.01460.x
[17]	M. D. Bekker, J. J. H. Beck, H. Putter, M. F. van Driel, R. C. M. Pelger, W. C. Weijmar Schultz, G. A. Lycklama a Nijeholt and H. W. Elzevier, “Sexual Experiences of Men with Incontinent Partners,” The Journal of Sexual Medicine, Vol. 7, No. 5, 2010, pp. 1877-1882. doi:10.1111/j.1743-6109.2010.01718.x
[18]	N. Draijer, “Sexual Traumatizing during Childhood; Long Term Consequences of Child Sexual Abuse by Relatives,” Ph.D. Thesis, VU University Amsterdam, Amsterdam, 1990.
[19]	J. J. van Lankveld, M. M. ter Kuile, G. G. Kenter, E. V. van Hall and P. T. Weijenborg, “Sexual Problems and Experiences with Sexual and Physical Violence in Gynecological Patients,” Dutch Journal of Medicine, Vol. 140, No. 38, 1996, pp. 1903-1906.
[20]	L. A. van der Hulst, G. J. Bonsel, M. Eskes, E. Birnie, E. van Teijlingen and O. P. Bleker, “Bad Experience, Good Birthing: Dutch Low-Risk Pregnant Women with a History of Sexual Abuse,” Journal of Psychosomatic Obstetrics & Gynecology, Vol. 27, No. 1, 2006, pp. 59-66. doi:10.1080/01674820500305788
[21]	F. Lamers-Winkelman, N. W. Slot, B. Bijl and A. C. Vijlbrief, “School Students about Abuse. Results of a National Survey about Child Abuse among School Students,” PI Research, Vrije Universiteit, Amsterdam/Duivendrecht, 2007.
[22]	J. Beck, M. Bekker, M. Driel, H. Roshani, H. Putter, R. Pelger and H. Elzevier, “Prevalence of Sexual Abuse among Patients Seeking General Urological Care,” The Journal of Sexual Medicine, Vol. 8, No. 10, 2011, pp. 1464-1468. doi:10.1111/j.1743-6109.2011.02389.x
[23]	H. W. Elzevier, P. J. Voorhamvan der Zalm and R. C. Pelger, “How Reliable Is a Self-Administered Questionnaire in Detecting Sexual Abuse: A Retrospective Study in Patients with Pelvic-Floor Complaints and a Review of Literature,” The Journal of Sexual Medicine, Vol. 4, No. 4, 2007, pp. 956-963. doi:10.1111/j.1743-6109.2007.00523.x
[24]	K. M. Penza, C. Heim and C. B. Nemeroff, “Neurobiological Effects of Childhood Abuse: Implications for the Pathophysiology of Depression and Anxiety,” Archives of Women’s Mental Health, Vol. 6, No. 1, 2003, pp. 15-22. doi:10.1007/s00737-002-0159-x
[25]	A. P. Klausner and W. D. Steers, “Corticotropin Releasing Factor: A Mediator of Emotional Influences on Bladder Function,” The Journal of Urology, Vol. 172, No. 6, 2004, pp. 2570-2573. doi:10.1097/01.ju.0000144142.26242.f3
[26]	F. Ercan, S. Oktay and N. Erin, “Role of Afferent Neurons in Stress Induced Degenerative Changes of the Bladder,” The Journal of Urology, Vol. 165, No. 1, 2001, pp. 235-239. doi:10.1097/00005392-200101000-00070
[27]	J. Cao, W. Boucher, D. Kempuraj, J. M. Donelan and T. C. Theoharides, “Acute Stress and Intravesical Corticotropin-Releasing Hormone Induces Mast Cell Dependent Vascular Endothelial Growth Factor Release from Mouse Bladder Explants,” The Journal of Urology, Vol. 176, No. 3, 2006, pp. 1208-1213. doi:10.1016/j.juro.2006.04.026
[28]	E. Dalal, O. Medalia, O. Harari and M. Aronson, “Moderate Stress Protects Female Mice against Bacterial Infection of the Bladder by Eliciting Uroepithelial Shedding,” Infection and Immunity, Vol. 62, No. 12, 1994, pp. 5505-5510.
[29]	F. Ercan, T. San and S. Cavdar, “The Effects of Cold-Restraint Stress on Urinary Bladder Wall Compared with Interstitial Cystitis Morphology,” Urological Research, Vol. 27, No. 6, 1999, pp. 454-461. doi:10.1007/s002400050135
[30]	M. Saito, A. Kondo and K. Miyake, “Changes in Rat Bladder Function Following Exposure to Pain and Water Stimuli,” International Journal of Urology, Vol. 2, No. 2, 1995, pp. 92-95. doi:10.1111/j.1442-2042.1995.tb00431.x
[31]	J. F. Peoples, M. W. Wessendorf, T. Pierce and E. J. Van Bockstaele, “Ultrastructure of Endomorphin-1 Immunoreactivity in the Rat Dorsal Pontine Tegmentum: Evidence for Preferential Targeting of Peptidergic Neurons in Barrington’s Nucleus Rather than Catecholaminergic Neurons in the Peri-Locus Coeruleus,” The Journal of Comparative Neurology, Vol. 448, No. 3, 2002, pp. 268-279. doi:10.1002/cne.10260
[32]	M. Kawatani, S. Shioda, Y. Nakai, C. Takeshige and W. C. de Groat, “Ultrastructural Analysis of Enkephalinergic Terminals in Parasympathetic Ganglia Innervating the Urinary Bladder of the Cat,” The Journal of Comparative Neurology, Vol. 288, No. 1, 1989, pp. 81-91. doi:10.1002/cne.902880107
[33]	J. Beck, H. Elzevier, R. Pelger, H. Putter and P. Voorhamvan der Zalm, “Multiple Pelvic Floor Complaints Are Correlated with Sexual Abuse History,” The Journal of Sexual Medicine, Vol. 6, No. 1, 2009, pp. 193-198. doi:10.1111/j.1743-6109.2008.01045.x
[34]	J. Stoker, “Anorectal and Pelvic Floor Anatomy,” Best Practice & Research, Vol. 23, No. 4, 2009, pp. 463-475.
[35]	B. T. Haylen, D. de Ridder, R. M. Freeman, S. E. Swift, B. Berghmans, J. Lee, A. Monga, E. Petri, D. E. Rizk, P. K. Sand and G. N. Schaer, “An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction,” Neurourology and urodynamics, Vol. 29, No. 1, 2010, pp. 4-20.
[36]	P. J. Voorhamvan der Zalm, A. N. G. A. Lycklama, H. W. Elzevier, H. Putter and R. C. Pelger, “Diagnostic Investigation of the Pelvic Floor: A Helpful Tool in the Approach in Patients with Complaints of Micturition, Defecation, and/or Sexual Dysfunction,” The Journal of Sexual Medicine, Vol. 5, No. 4, 2008, pp. 864-871. doi:10.1111/j.1743-6109.2007.00725.x
[37]	S. S. Faubion, L. T. Shuster and A. E. Bharucha, “Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction,” Mayo Clinic Proceedings, Vol. 87, No. 2, 2012, pp. 187-193. doi:10.1016/j.mayocp.2011.09.004
[38]	D. E. Irwin, I. Milsom, S. Hunskaar, K. Reilly, Z. Kopp, S. Herschorn, K. Coyne, C. Kelleher, C. Hampel, W. Artibani and P. Abrams, “Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study,” European Urology, Vol. 50, No. 6, 2006, pp. 1306-1314.
[39]	Roehrborn, “Benign Prostatic Hyerplasia: Etiology, Pathophysiology, Epidemiology, and Natural History (Chapter 91),” In: A. Wein, L. Kavoussi and M. Campbell, Eds., Campbell-Walsh Urology, 10th Edition, Elsevier-Saunders, Edinburgh, 2012, pp. 2582-2583.
[40]	T. Y. Rosenbaum, “Pelvic Floor Physiotherapy for Women with Urogenital Dysfunction: Indications and Methods,” The Italian Journal of Urology and Nephrology, Vol. 63, No. 1, 2011, pp. 101-107.
[41]	B. von Heyden, R. Steinert, H. W. Bothe and L. Hertle, “Sacral Neuromodulation for Urinary Retention Caused by Sexual Abuse,” Psychosomatic Medicine, Vol. 63, No. 3, 2001, pp. 505-508.
[42]	M. R. van Balken, H. Vergunst and B. L. Bemelmans, “Prognostic Factors for Successful Percutaneous Tibial Nerve Stimulation,” European Urology, Vol. 49, No. 2, 2006, pp. 360-365. doi:10.1016/j.eururo.2005.10.019
[43]	A. Yildirim, N. Uluocak, D. Atilgan, M. Ozcetin, F. Erdemir and O. Boztepe, “Evaluation of Lower Urinary Tract Symptoms in Children Exposed to Sexual Abuse,” Urology Journal, Vol. 8, No. 1, 2011, pp. 38-42.