that is an excellent resource. i have not read the whole document, but that parts i read were very thoughtful and gave compassionate, practical practices for helping health care workers in being aware of and sensitive to CSA issues that may affect a patient later in life - whether the patient is aware of it or not. i found the following passage very insightful:
"While not everyone who reports a history of childhood sexual abuse develops health problems, many live with a variety of chronic physical, behavioural, and psychological problems that bring them into frequent contact with health care practitioners. Because health care practitioners do not routinely inquire about childhood sexual abuse, its long-term effects are under recognized, its related health problems are misdiagnosed, and it is often not met with a sensitive, integrated treatment response. Childhood sexual abuse often co-occurs with other types of childhood adversity, including physical abuse, marital discord, separation from or loss of parents, parental psychopathology and/or substance abuse, and other types of abuse/neglect.31,60,108 Even when these other types of adversity are controlled for, childhood sexual abuse remains a powerful predictor of health problems in adulthood.30,33,145,183 It is suggested that the underlying mechanism for these difﬁculties is “that childhood sexual abuse causes disruptions in the child’s sense of self, leading to difﬁculty in relating to others, inability to regulate reactions to stressful events, and other interpersonal and emotional challenges”.108p.753 Kathleen KendallTackett93p.716 describes behavioural, emotional, social, and cognitive pathways by which childhood abuse affects health, pointing out that “adult survivors can be affected by any or all of these, and the four types inﬂuence each other. Indeed, they form a complex matrix of interrelationships, all of which inﬂuence health.” In addition, research in the ﬁelds of immunology, endocrinology, and psychosomatic medicine has demonstrated clear physiological relationships among stress, illness, and disease (e.g.,71,95,101,104)."
a couple of other comments that i should have included in the original post - that became clear to me while telling my T about the experience today:
this was one of the best experiences i have ever had of being "in the moment." i mentioned that the procedure lasted more than 45 minutes. but i was not even aware of the passage of time. i just was aware of being. and when it was finished, i felt a sense almost of regret that it was over.
the later part of the experience was also the first time i can ever remember being touched by a male - especially one bigger, stronger or more authoritative - without feeling a sense of danger or anxiety or defensiveness. it was not just neutral - though that would have been a welcome change from past experiences - but a very positive one - without a trace of any undertones.
my T was elated by this story - said it was exactly the kind of progress he was hoping and praying for.
"That you are here - that life exists, and identity; that the powerful play goes on and you may contribute a verse. . . What will your verse be?" Robin Williams as John Keating in "Dead Poets Society"