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The consequences of a history of sexual abuse for pregnancy and delivery are illustrated in case histories of three women, aged 28, 27 and 31 years respectively. The first woman (who had a history of sexual abuse, like the other women) reacted to labour with dissociative behaviour. This was anticipated by giving her directions for the proceedings during labour, which helped restoring contact. The second patient expressed insecurity during her prenatal check-ups, the reaction to which was inadequate. When labour started her fear had grown and led to an early plea for a caesarean section. An epidural made caesarean section redundant. The third patient had re-experiences during her prenatal check-ups. External examination or an ultrasound were a burden to her. Together with the patient a detailed treatment plan was made which gave her control over the situation. It is advised to question all women during prenatal care about a possible history of sexual abuse and if found, to discuss the consequences of these experiences in her everyday life, especially during her pregnancy. The obstetrical care-giver has to be aware of the circumstances that might provoke traumatic memories and anxious feelings. By knowing and anticipating these events--also called triggers--, the professional can give 'tailor-made' care during pregnancy and delivery.

Objective: To determine the frequency of sexual difficulties and of sexual and physical abuse., Design: Descriptive survey study., Setting: Outpatient gynaecology clinic of the University Hospital of Leiden, the Netherlands., Patients and Method: During 3 months, December 1994-February 1995, all consecutive new female patients were questioned by the gynaecologist by means of a short standardised questionnaire. Oncology patients and non-Dutch-speaking patients were excluded. Data were analysed with descriptive statistical procedures; relationships among variables were tested with the chi 2 test with Yates' correction or Fisher's exact test., Results: Of 325 patients 34.2% reported sexual difficulties, 15.4% reported sexual abuse and 7.4% physical molestation. Age of the patient and presence or absence of the partner during the consultation were not associated with differences in the patients' reports. 18.8% of the patients with these complaints answered affirmatively when asked if they needed specialised help., Conclusion: Sexual difficulties and sexual and physical abuse were common among gynaecology patients. Less than one-fifth of them required specialised help.