A history of sexual abuse and health: a Nordic multicentre study Malene Hilden, a Berit Schei, b Katarina Swahnberg, c Erja Halmesma ¨ki, d Jens Langhoff-Roos, e Kristin Offerdal, f Ulla Pikarinen, g Katrine Sidenius, a Tora Steingrimsdottir, h Hildegun Stoum-Hinsverk, f Barbro Wijma c Objectives To determine if a history of sexual abuse is associated with objective and subjective indicators of health and if certain abusive incidents had a stronger impact on health than others. Design A cross-sectional, multicentre study. Setting Five gynaecological departments in the five Nordic countries. Sample Three thousand five hundred and thirty-nine gynaecology patients. Methods The NorVold Abuse Questionnaire (NorAQ) on abuse history and current health was mailed to all patients who consented to participate. Main outcome measures Reason for index visit at the gynaecologic clinic as well as several questions on health were recorded. General health status was measured as self-estimated health, psychosomatic symptoms (headache, abdominal pain, muscle weakness, dizziness), number of health care visits and number of periods on sick leave. Result A history of sexual abuse was reported by 20.7% of respondents. A history of sexual abuse was significantly associated with chronic pelvic pain as reason for index visit (P < 0.01), laparoscopic surgery (P < 0.01), psychosomatic symptoms (P < 0.01), self-estimated poor health (P < 0.01), many health care visits (P < 0.01) and high incidence of sick leave (P < 0.01). Several subgroups within the group of sexually abused women were more likely to report poor health: women abused as both children and adults, women who experienced additional emotional and/or physical abuse and women abused by a person they knew. Conclusion Sexual abuse has a profound impact on women’s health. Taking a history of sexual abuse seems particularly warranted when the patient presents with chronic pelvic pain or symptoms of a vague and diffuse nature. INTRODUCTION Sexually abused patients frequently complain of symp- toms emanating from the lower abdomen and the pelvis. 1–14 However, not all patients with a history of sexual abuse develop long term sequelae. Characteristics of the abuse, such as timing, course and circumstances, as well as the relationship with the abuser, might influence the impact that such abuse has on health. We investigated to what extent a history of sexual abuse was related to various health variables in a population of gynaecology patients. In general, we expected to find that a history of sexual abuse was associated with poor overall health. In addition we expected that as the scale of the abuse increased, so the ill health of women would increase. METHODS The study is part of a multicentre study conducted at a total of five gynaecological departments in Denmark, Fin- land, Iceland, Norway and Sweden. The recruitment period BJOG: an International Journal of Obstetrics and Gynaecology October 2004, Vol. 111, pp. 1121–1127 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog a Centre for Victims of Sexual Assault, Rigshospitalet, Copenhagen, Denmark b Department of Community Medicine, Norwegian University of Science and Technology, Trondheim, Norway c Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Division of Women’s Health, Linko ¨ping University, Sweden d Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland e Department of Obstetrics and Gynaecology, National University Hospital, Rigshospitalet, Copenhagen, Denmark f Department of Gynaecology, St Olav Hospital, Trondheim, Norway g Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland h Department of Gynaecology, Landspitalinn, Reykjavik, Iceland Correspondence: Dr M. Hilden, Centre for Victims of Sexual Assault, Rigshospitalet, 4031 Blegdamsvej 9, DK-2100 Copenhagen, Denmark. DOI:10.1111/j.1471-0528.2004.00205.x