The gynecological care experiences of 44 adult survivors of childhood sexual abuse and 30 non-abused controls were investigated and compared. On a self-administered survey, survivors rated the gynecological care experience more negatively than the controls, experienced more intensely negative feelings, and reported being more uncomfortable during almost every stage of the gynecological examination than did the controls. Survivors also reported more trauma-like responses during the gynecological examination, including overwhelming emotions, intrusive or unwanted thoughts, memories, body memories, and feelings of detachment from their bodies. Eighty-two percent of the survivors in the sample had never been asked about a history of sexual abuse or assault by a gynecological care provider, despite clear evidence from this study that such information would be relevant to their care. Implications of the study's findings for gynecological care practice and training are explored, and questions for future research are discussed.

Substance abuse research has demonstrated that client sexual orientation influences treatment outcomes. Consequently, many substance user treatment programs offer services for lesbian, gay, bisexual, and transgender (LGBT) individuals. In a recent search of SAMHSA treatment listings, 11.8% (N=911) of substance user treatment programs (including residential, outpatient, and partial hospitalization) in the United States and Puerto Rico indicated that they offer specialized services for LGBT clients. However, a telephone survey we conducted in 2003-2004 revealed that 70.8% of these "LGBT" programs were no different from services offered to the general population, and only 7.4% could identify a service specifically tailored to the needs of LGBT clients. Implications for LGBT individuals seeking services are discussed, the study's limitations are noted, and future research directions are identified.

SUMMARY We examined associations between childhood sexual abuse (CSA) and emotional/behavioral difficulties, feelings about one's sexuality, and the "coming out" process in a sample of 227 lesbian and bisexual women, ages 18-23, recruited for an online questionnaire study. Participants with a CSA history ("experiencers") reported significantly more emotional/behavioral difficulties than their nonexperiencer counterparts, suggesting that CSA may be an important contributor to some problems and behaviors currently linked in the literature to sexual orientation. Lesbian and bisexual experiencers varied widely as to whether and how they felt a CSA history affected their feelings about their sexuality or their "coming out" process. We discuss the implications of these findings for counseling, research, and theorizing involving lesbian and bisexual young women.

Counselors are often challenged to address issues of social justice in the counseling context, and they must be deliberate and innovative in their attempts to respond. Counselors will be required to relate social justice considerations to their practices and to the theoretical foundations of these practices; they must then operationalize an approach that suits their particular practice setting. The authors present the early results of their attempt to meet this challenge.