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.

Clinicians who treat survivors of childhood incest are familiar with the profound difficulties these patients have in forming and maintaining adult sexual relationships. Because their trust was betrayed by beloved members of their original families, it is often difficult for survivors to feel trusting toward the partners they choose. Because Correspondence regarding this article should be addressed to Margaret Buttenheim, Ph.D., The Center for the Child and the Family,

Systematic investigations of the consequences of sexual abuse and clinical literature on interventions with survivors have frequently neglected the impact of sexual abuse on parenting.Grounded in both object-relations and trauma theory, this article presents a case illustration to depict the unconscious repetition of one mother's childhood abusive relationship with her own child. We explore how this survivor's parenting conflicts became increasingly salient during specific developmental stages of the child, as themes of sexuality and aggression triggered unresolved conflicts, distorted cognitions, and trauma reactions. The reenactment impairs parenting in critical ways, hence increasing the risk for sexual abuse in the next generation. Strategies for interventions to modify the mother's poor parenting responses are described using a therapeutic approach that integrates concepts from psychodynamic and cognitive-behavioral theories.The authors wish to thank Ingrid Wheelock, Ph.D. for helpful comments on previous versions of this article. They also thank the University Center for the Child and Family, University of Michigan for its support.

This article discusses the technical considerations that contribute to making "telling one's story" in an incest survivors group a ritual of active mastery leading to psychological growth. Survivors approach the task of sharing memories with a variety of wishes and fears that can emerge as powerful group transference paradigms. These paradigms, while they vividly illuminate the survivor's past and present interpersonal expectations, can threaten to derail the telling experience. Actively interpreted, however, the group transference aspects of the telling experience can yield valuable insights that become the focus for the remainder of the survivor's group treatment. This article details the process of preparing the individual survivor and the group for the process of telling (and listening) and the subsequent task of working through the insights derived from the telling experience. Two case examples demonstrate these techniques.

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