Supporting sexual assault disclosure: a qualitative study of women's experiences and preferences in gynaecological and midwifery care in the Netherlands

Background: Sexual assault (SA) can have serious consequences for physical, mental, social, and reproductive health. Worldwide, about one in three women report experiencing physical SA. Despite this high prevalence, previous research shows only a minority of healthcare providers (HCPs) consistently inquire about SA during initial consultations.Objective: This study aims to establish how gynaecologists and midwives can best address SA by exploring women's preferences with disclosing their experience of SA.Method: An explorative qualitative research design was used with a web-based questionnaire among women who disclosed their SA to a gynaecologist or midwife. The questionnaire was distributed via the Dutch Sexual Assault Center, social media channels and outpatient clinics. A reflexive thematic analysis was conducted.Results: Based on 147 responses, we generated three themes: (1) women need empathy and understanding of trauma response in HCPs. This entailed a non-emotional stance, authenticity, validation after disclosure and sufficient time for a conversation. (2) Women need HCPs to take the lead in addressing SA. This entailed inquiring about SA proactively, informing women about possible connection between SA and symptoms, addressing needs and options, and proving follow-up care. (3) Women need control over the narrative and care pathway. This entailed control over the level of detail women wish to share, the terminology used, medical records, and who is present during consultations.Conclusions: The results can be used to inform education and trauma-informed guidelines on how gynaecologists and midwives can best support SA disclosures. This way, negative responses and re-traumatisation can be avoided and the ongoing recovery process of SA survivors can be supported in gynaecological and midwifery care.